From Priesthood to Plastic Surgery: Dr. Sam Bartholomew

So I'm up there flying over these things going, I wonder if we crashed, what would that be like? And I don't know if it was a lack of oxygen from being at that altitude, but I was kind of like, huh, this is, this is weird because we're not supposed to be landing on this mountain over here. My life didn't start flashing in front of my eyes until I was hiking down Callar, you've done a lot of surgery. Yeah. That would mean I'll be 10,000. I mean, a lot of surgeries. Yeah. So I mean, you know, they talk about what, 10,000 hours to be an expert and I think I passed that a long time ago. And there's like this ethical component and I know the way that you practice. Right. Well, that's a good point. It's a mixed blessing that I was never really that interested in business because I sort of, I, I try to look at the interactions as more, tou know, as a doctor taking care of someone, whatever their problem is, whether it's cancer or it's a tummy tuck, you know, so I'm still doing kind of the same type of thing, but it's, and I, I try not to make it transactional. In this episode, we hear from Samuel Bartholomew, M.D., a plastic surgeon with an accomplished track record.

Phenomenal story from childhood all the way through into today's world of complex medicine and where he's headed, uh, with everything that he's doing. It is one that will make you really think about a lot of things, and I hope you enjoy it. Welcome to the show. So let's take it all the way back. Yes. You know what? Like, for the people that don't know you, uh, where's it all start? Man. The podcast is called The Pathway to Peak Performance. It's all about kind of hitting that next level, you and I in the have a lengthy conversation about that Yep. In a different point in time. Um, but tell people about your pathway to peak performance and like, all, like, take us through roll, just roll with it. Well, I think, you know, I, I grew up in a lot of different parts of the country, so my dad worked for the Federal Highways, so I moved around every couple years as a kid. And so, you know, it was challenging having to adapt to new environments, but that was the, the upshot of that is that had to come in, be the new kid.

And I think in looking back on it, that helped me be a little more flexible, a little more adaptable, and, you know, if I can, you know, get something positive out of that experience. And it was good. I lived in a lot of different parts of the country. Lived near DC, lived in Wyoming, lived in Ohio at Washington State, you know, and eventually went to school in San Diego, you know, where I went to school for, you know, college, med school.

You know, I think it was really just, uh, you know, I think a lot of those values that I have now were instilled as a young man. I mean, I think it comes from my parents in large part and kind of a good work ethic. I think it was probably the biggest thing initially. You know, it wasn't, I don't think it was just formed as much in this sort of idea of, you know, I'm gonna perform and excellence, you know, I kinda look at things a little differently now, but I think it was a, it was a work ethic. That's what I started with. Hmm. And just to do your best, work hard and this idea of, you know, just not settling, you know, I mean, um, I think I just got that from my, my parents and my, you know, rest of my family. So I, I really had that, that ethic going into college. And it was just a matter of kind of finding where I was gonna go. You know, I felt like I had all this potential energy and what, what was I gonna do with that? And kind of what direction I was gonna take in life. And, and that's what really took the, probably the longest amount of time when I was a young man, was figuring out what direction should I go with this? Yeah. And probably the biggest thing. Yeah. So being a plastic surgeon, we're gonna. I guess we're gonna kind of jump forward and jump backwards and stuff today. And what I mean, being a plastic surgeon’s like, people don't realize it's pretty heavy duty. Um, it's a tough specialty. It's a tough specialty. I, I think it is.

I mean, I, I enjoy, there's a lot of things about that that I enjoy that, uh, you know, I looked at a lot of different specialties when I was in surgical training. You know, I initially trained to do, uh, general surgery. I mean, I'm board certified general surgery and I wanted to be a liver transplant surgeon. That was kind of my aspiration when I was in medical school. I had a lot of, uh, a mentor who was the chief transplant, and I really just gravitated towards that environment. I thought it was very exciting, and it was cutting edge. And when I had a chance to do it a little more, so I went to general surgery residency, kind of got into that and I just, uh, I, I think it was really part of it was lifestyle and I realized that I wanted to, uh, have a little bit more control over my schedule than I would as a transplant surgeon. So I began looking at kind of other options and plastics was something that I looked at after about a year of research, uh, in tissue engineering when I was in general surgery. And I got a chance to shadow the craniofacial surgeon at OHSU for about, you know, several months. And, uh, I was, it, you know, I was hooked and I liked the, the planning. I love the anatomy. Um, there, it's a different, uh, you just, it's creative problem solving and they're really difficult problems, frankly. You know, I mean, I think part of the reason that I really enjoy the, the reconstructive aspect, aside from the gratification I get from helping patients, is that it's really challenging. You know, they come to me as a plastic surgeon to help fix problems that can't be fixed. Yeah, it was crazy the other night, like I, we, we were, we were talking and, uh, you had just come out of the OR, or you're going back into the OR, I can't remember what it was, but you were gonna go in and it was a lung and heart transplant. Tell what, what was that? Well, I, I didn't even ask you about that. It was a, this particular patient had had a heart and lung transplant about a year ago and developed some issues with an infection in the sternum. So one of the types of reconstruction I do is sort of thoracic or, uh, reconstruction after heart lung surgeries where folks will have infections or open wounds in their sternum.

And they're really difficult, you know, frankly, and there's different ways to manage them, but generally it involves moving muscle and skin to close these large holes, for lack of a better word. And so there are situations where I am able to help help those patients close these wounds, get them kind of moving on because. The mortality risk if you don't fix those wounds and they have an open chest where you can literally see the heart beating in someone's chest is, you know, high enough where you wanna fix 'em. So it's a, and this particular situation was difficult because patient's immune suppressed. So, you know, I'll be asked to come and assist with these cases. And so I get to come in and it's a, you know, it's an honor, frankly, you know, to be able to help somebody when they're that sick. And, uh, you know, I have colleagues that are in cardiothoracic surgery that trust me to do this. And so, you know, I, it's something I really, uh, take great pride in and I can help at a really difficult time and patient's life. So it was, you know, doing that reconstruction to close 'em up, basically kind of get things healed up. Got it. So very different than like the aesthetic work that you do. And the, so, so plastic surgery has a lot of different subspecialties and I really enjoy doing several of them. Uh, one of them being aesthetic surgery, but there's also this broad range of. reconstructive surgeries too. So there are a lot of different situations where I help reconstruction after accidents, cancer, a lot of different, you know, surgical issues that people have had where I can come in and help them, um, kind of repair the body and kind of move on. 'cause you know, a lot of these situations, people have been dealing with wounds for a year or more where it's affecting their life.

It's, it's just a, you know, a significant impact on their life and quality of life. So I can come in and help them kind of move on. I imagine the breast reconstruction portion stuff too, from breast cancer standpoint's gotta be, that's really gratifying too. So that's a big part of my practice is breast reconstruction and that is, changed and evolved over the years.

You know, I think the implants, the technology that, you know, that I have available to do that is better than it used to be when I started this, you know, even in training. Um. But it's a chance to help, you know, women at that. It's a difficult time. They have a cancer diagnosis and there's so many different, uh, options for reconstruction. Really trying to help them, give them options and help guide them through that and see if that's something they want to do and help 'em get through that surgically. Talk about a traumatic, I mean, that's a oof. Yeah. Talk work. It's just, it's really powerful to see too, what, you know, some of these patients will have had chemo.

