WEBVTT - Robert J. Cerfolio, MD 0:00:00.360 --> 0:00:03.600 My name is Craig Ferguson. The name of this podcast 0:00:03.920 --> 0:00:08.360 is Joy. I talked to interest in people about what 0:00:08.400 --> 0:00:16.200 brings them happiness. Doctor Robert J. Serfolio. We'll call him 0:00:16.239 --> 0:00:18.919 Surf because that's what he wants. And once you know 0:00:18.960 --> 0:00:21.080 about this guy, you'll think, you know what, give him 0:00:21.079 --> 0:00:21.840 everything he wants. 0:00:22.000 --> 0:00:24.000 He's an amazing character, wasn't it, this. 0:00:30.040 --> 0:00:32.479 Surf? Before we begin, I do want to say one 0:00:32.520 --> 0:00:34.760 thing to you, which is I want to apologize because 0:00:35.000 --> 0:00:36.960 you come in and you recorded in an episode of 0:00:36.960 --> 0:00:40.400 this and then we checked it back and we didn't 0:00:40.400 --> 0:00:44.120 record it. It's like it's the podcast equivalent of like 0:00:44.200 --> 0:00:48.880 you doing an operation and cancer leave at least leaving 0:00:48.920 --> 0:00:50.239 the key, your keys or. 0:00:50.200 --> 0:00:53.080 Something in there, or maybe your wallet or your phone. 0:00:53.400 --> 0:00:55.680 Like we got the cancer out, everything's good, but I 0:00:55.760 --> 0:00:57.240 left my phone there, so we got to go back. 0:00:57.960 --> 0:00:59.840 You know, I get this a lot from women that 0:00:59.880 --> 0:01:02.480 I go on dates. They say they accidentally left something 0:01:02.520 --> 0:01:03.680 back so they have to come back. 0:01:05.800 --> 0:01:06.319 You know. 0:01:06.640 --> 0:01:08.600 Listen, here's the thing, though, You're just saying, well, are 0:01:08.600 --> 0:01:10.680 you single? You're not really single? Now you got to 0:01:10.680 --> 0:01:13.800 go yes. I yeah, that's why that was a joke. Yeah, 0:01:14.680 --> 0:01:18.639 I like that very Yeah, I get totally understand. It's vibe. 0:01:19.040 --> 0:01:20.760 So listen, I want to talk to you a little 0:01:20.760 --> 0:01:22.479 bit because I was just saying to you, I got 0:01:22.480 --> 0:01:25.760 a screening coming up for an en dusky coming up 0:01:25.880 --> 0:01:28.800 in about a week, and it's only because they find 0:01:28.840 --> 0:01:30.920 a little irritation during the last ones. They gave me 0:01:30.920 --> 0:01:32.760 some PPIs to to treat it. 0:01:32.880 --> 0:01:34.080 They found Barrett's spirits. 0:01:34.200 --> 0:01:37.480 No, no, it wasn't barrets it was it was it 0:01:37.600 --> 0:01:43.000 was a lesion, an ulcerated lesion or something like blasia displas. 0:01:43.440 --> 0:01:46.759 Yes, right, so listen, I know that. 0:01:47.120 --> 0:01:50.320 We're not really on on your dime here, but is 0:01:50.360 --> 0:01:51.640 that good or bad displays? 0:01:51.920 --> 0:01:54.240 It's just a thing could be could be absolutely much 0:01:54.280 --> 0:01:55.400 better than some other things. 0:01:55.440 --> 0:01:57.280 They sure, well they did a biop so you didn't 0:01:57.280 --> 0:01:58.360 find anything right now. 0:01:58.280 --> 0:01:59.920 But they might do now is I don't know if 0:01:59.920 --> 0:02:01.920 you gonna have an ultrasound done at the same time 0:02:01.960 --> 0:02:04.680 in multiple quadrant biopsies. Sometimes they do that they get 0:02:04.720 --> 0:02:06.000 more representative tissue. 0:02:06.160 --> 0:02:07.560 Oh yeah, you might do that. 0:02:07.720 --> 0:02:08.160 I don't know. 0:02:08.440 --> 0:02:09.919 You're going to be chilled down on propofilo. 