They, you know, it's been a really difficult road even by the time they see me the first time, and then they're talking about them, then the mastectomy, and then do they want to do reconstruction? So really trying to be there for them, be, uh, aware of all the medical issues and try to offer them some options for reconstruction.

If that's something they wanna proceed with, well, now we're moving into, uh, a time when the world is changing dramatically with all the GLP one stuff. Yeah, absolutely. So, I, I mean, GLP ones I think are, are an absolute game changer. I mean, I've never seen anything like it in how it's transformed patients. And it used to be, you know, people would have weight loss through diet and exercise. You wouldn't see it as much successfully long term. And there were a lot of studies to sort of show that, uh, bariatric surgery was more effective than that. And so I think we're, we're seeing the GLP one so powerful. The people still have great success with the weight loss surgeries. I mean, it's still a great option for some folks, but the GLP ones really offered, uh, people a chance to change their bodies, frankly. Yeah, I mean, I'm seeing a lot of patients who have lost significant amount of weight. And another part of my practice is the reconstructive, uh, aside from reconstructive is the aesthetic part.

And a lot of that is breast and body contouring. So the body contouring is taking that extra skin and, uh, you know, the body has a, a great capacity to, to help contract and get rid of some of that excess, but there comes a point where it's just not gonna get rid of all of it, frankly. And so, um, some patients are just better off having surgery if they want to get rid of that extra skin. And, uh, that's what I can do is help them kind of do a little nip and tuck and tighten things up a little bit. There's a real art to that. Yeah. I mean, there's different, there's different ways to approach things in terms of the different types of surgeries available, whether it's a adominoplasty, a body lift, breast lift, breast implants, you know, there's different things depending on what patients are looking for.

It was funny, I was talking to the other day to a another person I was talking about like closures and how they've actually, and this is a cleft lip and palate Sure. Situation. It's like, talk, talk to me about how, you know, closures have advanced and, and over the years and one thing that's happening for sure is like, you know, you guys are just getting better and better at what you do.

Yeah. I mean, I, I, I think, you know, I just have to recognize all the great mentors and teachers I had. I mean, I think that's one of the great things about being in United States, you know, uh, surgical training system is we have great mentors. It's just a great program of great traditions. So I mean, I feel fortunate to have trained in that there's a lot of great surgeons out there, and I think we can, we all benefit from that. And the technology does get better. I mean, there's, and I think the techniques, you know, we're all trying to learn. I'm certainly trying to always get better and kind of hone what I do as I think every good surgeon should be doing. And, uh, but yeah, I would agree. I mean, I think surgery is, it's safer. It's, I think the outcomes look better, so yeah, it's, it's exciting to be a part of that.

Yeah. So out on the aesthetic side, I mean, obviously on the reconstructive side of things, um, patients seeking out for obvious reasons, right? I mean, that's part of the deal. Uh, but on the aesthetic side of things, people seek you out for obvious reasons. They want a certain outcome, certain look, certain feel very, very different situation.

And really, uh, patients who are, are healthy or they made some changes and they just want to change the way that their body looks a little bit increases competence. And there's different reasons why people do it. But I think that, uh, you know, that that's a very enjoyable part of what I do as well. Because even small things I mean, I, you know, I like big changes and very dramatic results, but even small things really can make a big difference with the patients, you know? Yeah. How they feel about themself and how they look. And, um, it's positive. So I, I, I enjoy doing that. And, um, you know, I think if you kind of look at all the non-surgical options that are out there, there comes a point, especially with patients who had significant weight loss, where they're just not effective for that group of folks. You know, they have too much extra skin. So surgery is really gonna give patients a better result. And so that's where I come in to help, you know, give them the body that they're looking for. Yeah, for sure. So, let's go back. Yeah. And let's talk about, um, I mean, you gotta be a, you have to have aptitude to number one, you know, make it to med school. Yeah. I mean, I just didn't show up here and become a, right. I mean, just don't, don't magically one day become a plastic surgeon. Right. There's a lot of steps that go into it, right? Yeah. Yeah. I mean I think, uh, uh, uh, you know, kind of where I started in terms of college, like, you know, how did I get to medical school? Well, I had no interest in being a physician when I went to college. I actually went to, you know, a small Catholic college. I was interested being a priest actually. So they had a seminary there. And really I spent the first probably three and a half years deciding if that was a vocation I was gonna follow, and ultimately decided I wanted to get married, have kids, and that really wasn't the path I wanted to take. And, uh, spent another three, four years kind of deciding where I was gonna focus my energy. And, uh, that process wa is an interesting story in and of itself because when I sort of looked at all the options and medicine had kind of come up, went to some of the folks at my college as I was finishing up. And it was very discouraging because there were all the steps you have to go through to get to medical school. So I kind of knew I was, I was up against it at that point and, uh, took about a year off. I was working, uh, I was a bartender, um, sort of volunteering in an ER at UCSD.

And that was it. I mean, I had that experience and I thought, and I'd always had a great aptitude for science. I always won science fairs. I was a, you know, I was always a smart kid. I mean, I, I, I had a lot of it. It was interesting 'cause I had thought about being a scientist, being an astronaut, all these aspirations when I was a kid.

Um, but I wanted something more with people, something, uh, especially I think from the priest angle. Uh, I just had this more altruistic idea. I wanted to make some, do some good in the world, do something different, help people in it, in some, in some way. And I really didn't know how to, you know, make that, uh, how to crystallize that. So when I saw what people were doing in medicine, it was exciting. Something just clicked, and I just graduated. Right? So, I mean, there was a part of me that really felt a bit of drift and I was looking for this direction. And when I saw that, I thought, you know, I can dedicate myself to pursuing this. I mean, this is something that just seems like it's, it's greater than me. And I, I really felt excited about it. So it was a question then of kind of looking at it more. And then I volunteered in the surgical ICU and would, and then I got a job working in a lab in the hospital, became a phlebotomist, all these little things. Meanwhile working like two, three jobs. And then decided I was gonna take the pre-med classes. So I was just, you know, completely consumed by wanting to make this happen. And so that's kind of where it went. And then I, um, got the prerequisites, there's all these steps, hoops you have to jump through to qualify for med school. And then I took the entrance exam, did really well, and was fortunate to get into a lot of great schools. And then I. Went to med school. I mean, it was my dream, but I had to be realistic. I mean, I think everyone has to think, well, what's my plan B and all that. And I had a plan B, um, but I just kept going. What was Plan B? Well, I thought about law school. You know, I have a lot of really good friends who were lawyers and they were happy and they're doing good work. So, I mean, I actually did some like kind of grunt work for a law clerk when I was in school too. And um, you know, I thought I was looking at the LSAT and so there were some other things I was interested in. You know, I wasn't really big into business per se. There was a lot of folks in my school that were, you know, business majors and all that. But, um, law seemed really interesting at the time too, so didn't have to go down that road. You know, things just kept happening, you know? I mean, I think that's part of it. You know, you have these little successes and then they all kind of accumulate into, you just keep heading in that path. And it just seemed like that's where I was meant to be. It's an interesting concept, right? It's sort of like a series of just, it's a cumulative effect of success. Little things, one step at a time. You hear that, uh, out of, uh, all sorts of professions, tier one operators, you know, successful business people, doctors. It's just the cumulative effect of incremental success.