0:02:10.880 --> 0:02:15.320 I'm going to be taking the big sleepy time, which 0:02:15.360 --> 0:02:17.119 we've established I love too much. 0:02:17.320 --> 0:02:19.000 Yes, well, yeah, I love too much. 0:02:19.040 --> 0:02:21.720 And that's why you know, I would take an endoscopy 0:02:21.960 --> 0:02:24.480 once or twice a week if I could, just just 0:02:24.520 --> 0:02:27.880 for the propofall. So listen, tell me this dude. You are, 0:02:27.960 --> 0:02:32.560 and we established this before, but you are, to my understanding, 0:02:32.919 --> 0:02:37.120 the number one robotic surgery guy in the US. Right. 0:02:37.240 --> 0:02:40.760 Yes, So that that's just not a measurable metric role, 0:02:40.960 --> 0:02:43.440 is it, really? You know, it's like saying, I'm I mean, 0:02:43.639 --> 0:02:46.160 I've done a lot of robotic thoracic surgery, but there 0:02:46.160 --> 0:02:49.040 are I'm I'm a lung certain of thoracic surgery. I 0:02:49.080 --> 0:02:54.120 do long lungs, esophagus and thymus, anything in the chest 0:02:54.120 --> 0:02:57.040 that's really not heart related, though we we can take. 0:02:56.919 --> 0:02:57.760 Our parts of the heart. 0:02:57.800 --> 0:02:59.959 But we're you know, even though we're boarded as cardio 0:03:00.160 --> 0:03:03.240 thoracic surgeons, we choose to do thoracic, which is the 0:03:03.320 --> 0:03:06.840 long the esophagus, the media stye, and the thymus stuff 0:03:06.840 --> 0:03:07.120 like that. 0:03:07.200 --> 0:03:11.200 So is that specialism or is a union? We're going 0:03:11.200 --> 0:03:13.360 all on. I'll strike tomorrow. It's a matter right now. 0:03:13.520 --> 0:03:16.480 You big that up could have joined the writers. The 0:03:16.480 --> 0:03:17.080 writers are. 0:03:17.280 --> 0:03:19.680 And the actors are still. But you know, I think 0:03:19.720 --> 0:03:22.359 as long as the doctor stay in, I'll be all right. 0:03:22.680 --> 0:03:27.480 So talk me through what a robotic surgery is, because 0:03:27.520 --> 0:03:31.000 it's not you just programming in a robot, and the 0:03:31.040 --> 0:03:32.760 ruleboat was ended well to tell me what it is. 0:03:32.800 --> 0:03:33.560 It's so interesting. 0:03:33.600 --> 0:03:35.760 Even the patient I operated on today, who came from 0:03:35.880 --> 0:03:38.240 very far away and is super educated, when he came 0:03:38.280 --> 0:03:39.880 in he looked at the robot. 0:03:39.960 --> 0:03:41.880 He said, now you're you're doing it right, not that 0:03:41.880 --> 0:03:42.480 big machine. 0:03:42.520 --> 0:03:45.320 I'm like, listen, bro, we've talked, you've looked at the videos, 0:03:45.320 --> 0:03:45.840 you've looked. 0:03:45.720 --> 0:03:47.080 At everything doesn't even make sense. 0:03:47.120 --> 0:03:50.560 But yeah, so what the robot does is we're able 0:03:50.560 --> 0:03:53.160 instead of making big incisions and spreading the ribs, we're 0:03:53.160 --> 0:03:56.000 making incisions that are a third of an inch eight millimeters. 0:03:56.400 --> 0:03:57.480 We will make three of these. 0:03:58.000 --> 0:04:00.640 The old robot actually had five millimeters reports we were 0:04:00.640 --> 0:04:03.400 making five millimeter incisions, not eight, which I think actually 0:04:03.400 --> 0:04:05.760 had a real benefit. This new one, I would hope 0:04:05.760 --> 0:04:08.040 that they're going to miniaturize it a little bit. So 0:04:08.080 --> 0:04:10.720 you put in these metal ports through these tiny incisions 0:04:10.800 --> 0:04:12.640 in the chest, and then through the poor come a 0:04:12.720 --> 0:04:15.480 series of different instruments right, and then they get hooked 0:04:15.520 --> 0:04:18.280 up to the robot. This great, big, giant mostrosity look 0:04:18.320 --> 0:04:19.200 like it's over the patient. 