Well, I think too, I, I think the difference between when I was doing my pre-med requirements and when I was in school is I was, I was more focused. So we're talking about pathway to, you know, peak performance. That's really where it started. And I think part of it was understanding what I had to accomplish. So I had very clear goals, and then I had a timeline and, and I knew what I had to do. But, but then you have to do it, you have to execute it, right? So, and for me, uh, the college experience was very different than my pre-med experience. And so it was more focused. It was sitting in front of the class. It was.

Studying pretty much, I don't wanna say 24 7. I mean, I was sleeping and working, but it was very dedicated to doing that. And I made a lot of sacrifices just to focus on getting good grades, studying and, and I had a really good mentor, you know, I had an advisor who gave me a lot of good advice and she was great. And I think that was helpful too. You know, I had to find somebody who was, uh, who had my best interest and I could trust to gimme good advice along the way. But it was really, it, it was that dedication and sacrifices, I think, where it started and, and long hours. And then realizing too that I had to, I had to work through school at that point, and so I had a couple jobs and it was just that, you know, I was hungry for it.

And so I had to spend extra time. I mean, just everything I did was just dedicated to doing that. Not everybody is that way. [No, but I think, uh, I think I just realized, I, I think I just felt such great potential when I was younger and I think when I was, when I finished with college, I, I thought, you know, I just, I have a lot of undeveloped potential in a way.

I don't know if I looked at it exactly like that, but I really felt like I, I really wanna do something with these skills I have, and I just didn't know the direction. And, you know, I prayed about it. I did a lot of, you know, I went to the ER and did a lot of volunteer work to see, and once I really knew that's the direction I wanted to go, I was just all in.

It's interesting. Do you feel like there were somebody along the way that was helping you? I mean, or were you just, just Well, that's my advisor, you know, she, she was, um, really good about, you know, Dr. Lewis was great, you know, she gave me kind of the, the timeline and helped, you know, basically said, if this is what you, if this is your goal, you wanna go to med school, here's what you do, here's the timeline, and just do it, you know?

And, uh, and I, and I did it, I did it to a t. You know, and I was on it. There was no slacking, you know, I was, I had roommates to be throwing parties and I'd be in there studying my going to chemistry, you know, on a Friday night and I was living at the beach and, but I was able to focus and just, uh, it really was sacrifice. I don't think I looked at it so much like that at the time, but I just knew this is what I wanted and I was gonna fight for it. And, uh, and I had, you know, um, you know, a lot of good professors along the way, but, you know, I had to do the work. I mean, that was the thing. Yeah, it was a lot of work and it was a lot of late hours.

And, uh, there is your great degree of sacrifice I think that comes with doing these types of things. I mean, you have to sacrifice something. Yeah. And then you transitioned, well, it was medical school and that was, uh, in medical school was a tremendous experience. I mean, I was, I was actually here at, you know, UCSF, you know, across the bay, probably best experience in my life in terms of the culture of excellence.

And I think that's where I really got that taste of — here were really the smartest, most capable people I'd ever been around. And they were the top of everything. You know, people that were getting, you know, valedictorians, they were the people that were just, you know, the tops of every school. I mean, I can rattle off all, you know, the schools in the Bay Area, you know, Berkeley, Stanford, you know, a roommate from Harvard. I mean, these were people that were just extremely bright. They were, and they, and they were talented too. They weren't just burned on paper, but they had emotional intelligence. And so that was a great milieu to be involved in, because I think it really raised me up in a way. I mean, I, I learned so much speaking about work ethic, and these were people that were just zealots about for the most part.

You know, everybody has their different pathway to success. But I just saw how committed people were to just being just better than average. You know, not settling for mediocre, you know, this way to do it more, you know, can you answer that question before going to seek the answer from somebody else? I mean, there were just all these different little things I learned.

And, and just from seeing directly, whether it was in the classroom or on the rotations, in the wards, in the residents, I mean, it was just a, it was just tremendous. And I think it instilled in me this, this idea about excellence and that I wanted to pursue that, whether it be writing a note for, you know, a patient interaction or doing a surgery, just everything, trying to do the best I could and strive for that when that carries pseudo residency, you know, the, the two residencies I did. Yeah. Yeah. So talk about those if you would. So, as I mentioned, I wanted to go, uh, be a liver transplant surgeon. I, I thought that was extremely exciting. We, uh, I, I had some great experiences with that. You know my advisor was, uh, the chief of transplant surgery later, the chief of surgery. And, uh, I just, it was just tremendously exciting, and I really enjoyed that interaction.

So I finished medical school, went up to general surgery and. I enjoyed the work, but it was, again, it was kind of a lifestyle there, there was definitely some of that and I, 'cause I, I had a chance to see like, wow, this is what it's gonna be like for the rest of my career. And so I began to look at other sort of branches of general surgery.

So, you know, and this is kind of an old fashioned model, but you train as a general surgeon and then you can become a heart surgeon or a vascular surgeon or a transplant surgeon or a plastic surgeon. Now they have these more integrated models where you kind of do it all together at a med school, but this is, you know, kind of the old track.

So I was looking at, you know, what direction I wanna take. So, um, plastics was definitely not on my radar. Um, but when I had a chance to kind of see what they actually did and, uh, mentor and, you know, follow the one, particularly Wayne Ozaki, who's actually the chief at UCLA now. So he was really, um, excited for him. He is, he was a tremendous just seeing, uh. His level of skill and how he interacted with the other surgeons he worked with. And I just like the collaboration, you know, I mean usually, especially if you're doing reconstructive surgery, there's a lot of collaboration with other surgeons. So you get to work with really bright people in challenging situations. And uh, so I did that and then, um, decided I wanted to train in plastic surgery. So then I was fortunate to go to UC Davis, so not that far from here. And spent a few years just doing a tremendous amount of training across a broad range of things. And, uh, had always been interested in cranial facial surgery.

So that was something I was initially interested in and decided not to pursue that route. And then went back up to Portland, got invited to join a couple guys up there that were in practice and you know, the rest is history. Yeah. Portland's a great place to live. I mean, it's such a, you're an hour from the coast, you're out from the mountains.

I do a lot of stuff outdoors with my boys, you know, go mountain biking, surfing, motorcycles. I mean, there's a lot of things that you can do outdoors there. Yeah. Kinda hard to leave. Yeah. I, I remember going to Portland, um, the first time and just being like, wow, you know, as a San Francisco guy, I was like, wow, this place is really cool.

This, the spirits, the outdoor part of it is exciting. I think that's why people like it and stay, I mean, I just, and I think I did more things outdoors the longer I was there, so more fishing and more hiking and more stuff outdoors. 'cause it's a, it's a nice place to be. And people were very pleasant. I mean, I think that was the thing I noticed when I kind of went there is how nice people were generally. I mean, yeah, it seems, seems genuine. I mean, it is. I think it, he's genuine, but yeah, I mean, it's interesting. Um, you talk about the outdoors, you like challenging things. You live, you were cast for Wyoming. Talk about cycling. Yeah, we were, we were just chatting about that. So, you know, I always, I grew up playing team sports and I think that was, uh. That was good too. You know, I think a lot of the, the lessons I learned about working with others and some of those challenges, you know, leadership was from playing football, playing soccer, playing basketball. Um, but I knew I wasn't gonna do that forever. You know, I knew I'm not a college athlete and at least for those, those forts, and so I, I had a chance to see a bike race in, in Casper. It was Casper Classic, was just this, uh, stage race. And it just seemed really exciting. And these, these guys seemed like they were pushing themselves to the limit. And I'd never really done any individual endurance sports. And I just thought, man, this looks really interesting. And I, I, I liked the idea of pushing myself.

It was just a time in my life where that was just, uh, uh, something that was really attractive to me. And so I started riding my bike in the middle of the, you know, the prairie, you know, got a road bike. And then, uh, one of the reasons I liked San Diego where I ended up gonna college, was that they had road racing. So I was on the cycling team and we'd travel around to other schools. Would race, you know, here at Stanford and UCLA. And so it was good. And it's been something I've kind of taken up again in middle age. Uh, got away from it for a while and it's been the best thing ever. You know, I just, it's, it's definitely part of my pathway.

I haven't really talked about kind of things I do now, but that, that aspect of physical activity and endurance and, you know, kind of some degree of physical suffering, I think that has been, uh, you know, something that still is, I, I find helpful and drives enjoyable, drives me. Yeah. So you're a father, there's a pathway to peak performance in being a father, isn't there?

Yeah, absolutely. I mean, I think part of it is, uh, we only have so many hours in the day, right? You got 24 hours in a day. Where am I gonna spend them? Who am I gonna do things with? And you know, for me, my, my kids, that, that was a big thing. Even looking at where I was gonna, what I was gonna do after plastics residency, you know, I was gonna do some more training and for me, there, there came a point where it was, do I do the next fellowship and do in another year of training, or am I gonna spend it with my family? For a while I struggled with that and, and, and at the end I'm like, I need to be there for my boys more. You know? Or it was my one son at the time for my second son was born. But, you know, we have to make decisions, you know, and so it's not necessarily, you know, binary, but it was, I wanted to be more flexible to be able to spend more time with my kids. And so for me, the choice was do I go into academics or do I pursue this route where I was gonna be even more focused on my career, or was I going to be, have more time to be a, a husband and a father? So that's what I chose, you know, I think it's about values and I just decided for me, and, and a lot of it was wrapped up in pride, frankly, you know, I mean, looking at big institutions, I mean, frankly, I had a fellowship lined up and when I, you know, I had an experience, I think I was telling you about what happened in Nepal. It, it just changed my life, frankly, you know? So I decided that I was going to not, you know, I was gonna do a little different path. Yeah. I think now that you bring up the Nepal story, you gotta tell that story. That's a crazy, that's a crazy story. Well, it, it did change my life. So when I was in residency, my, my last year, we had opportunities as residents to go do, uh, medical missions.

You know, service works. You go, you do, uh, usually a lot of cleft lip and palate surgery, or you do, uh, burns. There's a lot of different things, but, um, in a different countries. So there's a, a group called Rotoplast, which great organization kind of based in San Francisco, actually. They had a, a trips, uh, going out to Nepal and was their first one. So my mentor at the time, uh, Gran Wong. I went with him. And so we went out with a group and there were a couple other surgeons, another, um, surgeon from the Bay Area. So we had a great week doing cleft lip and palate and burn surgery, and some hand surgery too. And it was tremendous. I mean, it was, you know, they would, uh, you know, patients would get sort of recruited and then they would literally take buses or walk for, you know, miles and, um, they would, you know, we'd, we'd see them, do surgery, see them after for the aftercare. And it was just, uh, it was incredible. I mean, it was really, um, you think about all the good you can do and that was just a such an amazingly positive experience, you know, 'cause some of these poor children had, you know, cleft lip and pal, a lot of them are just incredibly ostracized. You know, in some cases they look at it as some moral failing. I mean, it was just this awful thing. So you can really make a difference with them socially too, not just physically. So that was a tremendous experience. At the end, we had planned to do some traveling, and one of those trips was going to go, uh, we went up to the Everest, Mount Everest base camp. So we were in Kathmandu and then a, actually a small hospital just south of there in Banepa. And, uh, one of the surgeons had a contact at the airport. So we went up, you know, a couple days in a row to see if the weather conditions were good. So at the time they, you, you couldn't get a helicopter up to Everest. So the only people that were flying were either rescue helicopters or, uh, it was the military. So we were up with a military — you know there were a couple guys were pilots up there at the airport, literally. And, you know, it was, uh, you know, you pay them and then they were looking at weather conditions at the, you know, Lukla the airport, which is at the end of the Kubu Valley. And then you fly there and then you take the helicopter up the, up the valley to the base camp.

So finally I'll get the good weather. So good weather. So we're in this rickety old helicopter that was apparently a gift from the, from India to the Nepalese, uh, army. And so it's myself an anesthesiologist from England, uh, Dr. Blanc, and then the two pilots. And if you look at this helicopter, it looks like it's about ready to fall apart.

You know? I was just excited. I was like, Hey, we're going to Mount Everest Bases Camp. It's gonna be great. We'll go for the day. And that was kind of the idea. And we literally had planned out, we were gonna go to southern Nepal, which it's, it's an interesting country 'cause it has in the south it’s like jungles. So we had already made reservations for this jungle. Tour we're gonna hang out, you know, this place where there's tigers and you know, elephants. So we had all this planned out. Well, we basically, you know, it's, it's an amazing view. So you're in this little helicopter and we're flying, we fly from Kathmandu in the helicopter to Lukla. And so you go through the he part of the Himalayas to get there. And it was spectacular. You know, I, I've lived in, you know, the Pacific Northwest, been around mountains, but in, in, in, lived in Wyoming, and you've got the continental divide, but this is like on a whole other level of just awe inspiring natural beauty, right?

And along that way, we passed the, we go over these like ridge lines of, of snow, and you can see people walking around. You just realize how fragile you are today. You're just up there in this little helicopter, right? And it, and it's interesting at that time as we're flying over this, I'm thinking of a friend of mine who I went to college with. So he, he, he was in the Marine Corps. Went to do some work. He was a, an FBI, uh, director as a regional office for a while. He's just a tremendous human being. But he had an experience where he is, his parachute malfunctioned and, and the way down he's thinking about things. And he told me this story. And so he's like, you know, if I survive this, I'm gonna, I'm gonna change my life.

I'm gonna do something different. And it, it's, and for him that was really about more of a religious, you know, if he's a pastor and he does it, it's just, it, it changed his direction. So he survives, he like, hits this roof and us guy survives this thing. He's but really without a scratch. And I just thought it was the most amazing story.

Right? So I'm up there flying over these things, going, I wonder if we crashed, what would that be? Like, what would I do different baby. Huh? What if I had a chance to, and I like to think I was still trying to be a good man, a good husband at that point, a good dad. But I thought, man, I, I, I would do even better, you know? If I had another chance, like if I was literally gifted, like more time on the cert. So, fast forward we get to Lukla, which is, you know, dubbed the most dangerous airport in the world, right? 'cause there's a lot of crashes there. So the helicopter comes in, no problem. And then just because of weight and because of the, the atmosphere, you can only have so many people in the helicopter, right?

So they go, Hey, we're gonna, we're gonna flap the valley, we're gonna drop people off and we're gonna shuttle you guys up to the base camp one at a time. So like, right? So we go up and Jock, it was amazing. Like I never really seen a glacier like that before. So you get further up and you see the glaciers right there, and you're flying over really these ice fields.

And then you're looking and every, it's like a postcard everywhere you look, it's just spectacular. And it's just, it was just awe inspiring. And you can kind of see Everest in the distance and then you kind of snake around the valley. So we landed and there's all these little farms and then, and I was fortunate that, hey, I get to go first, right?