0:04:19.279 --> 0:04:21.160 Right. Does that have a face on itth it does? 0:04:21.320 --> 0:04:23.280 He asked me if I name my robot, I'm like, listen, bro, 0:04:23.320 --> 0:04:25.120 we don't name the robot. That's not something we do. 0:04:25.640 --> 0:04:28.359 But then we sit in a console remotely. Now you know, 0:04:28.400 --> 0:04:31.040 I've operated and I think twenty six countries. In one country, 0:04:31.080 --> 0:04:33.080 I was a mile away from the patient, which would 0:04:33.120 --> 0:04:36.160 never happen in the United States. Could never fly in China, right, 0:04:36.200 --> 0:04:37.800 But they wanted a big room of people. They had 0:04:37.839 --> 0:04:40.640 eight hundred people, and they wanted me to answer questions 0:04:40.640 --> 0:04:41.400 as I was operating. 0:04:41.520 --> 0:04:42.960 We teaching situation. 0:04:43.080 --> 0:04:45.120 Yeah, when I go on these things are always you know, 0:04:45.279 --> 0:04:47.520 for charity and teaching and a honor to do it. 0:04:47.560 --> 0:04:49.080 I love to do it. So it was like a 0:04:49.120 --> 0:04:51.640 corporate gig for a comedian. Then it's like, hey, I'm 0:04:51.760 --> 0:04:53.320 very happy to be in China. I'm going to do 0:04:53.320 --> 0:04:55.200 a little bit of thoracic here for you. I love 0:04:55.200 --> 0:04:57.880 you guys a little bit. I think they get paid, Yeah, 0:04:58.520 --> 0:04:59.720 they pay for our flight. 0:04:59.520 --> 0:05:00.919 But that's a that's it. 0:05:01.240 --> 0:05:03.919 See, you know, I knew being a doctor who was 0:05:04.200 --> 0:05:05.120 the way to go finance. 0:05:05.200 --> 0:05:07.680 You made a good decision when you nail the MCATs, 0:05:07.680 --> 0:05:09.000 you made a good I. 0:05:08.960 --> 0:05:11.479 Tell you I did not make the decision. If I 0:05:11.520 --> 0:05:13.720 had made the decision, it would be something else. I 0:05:13.760 --> 0:05:16.840 was dealing with the cards. I was deal So you 0:05:16.880 --> 0:05:18.960 go in there and you so you work remotely in 0:05:18.960 --> 0:05:20.719 the sense that is it like a video gamer. 0:05:20.839 --> 0:05:23.880 Yes, so we are sitting in a console that has 0:05:23.920 --> 0:05:26.200 an immersive experience. So it's a three D We put 0:05:26.240 --> 0:05:29.400 our head into a console like this, and there's all ergonomics. 0:05:29.520 --> 0:05:31.800 You have your own chair, but there's a giant machine 0:05:32.320 --> 0:05:35.039 with two hands here, multiple pedals for your left foot, 0:05:35.080 --> 0:05:35.680 your right foot. 0:05:35.680 --> 0:05:36.640 There like six options. 0:05:36.640 --> 0:05:38.760 It looks complicated, but it's actually very I mean, I'm 0:05:38.800 --> 0:05:39.839 doing it, so how hard can it? 0:05:40.200 --> 0:05:41.680 Come on? You're trusting yourself. 0:05:41.720 --> 0:05:41.920 Done. 0:05:41.960 --> 0:05:44.120 No, I'm giving it to you straight. It's it's like 0:05:44.120 --> 0:05:46.680 an airplane. It looks super complicated, but you know once 0:05:46.720 --> 0:05:48.720 you get to know it exactly. Yeah, And so you 0:05:48.720 --> 0:05:50.479 move your left foot and the right foot and in 0:05:50.560 --> 0:05:53.599 the right chest. You're going to have two left hands, 0:05:53.640 --> 0:05:56.080 so you can toggle your foot and make your left 0:05:56.080 --> 0:05:58.120 hand the one here or the one behind it, and. 0:05:58.040 --> 0:06:00.000 Assist yourself, so you're like your four hands. 0:06:00.320 --> 0:06:02.560 You have three hands and a camera, so you're driving 0:06:02.600 --> 0:06:05.520 your own camera, which is a big advantage over laparoscopy 0:06:05.760 --> 0:06:09.120 or video assist a throoscopy or arthroscopy, which where they 0:06:09.120 --> 0:06:11.160 put a scope into joint and you have to hold 0:06:11.160 --> 0:06:13.360 it here it hooked up to a robot, and as 0:06:13.400 --> 0:06:15.640 I move my hands and feet, the camera moves where 0:06:15.680 --> 0:06:18.680 I want to go. Gigantic advancement because when I did 0:06:18.720 --> 0:06:21.080 these cases with someone driving the camera, I'm like, listen, 0:06:21.080 --> 0:06:21.920 did you bring the camera? 