So we, it's just me and the two pilots to get, get in there, and then we're flying up next to the glacier and I'm taking pictures with my little teeny eight megapixel camera, you know, this is 2008. And, uh, so base camp is really just in the rocks. I mean, it's really not that much to look at. It's a bunch of tents and there's, you know, mountains around there, and it's around says, 17, 18,000 feet. So it's, it's pretty high. We're, we're circling. And it's, and it's really noisy, you know, there's not any, uh, I didn't have a noise canceling, you know, headphones, you know, the, the pilots did, but it's, uh, again, it's uh, just the nature of the, the equipment. So they go, you know, the, it's just too windy. We're going back, we can't land, right? And I'm like, Hey, this still, this is great. This is really exciting. I got to see, you know, Mount Everest is right there. This is spectacular. And within a few minutes though, it became obvious that we were going down. And I don't know if it was the lack of oxygen from being at that altitude. I was kind of like, huh, this is, this is weird because we're not supposed to be landing on this mountain over here.

And really, you know, it's about 18,000 feet, I wanna say, give or take, but it's, it's called Kala Patthar, which is this little, looks like kind of a hill, but it's really high and it's right next to the Everest base camp. And, uh, and it happened really fast, so I didn't have a chance to really think about that, but we just literally lost power.

I mean, basically just slammed into the, the side of this thing and, uh, you know, overturned. And I just remember thinking, oh my God, am I, I mean I'm one, am I alive? And I was just like, thank God. So I was upside down in the, in the harness. So I unstrapped myself and the pilots had been banged up. They were kind of bleeding and banged up, but we were all able to walk out and survived it essentially. So I had a satellite phone. We, you know, all the electronics were destroyed, so we used the sat phone to call the base, and they sent another helicopter up. We had to hike down, and there's, from there, there were these guys that then hiked up. So we were going over the valley and, and this group of trekkers had seen us go over and they heard us crash. So this, uh, Dawa Sherpa, who's now a friend of mine, I still keep in touch with Da. He's the, he has a guide service in Nepal. He was guiding these, uh, this group from the UK up. And so Richard and him, you know, hiked up the side of this, uh, uh, of Kala Patthar, which is a pretty steep grade, and then helped us, you know, basically helped get us down. Uh, got some first aid supplies for the, uh, for the pilots. And it was, uh. It ultimately helped us get kind of out of there safely. 'cause we were going the wrong direction initially. We were going towards the cliff where it was, you know, kind of a drop off and they were like, no, no, no, you guys wanna come down here. Went to the glacier, hiked down to, I wanna say Gorshap. There's, there's a little kind of like village that's the last village before you get to the base camp. And so that's where we waited for the, the other helicopter that then took us back to Kathmandu. But, uh, I, I didn't start, my life didn't start flashing in front of my eyes until I was hiking down Kala Patthar.

Honest to God. I mean, that was, I, I was walking down there and I, I mean all these things, you know, the birth of my, my son at that point getting married, high school, childhood. And it was, uh, I just remember that it was really powerful. Like, you know, I didn't, I don't think I had time when it was happening. Was that like a delayed effect, you think? Yeah, I mean, I didn't have time to think about that, but it was definitely like, I dunno if it was the, uh, the adrenaline, but it was definitely like all that just kind of came rushing. As I was hiking down, it was interesting. Wow. Yeah, so, so that really kind of made me think like, wow, I survived this with relatively minor injuries. I mean, went to the hospital later, but I was checked out. I was fine. Um, but it really made me think, made me think like, wow, I, I, I felt so fortunate to have survived and especially since I was thinking about what was gonna happen if I crashed. I mean, it was just odd that I was even thinking about that, you know, before.

So I, I, it took me a while to kind of put that together. But I had had a position lined up in Boston, and it was gonna be another year of training. And it was, honestly, it's just too much for my family. And I think I was trying to put my own interests ahead of my family’s. And I remember there was a day when I, so I'm back, I'm in residency and now I'm trying to deciding, this is in the spring before I'm supposed to go. And, uh. My son was about, it wasn't quite two at the time, but we're watching the, the clouds and jumping in puddles. And I thought, there's no way I'm, I'm, it's gonna be about my son and my wife. And I'm, you know, I, at least for me, it's a different direction. Now there's some people that like, you know, they do the research, the, the clinical, they, uh, they teach, they call it the triple threat, right? If you're an academics. And, uh, I just decided, you know, that's just not for me. And I, and for me it was like, you know, my wife and my, my son, that's more valuable and that this is the route I should take. So for me it meant I'm gonna go to Portland, and that's where I come from is I trained up there and, uh, go back and at least that's where it was gonna start. And so that's where I just decided to take a different route and, uh, and uh, best decision ever. It really was because I think I realized that, you know, it's just about values, right? I mean, for me it was realizing what my values were, so I had to get those in order. And you, you'd think, well, didn't you have those in order before? But you know, there's competing interests in my own pride. And I was like, you know, my marriage is more important in my son is more important than my career. And at least for me, I had to make that, you know, change. I mean, maybe for other guys it's different and it all works out in some way. But for me, that's where it started.

And, and I think that I've been able to kind of take that and still try to excel with what I'm, where I'm at, you know, in terms of my practice, but in a different way. And so it's, for me, it's all been about, you know, clinically it's not teaching and doing research. It's, it's really focusing on the art and science of surgery and how I do it, you know, on a daily basis.

So. Well, that's where my, yeah. Yeah. So much of that is reps also too, right? I mean, you know Yeah. You, you've done a lot of surgery. Yeah. That, I mean, I'll be 10,000, I mean, uh. A lot of surgeries. Yeah. So I mean, you know, they talk about what, 10,000 hours to be an expert. And I think I passed that a long time ago. And I think at the end of the day too, you know, from a surgical stand standpoint, you know, like, you know, talked to Mike Longacre about all the research and stuff that he's done and, you know, we've talked about him extensively. Yeah. But yeah, he's phenomenal. Um, but, um, you know, I think in the surgery game after being around it for all these years, um, it's really like you see, you see like, you know, surgeons who really are getting those reps, getting those cases, getting, you know, they're just, you're doing so much. You said that 10,000 hours, it's like you think about it in any, and if you've done a thousand surgeries, you're pretty proficient, but it just keeps getting better and better, doesn't it? Yeah. I mean, thousands of certain techniques I’ve done, I mean, there are just certain. Individual surgeries. I mean, you know. Yes. So I think it, it, I think repetition and experience definitely matters, but it's also a passion for an outcome. Right? Isn't there that Isn't that true? I mean, I, I, you, I, we can't speak about surgeons on a whole, but what we can do is we can talk about your passion for an outcome and knowing you, you literally, like you have a passion for well, getting the right outcome.

Well, I always plan things with the idea that I want the best result for the patient, and I want it to look good. I want them to do well. I mean, there's that, you know, have a vested interest in it and I care about it. You know, I mean, I think that helps. I mean, I think that's what, you know, drives me. So every individual surgery patient, I mean, I really look at that, like I'm gonna focus on that during, you know, that particular time. And I mean, I think that degree of concentration, and I mean, I think it makes a difference. You know, when I focus on something for like. It seems like that's a continuous theme for you is that you, whenever you do something, you focus in on it, you get locked in, you stay focused on it until you're, you master it.