0:06:22.000 --> 0:06:23.080 I don't want to look at it? Move it up. 0:06:23.400 --> 0:06:26.320 You know, it's a constant dialogue. If you have great assistance, they. 0:06:26.240 --> 0:06:28.160 Know where you want to look, but no one knows 0:06:28.360 --> 0:06:30.160 where you want to look more than me. So with 0:06:30.279 --> 0:06:32.920 the robot, I drive the camera. The robot is a 0:06:32.960 --> 0:06:34.840 slave to my hands. If I don't move my hands 0:06:34.839 --> 0:06:37.400 to robots, it's still right. If I don't move my feet, 0:06:37.440 --> 0:06:39.440 the robot doesn't move too. So it doesn't go this 0:06:39.600 --> 0:06:40.680 patient is It. 0:06:40.600 --> 0:06:44.000 Doesn't It doesn't do anything that at some point we 0:06:44.120 --> 0:06:46.280 will get to where parts of the operation. 0:06:46.440 --> 0:06:49.040 I think we'll say to the robot, here's the artery. 0:06:49.080 --> 0:06:51.920 Here's the vey and here's the Broncus robot. Get around 0:06:51.920 --> 0:06:53.760 the artery because at some point it's going to be 0:06:53.760 --> 0:06:56.320 better than us. I firmly believe that, despite what my 0:06:56.360 --> 0:06:57.279 colleagues say it. 0:06:57.360 --> 0:07:00.720 So that's it's like the benefits of AI right that correct. 0:07:00.760 --> 0:07:02.960 I was in Italy a couple of days ago lecturing 0:07:02.960 --> 0:07:04.760 on this, and the people in the audience again were like, 0:07:04.800 --> 0:07:07.080 you know, sir, if you're you're pushing this, you're gonna 0:07:07.080 --> 0:07:07.800 get us out of a job. 0:07:07.800 --> 0:07:10.640 And I'm giving it's about getting patients better care. 0:07:11.040 --> 0:07:13.840 If you're crazy, we know we're not like they did 0:07:13.920 --> 0:07:16.760 say you're crazy, you're grazez. 0:07:17.000 --> 0:07:21.600 You make it the roll. Boy, it's about news one 0:07:21.680 --> 0:07:22.080 of the role. 0:07:23.080 --> 0:07:26.680 But so let me so. But the tack title approach 0:07:26.920 --> 0:07:30.720 you as a as a surgeon. Now, presumably I would 0:07:30.760 --> 0:07:34.840 imagine that as you're training and going through building up 0:07:34.840 --> 0:07:37.680 becoming a surgeon. Right, it's a very tac tale thing. 0:07:37.720 --> 0:07:39.440 You ran there with the sounds and the smells and 0:07:40.240 --> 0:07:42.200 you are so boy, you are You're pretty sure you're 0:07:42.200 --> 0:07:43.720 a pretty smart guy. How did you know that? Yeah? 0:07:43.760 --> 0:07:45.720 I used to be a doctor used in my mind 0:07:45.840 --> 0:07:47.760 before ye, well, I'm not a doctor, but I did 0:07:47.760 --> 0:07:50.000 a yoga class in LA which makes you a doctor. 0:07:51.120 --> 0:07:55.920 Yeah about New York City. So do you lose anything 0:07:56.000 --> 0:07:56.320 with that? 0:07:56.560 --> 0:07:58.480 Such a great question, And again I hate to go 0:07:58.560 --> 0:08:01.480 back to experiences, but today I have and I'm very 0:08:01.520 --> 0:08:03.160 honored because they don't come to see me. They come 0:08:03.200 --> 0:08:06.040 to see NYU and the NYU team. So I have 0:08:06.600 --> 0:08:09.320 a doctor from Brazil and two from England who were 0:08:09.320 --> 0:08:11.720 there today. And the case we did is a metasectomy. 0:08:11.760 --> 0:08:14.080 I won't de technical, but it means there's little tiny 0:08:14.120 --> 0:08:17.200 spots in the lung that are very small that both 0:08:17.240 --> 0:08:19.520 surgeons said where they are they would make a big incision, 0:08:19.640 --> 0:08:21.520 spread through it is, put their fingers in and feel. 0:08:21.520 --> 0:08:23.560 I'm like, yeah, you could do it. That's how I did. 0:08:23.960 --> 0:08:27.160 I've done eighteen thousand, nine hundred operations. That's how I 0:08:27.160 --> 0:08:30.200 did my first ten thousand. Now we can't do that. 0:08:30.280 --> 0:08:34.040 So with the robot, although you can't feel, you can 0:08:34.160 --> 0:08:36.480 still take your instrument and rub it over the lung. 0:08:36.520 --> 0:08:38.360 Then you can see a little tiny nodule, a four 0:08:38.360 --> 0:08:40.600 millimeure nodule like a pop out on the top of 0:08:40.640 --> 0:08:43.720 the surface, or even five to six millimeters under the surface. 0:08:44.120 --> 0:08:45.080 So we've come up. 0:08:44.960 --> 0:08:47.360 With ways so you do this, But you would have 0:08:47.520 --> 0:08:50.640 to be a surgeon who's experienced the tag tile, you've 0:08:50.679 --> 0:08:52.520 been through that to feel that. 0:08:52.760 --> 0:08:53.920 I don't think that's a fallacy. 0:08:53.960 --> 0:08:55.560 I think to say, hey, you got to open up 0:08:55.559 --> 0:08:57.040 and do a whole bunch of opens, or go to 0:08:57.120 --> 0:08:59.240 a lab now and operate on animals and do opens, 0:08:59.280 --> 0:09:01.040 I don't think so. I think we've gotten so good 0:09:01.040 --> 0:09:03.560 with simulation and teaching that we can teach the non 0:09:04.120 --> 0:09:08.480 experience palpader with the tactile so young surgeons who have 0:09:08.559 --> 0:09:11.199 not opened, because we do everything robotically, everything one hundred percent, 0:09:11.400 --> 0:09:13.560 me and my partners, we don't ever open. That's why 0:09:13.559 --> 0:09:16.000 people come from all over the world, and our conversion 0:09:16.080 --> 0:09:18.840 rate has been essentially zero the last four or five years. 0:09:18.880 --> 0:09:21.400 Does that cut down on a post off infection as well? 0:09:21.400 --> 0:09:21.760 Well, it's not. 0:09:22.040 --> 0:09:24.040 Well, don't get a lot of infections, but the pain. 0:09:24.200 --> 0:09:26.600 So I'm not about to write a paper. I've operated 0:09:26.600 --> 0:09:29.400 on one hundred and six surgeons. They've all been back 0:09:29.440 --> 0:09:31.880 in the o R within seven to ten days. So 0:09:31.960 --> 0:09:34.920 your recovery, because you have tiny little nicks, that's it. 0:09:35.080 --> 0:09:36.720 And then you know, we we have now we have 0:09:36.760 --> 0:09:39.120 to make the one incision bigger because we put the 0:09:39.320 --> 0:09:41.480 tumor which is in a lung and a bag, and 0:09:41.520 --> 0:09:43.319 then we're like pulling the bag. I got my foot 0:09:43.320 --> 0:09:45.280 on the guy's chest trying to pull the bag out, really, 0:09:45.440 --> 0:09:46.880 because you want to make the decisions as small as 0:09:46.880 --> 0:09:47.080 you can. 0:09:50.400 --> 0:09:52.560 And it does make that sound? Does it really something 0:09:52.600 --> 0:09:56.520 like that? That's horrifying and awesome at the same time. Now, listen, 0:09:56.600 --> 0:09:59.160 because I think about this, because I've made a couple 0:09:59.200 --> 0:10:01.920 of surgeons in my life. You seem very like this 0:10:02.000 --> 0:10:04.320 to me. They're kind of their jobs, you know. You 0:10:04.400 --> 0:10:08.319 guys are your competitive, you're sporty. Yep, you're kind of 0:10:08.520 --> 0:10:12.120 you know. I've met male and female surgeons and they're 0:10:12.280 --> 0:10:15.560 very similar. There's that real kind of sport mentality. 0:10:16.160 --> 0:10:17.920 I played baseball in college, and all three of my 0:10:18.000 --> 0:10:20.760 boys were captain of their high school baseball teams. And 0:10:20.880 --> 0:10:23.080 they went on to college and played D one baseball. 