Well, I think, and I think as I've gotten older too, it's like, how do you maintain that so that you set yourself up for success in terms of, um, you know, taking care of myself physically, you know, I mean, I have a routine I go through. I mean, all these things, I mean, there's definitely a mindset, but there comes a point when you have to, you know, take care of yourself to set your body and your mind up for success. I mean, that's definitely part of it. I mean, that's a, that's a big part of it, frankly, as I get older, to be able to repeat the, the successes and to it's, you know, creating these, you know, it's, it's successful habits, you know, it's a routine, you know, I mean, my, my routine, you know, I pray every day. I have my, my constant, we talked about constants, right? So for me it's, you know, part of that's spiritual, part of that's physical, you know, it's taking care of myself, it's working out, it's dedicating. Part of my day, part of my week, to each part of that, of my being to care for myself in some way so that I'm optimal, so that when I have a patient or someone who's sick or, or that wants enough, you know, to improve their body and their shape, you know, I'm there able to do that, you know, optimally, you know? Yeah. I think there's, you know, for me that peak performance is taken care of myself and being on the top of my profession in terms of like, looking at what, uh, state of the art in terms of the, the techniques or the technology or the surgical equipment. I mean, there's just a lot of different moving parts to that, but it starts with me.

Yeah. That's never ending. No, I mean, and I think that's what's exciting too, is that it constantly changes and uh, it really gets better in a way. And in some ways it gets easier. 'cause you, you do the same thing to a degree, but then you're like, how can I get better at it? How can I do it faster? Or how can I do it with fewer steps? How can I have, you know, how can I improve the patient's experience so that, you know, they either, you know, less discomfort post-op, easier recovery. I mean, there's just so many things you're trying to improve that whole process. And so I enjoy that. I mean, and it is a challenge, you know, there's always some way to approach that. So whether it's enlisting others or, um, you know, definitely I look at, so every time I do a surgery, I'm always, I always take notes. I learned that early on. So, you know, most cases, I mean, a lot of routine things, I don't necessarily do that as much anymore. But if there's, I, I try to learn from each surgery and think about, okay, I kind of debrief myself, you know, what can we do different?

You know, how can we improve that process? So, I mean, I think that is definitely part of. What I continue to do in terms of trying to improve outcomes and be a better surgeon. Um, 'cause these are, these are the things that aren't in the textbooks or in, I mean, you sort of learn them in residency, right. You know, improving. But ultimately you have to take ownership in charge of it and do it yourself. And so from, you know, it's just a regular basis that's not being arrogant or not being, you know, cocky. Do you have everything all figured out? It's trying to continue to get better. Yeah. It's exciting. And I think it's true, like the, the evolutions of that are, you have a choice to make.

You can either make it hard or you can make it easy. It's just your attitude about how you're gonna handle things and how you're gonna move through life. There's a lot of inertia for a lot of people. They don't want to change. But if you're excited about change and, and going to that next level, it can be pretty interesting and um, and actually exciting.

Right? Yeah. Yeah. So, young surgeon or someone that's interested in being a plastic surgeon, where do you think plastic surgery's gonna be In 10 years from now? If, if you look at it, I think the technology may change to some degree, but I, I, I think in a lot of ways it, what we're doing on a day in and day out basis is gonna be similar.

It's just that some of the techniques may continue to change some of the, you know, the instrumentation, you know, AI or some of these things from microsurgery in particular. So different, I, I think it's gonna depend on the type of, uh, subspecialty of surgery. So if, if you look at what's being done, the aesthetic surgery gets a lot of the press.

I mean, that's what's big on social media. A lot of the TV shows around that. But really there's a lot of plastic surgery and the reconstructive surgery that no one knows about. And I don't wanna say it's behind the scenes, but it's the kind of things that aren't as glamorous, but it's the things that are happening every day across the world to help people put their bodies back together. And so I think those techniques actually continue to improve too 'cause we have better understanding of anatomy, blood flow and like, and I do things, some, some new techniques that I've learned, even been in practice to do, have better outcomes and reconstruct things better than I could 10 years ago. So I, I think we're gonna see all that.

I mean, I, I think technology plays a role and it's just a question of, you know, how you fold that into your practice. Um, you know, imaging. I mean, there's just a lot of things that help me. At the end of the day though, plastic surgery is still about using your hands to do a surgery. You have to assess the patient. There's analyzing what the issue is, coming up with a plan and then executing it and, you know, shepherding them through that whole process. Yeah. So, and I think we can come up with better ways, um, too for that, that patient experience. I think patients do better with anesthesia. I think the post-op recovery process has been honed over the, the years and I think it's only gonna continue to get better.

I mean, I think recoveries will get, hopefully, a little easier for patients. I think nutrition and the role of that, or even peptides, you know, we've talked about this, you know, what other things can we do in the perioperative period to help patients optimize their healing, their nutrition. So I think all these things are, are just gonna be additive and I think that hopefully patients' experiences will continue to get better as we refine a lot of these things over time.

Yeah, I think the, it's gonna be really interesting to see how peptides play a role. I'm with you on the nutrition side of things too, and the diets that people are, are, are eating, um, are changing, people are, things are changing. And, um, and may, it may be, it may take a while, but, um, I think at the end of the day it's gonna be interesting.

I'm curious what you think about where stem cells are gonna play a role well in plastic surgery? Well, that's a great question and I think it's to be decided. So that was one of the things I actually looked at doing when I was in training. So I spent a year doing research in a lab at OHSU on adipose stem cells. So these are stem cells that come from adults. We actually all had stem cells in different parts of our bodies. In particular, there's this population that kind of lives in the fat of our bodies and helps make new cells. And uh, you know, they're kind of, we call 'em multipotential URI potent to some degree where you can expose 'em to different growth factors to get 'em to say, turn into cartilage or bone.

So that process is still being refined. I think it's incredibly exciting, um, for things like, you know, joint, joint health brains, they've looked at cardiac muscle repair. So in terms of plastic surgery, I think we're gonna hopefully see how those things may help retention of safe fat grafts or wound healing. So, I mean, that's kind of a less sexy side of plastic surgery is the wounds and, and getting people to heal these chronic wounds, maybe even without surgery. But how can we get stem cells to help repair, you know, the, the environment that's been damaged. Yeah. And I think that's, it's a, it's a very complex issue.

I mean, people have been looking at this for longer than I've been in medicine, but it's, uh, I, I think it's exciting 'cause I think we can see things that can be corrected without surgery, or we can heal things or we can optimize them. So I think there's a, there's certainly a lot of work going into this, whether it's for, uh, aesthetic medicine, how to improve the quality of skin, treat wrinkles, uh, you know, a lot of it's looking at wound healing.

You know, tissue engineering is another part of that too, you know, for creating or growing organs in the lab or growing an artificial breast or an ear. I mean, that's why I was really excited about plastics when I was looking. I spent that year in the lab because I just thought. This is amazing. You know, we're just on the cusp of all these really exciting developments and a lot of them have yet to be realized. But I think it's exciting. I think just being in that environment, it, it's exciting. Yeah, it's super exciting. When you think about, I mean like, let's go to like, you know, you're talking about those people that are, you're seeing in on those mission trips and burns, you know, the notion that you could, uh, regrow skin in the lab from stem cells and actually, you know, do a skin well.