0:10:23.200 --> 0:10:25.120 Yeah, well, are you boys own medicine? 0:10:25.280 --> 0:10:25.360 No? 0:10:25.800 --> 0:10:27.120 Well, they were a little too smart. 0:10:27.120 --> 0:10:29.160 They thought I worked too hard, and they're doing things 0:10:29.160 --> 0:10:30.880 that are may be a little bit better for society. 0:10:30.920 --> 0:10:33.160 I don't know, but that that kind of drive your 0:10:33.200 --> 0:10:35.160 father was a doctor. He was, Yeah, it was your father. 0:10:35.240 --> 0:10:37.360 Very sporty and very he was. He played baseball in 0:10:37.400 --> 0:10:39.360 college as well. What kind of doctor? What kind was he? 0:10:39.400 --> 0:10:43.120 A surgeon? Was a surgeony urologist? Oh plenty of I'm 0:10:43.160 --> 0:10:45.680 fifty one years old. I mean it's like I'm sixty 0:10:45.720 --> 0:10:48.520 one too, right, Well you know then, yes, now you 0:10:48.600 --> 0:10:51.559 know as a as a doctor, you're probably a terrible patient, right. 0:10:51.600 --> 0:10:52.240 I really am. 0:10:52.280 --> 0:10:55.920 I had surgery about nine days ago, right before I 0:10:55.960 --> 0:10:58.320 flew to Italy days ago, and I was back in 0:10:58.360 --> 0:10:59.520 the o R two days later. 0:10:59.600 --> 0:11:00.680 Can I see what it was? 0:11:00.800 --> 0:11:01.400 It was? Yeah? 0:11:01.400 --> 0:11:03.679 Because I've done so much surgery, it's a very common 0:11:03.720 --> 0:11:06.880 for surgeon. As we looked down, I had advancing arthritis 0:11:06.920 --> 0:11:10.800 in my cervical proteinebro bodies, and so they just pucked 0:11:10.800 --> 0:11:12.559 a little bit of the bone out with a little incision, 0:11:12.640 --> 0:11:15.199 took a little the disc out, and I had a 0:11:15.240 --> 0:11:17.600 little numbus in my finger, which is scary when you're 0:11:17.600 --> 0:11:19.720 a surgeon, like I kind of need that puppy. 0:11:19.760 --> 0:11:21.560 I may not be good, but I'm valuable to me. 0:11:21.800 --> 0:11:23.959 Sure. It was like a concert penist or something, and 0:11:24.080 --> 0:11:27.440 you need that one hundred percent is it demystified for you? 0:11:27.520 --> 0:11:29.560 Then surgery is like because a lot of people, surgery 0:11:29.600 --> 0:11:30.559 is like, this is a very big deal. 0:11:30.600 --> 0:11:33.520 I'm very frightened. I'm very upset. Doesn't you're like, nah, 0:11:33.720 --> 0:11:34.600 go ahead, I'll get it done. 0:11:34.640 --> 0:11:35.480 I'll bet it's. 0:11:35.559 --> 0:11:38.160 Yeah, because I I obviously I know the people who 0:11:38.160 --> 0:11:40.760 are really good. They did a minimally invasive incision in 0:11:40.800 --> 0:11:42.680 my neck and I literally was in my office. 0:11:42.960 --> 0:11:44.280 Now he told me to take a week off. 0:11:44.280 --> 0:11:46.320 I was in my the finished the operation at one, 0:11:46.720 --> 0:11:49.160 I saw a patient in my office at five, and 0:11:49.200 --> 0:11:51.319 then I was back in the operating Monday, and I 0:11:51.360 --> 0:11:52.600 flew to Italy the next day. 0:11:52.640 --> 0:11:55.760 See that's see, that's just you know, listening to your dog. Well, 0:11:55.760 --> 0:11:57.920 it's the amount one hundred percent. But you asked if 0:11:57.920 --> 0:12:00.000 we're good patients. I was giving an example to Supper. 0:12:00.200 --> 0:12:01.920 You're just you are. 0:12:02.760 --> 0:12:04.559 I just think that my surgeon was so good that 0:12:04.800 --> 0:12:05.600 you did. 0:12:05.520 --> 0:12:07.679 You ever get when you were training right at the start, 0:12:07.880 --> 0:12:11.880 when you're looking at you know, all the different disasters 0:12:11.880 --> 0:12:14.320 that can go wrong with the young body, Yeah, did 0:12:14.360 --> 0:12:16.880 you get them all? Did you become a hypochondriac because 0:12:16.880 --> 0:12:20.120 you were still? See I would have like even talking 0:12:20.160 --> 0:12:22.800 to you, I'm thinking, oh my god, I hope i'm catch. 0:12:22.640 --> 0:12:24.400 So I hope he's not got anything on his end. 0:12:25.440 --> 0:12:28.120 So I did wash my hands and I washed your 0:12:28.120 --> 0:12:30.360 card for you too, by the way, so you're good. 0:12:31.040 --> 0:12:33.520 But you know, that's something that I think is maybe 0:12:33.520 --> 0:12:37.880 something about the mindset. Because if you're a jockey, you're sporty, 0:12:38.000 --> 0:12:42.000 you're a competitive personality. I think that probably helps going 0:12:42.040 --> 0:12:44.200 in right, because you against the disease. 0:12:44.320 --> 0:12:45.240 Right, it is it is. 0:12:45.440 --> 0:12:47.400 But uh so you know now, as someone who has 0:12:47.440 --> 0:12:51.040 an MBA and was of executive VP and COO of 0:12:51.040 --> 0:12:52.880 a healthcare system and a leader, those are some of 0:12:52.880 --> 0:12:55.120 the bad things about surgeons. And it has to do 0:12:55.160 --> 0:12:58.440 with our training. So that's interesting because in college you 0:12:58.520 --> 0:13:00.240 have to be in the top one percent, so you're 0:13:00.320 --> 0:13:02.160 kind of hoping a little bit of people around you 0:13:02.200 --> 0:13:02.880 don't do well. 0:13:02.920 --> 0:13:05.199 That's terrible as a leader. And then as you're in. 0:13:05.160 --> 0:13:07.000 Medical school, you got to be AOA in the top 0:13:07.000 --> 0:13:09.440 two percent to get a surgical residency, and then to 0:13:09.520 --> 0:13:12.040 become a cardiothoracic surgeon, which is one of the hardest 0:13:12.040 --> 0:13:15.880 besides neurosurgery or ortho. So again you you sort of 0:13:15.920 --> 0:13:19.120 take resources and can become I always say you can 0:13:19.160 --> 0:13:21.080 kind of sometimes tell who's going to be the surgeon, 0:13:21.120 --> 0:13:22.920 who's going to be an interness by looking at people 0:13:22.920 --> 0:13:24.920 play in the playground at six or seven. And that's 0:13:25.840 --> 0:13:27.840 but I think if you're going to lead, it's just 0:13:27.880 --> 0:13:29.800 the opposite. You have to give all the resources to 0:13:29.840 --> 0:13:32.560 everybody else. You have to be humble and listen and 0:13:32.640 --> 0:13:35.679 to be able to make fast, quick, definitive decisions, which 0:13:35.720 --> 0:13:37.640 you have to do in the oar when someone's coding 0:13:38.080 --> 0:13:39.040 is exactly what wrong? 0:13:40.960 --> 0:13:43.160 So patient is dying, so come in. 0:13:43.240 --> 0:13:45.160 You know, when you're a surgical resident you get called 0:13:45.520 --> 0:13:47.400 once a day, twice a day to a floor and 0:13:47.440 --> 0:13:49.480 a patient is coding and dying. You have to come 0:13:49.480 --> 0:13:52.680 and immediately take charge to everybody to shut up. You say, 0:13:52.760 --> 0:13:54.960 do this, start up in nefferin, we're going to do CPR, 0:13:55.520 --> 0:13:58.280 and you're barking out orders. Right, So that's a great 0:13:58.400 --> 0:14:01.000 leadership style for that particular moment. 0:14:01.080 --> 0:14:02.680 Do you kind of you kind of get a Russia? 