They have, yeah, they have that to a degree with spray on skin. I mean, there's a lot of things, you know, temporary skin substitutes, so there's a lot of things like that where it has rare, practical applications and I think they're just going to continue to refine that and make it easier to do 'cause I think there's a lot, it's, it's very labor intensive in terms of how the cells have to be cultured and grown up. And I think it's continuing to improve for the burns, uh, population. But I think again, it's going to be, continue to be refined over time. So back to the pathway to peak performance. Yeah. What's next with you? What's, I mean, I know you're doing a lot of things right now, but what, what's like, what's the next big thing?

Well, the next big thing is just trying to deliver a better, I mean, this is more sort of practice management sort of stuff. I mean, I, I'm always trying to look at, you know, right now it's, um, you know, as a new type of implant that's out, utilizing that in my practice, some new techniques using like an internal bra. I mean, there's all these different things that I've been working on over the last few years. What's the new implant? Uh, it's called Motiva. So it's a brand that's been available, you know, in the rest of the world for the most part, for, for many years. I think about 14 years. And, uh, it just got approved in the US so it's got some different characteristics in terms of its production.

It's like six generations. So there's some characteristics of it that make it a little different than the current implants we have and the safety profile historically has a little lower rupture rate, a little bit less scarring that forms around the implants. So I've been putting more of these in and, and, uh, I'm excited to see how they're gonna do long term.

Interesting. Yeah. So, but you know, for me in the practice it's, you know, I, I realize like I, I can do the best surgery in the world, but a lot of that also has to do with the patient's experience too. So it's really trying to be a good leader. It's trying to be a good example in my office about being conscientious, taking care of patients, and then also trying to make that experience, uh, streamlined, comfortable so the patients feel taken care of, and really trying to continue to improve that. I mean, I think that that's, um, you know, it's, it will always be something I'll be working on in terms of improving that, but that's kind of been the, my latest focus is patient experience in terms of when they, you know, come meet everyone from the folks at the front desk to, you know, the, the back office.

I mean, my, I'm MAs uh, it's just, it's just all part of that process, you know, and surrounding myself with, with good people. I have a PA Rachel, who's just fantastic and she's part of that too. So you, you have to find people that you trust that can be part of your, an extension of yourself in terms of how you, how I care for people, not just continue to refine my own skills, but also the, the practice as a whole. Yeah. So that's what I'm doing. I mean, that's, and just looking at ways to improve patient education, the patient experience. I mean, 'cause I think at the end of the day, patients want to come in, have their problem addressed, they want to have it disrupt their life as minimally as possible, and they don't, they wanna feel as little discomfort as possible and have a nice outcome.

So, delivering that, there's a lot of moving parts to that, but that's where my skill, my expertise, my experience, you know, it definitely helps to guide them where I think they're gonna get the best outcome and be happy with it. Or in some cases not, or look at some other options. I mean, this is not a matter of selling patients surgery, it's trying to find out how I can best help their concerns or problems, and then giving them a realistic idea of what, you know, I can do for them and kinda the best way to go. Yeah. I think, you know, that's, that's the one thing I'm so glad you brought that up because, um, there's like this ethical component and I know the way that you practice right. Well, that's a good point. Yeah, I mean, I think it's a mixed blessing that I was never really that interested in business because I sort of, I, I try to look at the interactions as more, you know, as a doctor taking care of someone, whatever their problem is, whether it's cancer or it's a tummy tuck, you know, it's, I'm still doing kind of the same type of thing, but it's, and I, I try not to make it transactional. I guess I just, I just don't really enjoy that part of it, so I, I don't look at it like somebody has to come in and leave with a surgical plan all the time. You know, some people that maybe they don't need surgery. Or maybe they have some health issues that need to be addressed before we do that. So it's really trying to take a doctor, frankly, at the end of the day. I mean, that's what I'm trained to do and not just be having people signed up for plastic surgery. You know? I mean, it's, yeah. And I really think we're, we're all trained as, as I say, we as surgeons, um, you know, are, are really, they try to instill in this those sort of ideals or those values as surgeons. So, I mean, I, and, and I look to my mentors throughout the years, so it's not like I just kind of came up with these ideas in a vacuum. Um, you know, I think I had a lot of good examples of people who were conscientious and were good doctors, good surgeons too. So, I mean, and I've tried to emulate that and do same thing and carry that on. I mean, it's, uh, I take great pride in that. I mean, it's, uh, I'd feel like I'm part of something bigger when I do that.

I mean, it's, uh yeah, I feel great responsibility for being a surgeon. Yeah. I think it's also, I mean, trying to manage patient expectations too. Sometimes people, you know, they have this sort of illusion of, I would imagine, I mean, that must be tough. I, I think that's true. I mean, I, I think that the internet, social media tremendously powerful.

I mean, I was just talking to somebody about this the other day, how like, you know, we, uh, still for the most part liking a cart catalogs even in medical school, right? So now a tremendous power, you know, on the plane I'm reading like journal articles, I can look at stuff, I can continue to be up to date and learn things at a speed that was not possible 20, 25 years ago.

But at the same time, I think people are exposed those, especially your social media to potentially things that aren't realistic in general or that aren't really fair. And so I think that can give people a false idea of kind of what's healthy or beautiful or normal or that, or those things can need to change. I mean, beauty's, you know, there, there are some objective things we look at as in plastic surgery about, you know, how do we measure beauty?

Also, there's a tremendous subjective component to that too. And so yes, it can be difficult. So I think that I, I try to put things in perspective. Uh, so if I see someone who has an expectation that isn't realistic, I try to explain it, you know, just to kind of tell them what I can and can't do, I guess. Yeah. And I think part of that is just knowing, you know, what the limitations of surgery are. Not over promising things too, I don't think that's fair to patients. And I think because I think sometimes people see things and I don't see too many of those folks that come in say, hey, I wanna look like this movie star or something.

But at the end of the day, it's about doing the service to the patient. And sometimes that means telling them, here's what's more realistic given, you know, your health or your body type or things. And then we go from there. Yeah. So one of the things that is, um, kind of interesting, I always try to talk to people about is flow state. When you're in that kinda state where everything is just sort of like going, right? You're at that peak level and it's almost like you're in a mode where you don't have to really think about too much. You're just doing it. Does that happen for you in surgery? Yeah, it really does. And um, you know, kind of thinking about it, you know, usually I'm working in a pretty small space. It can be a few square feet, uh, maybe a body, but I, I can be working there for 2, 3, 4, 6 hours. And, uh, there's definitely points where, you know, there's, it's just kind of timeless in a way, but I'm just focused. And I think part of that's just, I, I think my temperament, you know, I, I've always been someone who could focus on, you know, a task for a long period of time. But I think it's also trained, you know, I've been doing it for a long time. Um. But it just, yeah. When things flow, and part of it is, you know, there's certainly decisions that I have to consciously make, but a lot of it is just having done it, you know, there's part of the, the training and the inherent, and we talk about muscle memory and surgery and yeah. But I, I, I think it's definitely something and, and that's what I enjoy. Like after a, a good day of surgery, I can feel like, yes, you know, I, I operated for eight hours and it was just, you're sort of in the, in the flow, in the zone. I mean, it's, uh, I, I, I think if I couldn't sit still for that long, I wouldn't be a, as a good surgeon. When you think about it, if you go back to what, the fact that you could focus the way that you could in order to study, we talked about cumulative success. Yeah, yeah. Like, yeah. It's all, all those things are additive. I mean, it is training. I mean, you know, you just don't show up one day and do surgery for eight hours.