0:14:03.120 --> 0:14:05.280 Oh my god, yes, anyone who says you don't you 0:14:05.520 --> 0:14:06.800 well if the patient does. 0:14:06.640 --> 0:14:10.880 Well, yeah, well let me ask you, because that that's 0:14:10.920 --> 0:14:12.480 that kind of leads me into What I wanted to 0:14:12.480 --> 0:14:14.240 talk to you about a little bit is the emotional 0:14:14.280 --> 0:14:17.520 impact of what you do because you're facing literally dead 0:14:18.280 --> 0:14:20.560 as as your profession, you you face death. It's what 0:14:20.600 --> 0:14:23.360 you do correct and and you try and head it 0:14:23.400 --> 0:14:26.040 off of the past or or is there a point 0:14:26.200 --> 0:14:28.720 where it's too much, where you can't take it. 0:14:28.760 --> 0:14:32.240 Maybe because how my father treated me, how he trained me, 0:14:32.920 --> 0:14:35.160 I saw it well, so I think he made us 0:14:35.200 --> 0:14:38.480 really tough. His dad was a immigrant from Italy, came over, 0:14:38.680 --> 0:14:42.320 was a farmer, second grade education, the concept of hard work, 0:14:42.360 --> 0:14:45.880 and I do think and resilience and toughness and and 0:14:45.920 --> 0:14:47.360 I love when people say the kids don't have it. 0:14:47.560 --> 0:14:48.680 The kids have that cost too. 0:14:49.200 --> 0:14:51.680 They're going to and they're gonna be better doctors, better 0:14:51.800 --> 0:14:55.200 fathers and husbands and daughters and wives and granddaughters and 0:14:55.240 --> 0:14:56.360 grandsons than we are. 0:14:56.400 --> 0:14:58.880 They're going to be sure. The definitely getting better, and 0:14:59.520 --> 0:15:01.840 they're going to be more resilient. But it's her job 0:15:01.880 --> 0:15:04.560 as older people to say kids are terrible. There they 0:15:04.640 --> 0:15:06.280 were better when I was a kid, but they weren't. 0:15:06.280 --> 0:15:08.600 You and I both know it. They weren't better, awful. 0:15:09.160 --> 0:15:10.400 But I heard that today. 0:15:10.120 --> 0:15:12.160 From the one of our visitors from England and I 0:15:12.320 --> 0:15:15.520 and I said, listen, I politely disagree with you. These 0:15:15.560 --> 0:15:18.080 doctors are going to get better outcomes than us because 0:15:18.200 --> 0:15:21.720 each generation gets better and they may not have the 0:15:21.720 --> 0:15:24.080 same experience because we spent one hundred and twenty hours 0:15:24.080 --> 0:15:25.920 in the hospital now a week. Now they can only 0:15:25.960 --> 0:15:27.880 do eighty hours a week. And it's tough to get 0:15:27.880 --> 0:15:30.080 good at anything with eighty hours a week. But it 0:15:30.080 --> 0:15:31.560 would just help. I'll try to give my boy I 0:15:31.680 --> 0:15:33.560 learned to play the guitar in twenty minutes. 0:15:33.360 --> 0:15:35.840 A day is better enough. He's twelve. 0:15:36.040 --> 0:15:38.400 It'll get it's pretty good. Yeah, he's committed to it. 0:15:38.400 --> 0:15:40.640 It'll do. But I mean there's you know, your ten 0:15:40.720 --> 0:15:42.200 thousand hour rules. It takes time. 0:15:42.280 --> 0:15:45.160 So they may have a little delayed gratification, but they're 0:15:45.200 --> 0:15:48.240 more balanced, they're better in their roles at home and 0:15:48.280 --> 0:15:49.560 at the end of the day, that may make them 0:15:49.560 --> 0:15:51.760 a better doctor and a better leader. That has a 0:15:51.760 --> 0:15:54.440 different leadership style besides authoritative. 0:15:55.280 --> 0:15:57.440 So the leadership thing is interesting me because you go 0:15:57.520 --> 0:15:59.800 back to your dad. Your dad was clearly a now 0:16:00.480 --> 0:16:03.880 lead oh yeah, and you clearly have that too. 0:16:04.000 --> 0:16:05.720 It's like unfortunately. 0:16:05.320 --> 0:16:08.720 Leader, I mean you've written books about how to you know, 0:16:08.880 --> 0:16:10.840 succeed and how to do your best and how to 0:16:10.840 --> 0:16:13.440 get the best out the things correct, super results, are 0:16:13.440 --> 0:16:15.720 super achieved for performing. 0:16:16.200 --> 0:16:19.000 Thank you for plugging it about. Well, look, it's my job. 0:16:19.240 --> 0:16:21.160 It's just like you know, I make the incision. I 0:16:21.240 --> 0:16:25.800