You know, it's all these little steps that kind of, and all these experiences and practice and the training and the, and having to, uh, be an assistant you, so you pay your dues for years, you know, I was a resident for eight years, you know, that's a long time. But you get to learn a lot during that time. And, um, and you're just, you also see what a profound responsibility you have as a surgeon. But, um, and I think I just, I just appreciate that at the end of the day, you know, I can spend hours and I think it makes me, I think from a technical standpoint better because I can focus on just trying to continue to refine the steps and be a better surgeon. And there's, there's definitely something to that, you know? Do you ever walk outta the OR and go, whoa, like what just happened? Like, uh, the time just went by like that? Or, or are you conscious of it the entire time? Well, I, I'm always amazing it doesn't feel, you know, like sometimes, you know, like you're waiting for the flight to go and you're like, 10 minutes seems like an eternity.

And, you know, I can turn around three hours later. I'm like, wow, that was, you know, or at the end of the day it's like a, you know, it's like five o'clock and I'm like, man, where did the time go? We've been in here operating all day. And so I definitely think there is something to that in terms of you, you know, you kind of get very focused on it, you know, the task at hand and there's something kind of timeless about that. I mean, I mean, that's just definitely part of it. When you scrub up, when you're going into scrub up, um, do you have like a, like a routine, like a checklist that you're going through? So I kind, I, I do, and, and, and frankly, I've already looked, I mean, I look at the case with the patient. We go over these things before, what we're, do what I'm doing, the surgical plans, I'm thinking about that honestly. I say, you know, I'm always, so I, I learned this from another surgeon, you know, I always, you know, pray for myself to do a good job, take care of the patient. So I really try to do that in every case.

But I mean, it's really trying to mentally prepare myself and, and then kind of walk it through. Jean Keeley was a, was a Olympic skier and so he would talk about skiing the course before he would race in the Olympics or down giant slope or whatever. I always thought that was interesting. And so, like, one of the things actually I learned, or I was really interested in was this mental training.

So I remember doing that with cycling. You know, doing it for soccer, but this idea that you could walk yourself through. And the thing about sports is it's so unpredictable. With a surgery, I can go through and I can do the surgery in my head or have gone through the steps. And so it's, it's kind of a fast forward addition of that, you know, a sort of plan like, okay, what am I gonna do?

So I've already done the surgery mentally before I go in there, visually seeing myself or seeing the steps and the time. And I think it tries, it makes things more efficient. I mean, where am I gonna put my hands? What am I gonna do? All these little technical things that come into doing the surgery before I'm actually there. And trying to, and then realizing too, there's some gaps in there. Like, okay, how am I gonna do that a little differently this time? Or what could I do to be a little bit more, um, smooth with that, you know? And, uh, I, I like that aspect of it because it's, it's just my two hands. I mean, there's. I mean that, and, uh, I mean there, there's more to it than that, but, well, there must be something also kind of interesting in the, in the sense that it's kind of like remodeling a house, right?

You kind of don't know what you're doing until you're in the walls. Well, I always, yeah, that's funny you use that analogy because there's a, there's some plasterers I that use, that, I'll use that once in a while that, you know, I do a little plumbing, a little electrical work, little resurfacing, but I mean, it's that sort of downplays a little bit. But, um, there are situations where, and, and usually it's more on the reconstructive end of things, where I'm kind of waiting for, say the, the cancer surgeon or the other surgeon who's doing the cancer surgery to kinda leave me with the, you know, the defect. I have to fix it. So I have to usually have a few things in mind in order to make the best of the situation, you know, so sometimes I do have to make things up. Um, it's not very often, but then one of the things I liked about plastic surgery is being able to think on, you know, one's feet. So I think I've gotten, you know, pretty good at that. You know, so, because occasionally I get called in to help another surgeon in the middle of the day, you know, and I remember a case comes to mind where they had some difficulty closing this abdominal wound and I was operating and they asked me to come over and I was just able to scrub in. And it's one of those things where it's literally the patient's asleep. They can't really, you, you're there really in a difficult situation to help. And I was able to do some things kind of, uh, you know, kind of rearrange the tissue in a way where you get it close and, uh, worked out great. Being able to kind of be adaptable and, uh, you know, not be afraid of that. Yeah. Well, we talk about peak performance. I, I, I get the sense from you that, that you never really feel like you've ever, you, you always are looking for the next level, but you have been recognized in well, I'm very, yeah. I feel fortunate to have been recognized by the doctors in Portland. And, you know, we, I think as we get further along, it's, those metrics are different, right?

So, I mean, I, I think. It's a tremendous honor to have other doctors, you know, sort of recognize me. I mean, I'm not the only plastic surgeon in Portland, but I mean, I've been recognized as a, as a outstanding plastic surgeon. And I think that, and I, and I really try to do, you know, you learn these things as a resident, you know, you try to be a, as a, as a consultant, you try to be available, amiable and able, you know, so, I mean, I've always tried to really deliver good care, um, you know, for the community. And, and I think I've made a positive difference in the community in Portland. I mean, I've really taken great pride in that and been a part of that for now, almost 20 years and 18 years. Um, but I think, you know, I, I think that work has been recognized and I'm proud of that. But, but that aside too, trying to just strive for excellence.

So it's like continuing to try to do, you know, the best. And those, those things are, it's hard to, you know, what does the best mean, but really trying to give better outcomes and my best effort and try to do a little bit better each time. Yup. So, I mean, I think having just that attitude like I'm not done, you know, where I haven't figured it all out. You know, always trying to do better. And I think really it's being around people like when I was in medical school residency, my colleagues now, I mean, just being around, that's, that's the meal you have of the medical field too. You have very bright people that are really trying to, that, that are at the, you know, the top of their profession. I mean, I think medicine attracts a lot of very bright, capable people and it's nice to be a part of that, uh, that culture, that community, um, 'cause it makes me a better doctor, a better surgeon for sure. You know, will enjoy that, enjoy those interactions. But I mean, I think that's the, that, that's the attitude I have, you know, I mean, I think, uh. I, I just feel, and, and, and I'll tell you, it kind, it really does go back to that experience I had in Nepal. It's like, I feel somewhat of an obligation. I mean, I'm like, I, I really feel a gift, like I'm still alive. You know? I really feel like that was a tremendous gift. I feel blessed to have survived that.

And so I feel like I, I want to give it all I can and do the best I can and not leave anything, you know, leave it all, like in cycling you say leave it all on the road. You know, I, I don't wanna leave anything on the table. I want to just go all out, do the best I can, and then when, you know, my practice is, is over and that's, and I'm retired, then I can, I can hold my head high and know that I did tremendous work and do my best. Yeah. Alright, well, on the way out the door here, okay, let's talk about how do you decompress? Yeah. From a job that's pretty intense, man. I mean, let's, let's call like it is. There's a patient, it's asleep on the table. You got an anesthesiologist there, but they're asleep on the table and you're, you know, you're operating.

Um, I get it that over time, you know, it probably doesn't affect you as, as it did the first surgery that you did, but there is this effect that it does have. How do you unwind? What do you do? I mean, I'm beyond the obvious of, you know, oh, you know, I spend time with my kids. So I try to go for a walk, walk the dog with my wife every day. I try to do that. I exercise on a regular basis. I have kind of a prayer and reading. So I read, actually I read whether it's something spiritual, political, I mean, I try to read 'cause I like that aspect of it, whether it's online or books. I mean, I read good old-fashioned books too. Um, I try to read something that's gonna make me a better person, a better man, better surgeon, you know, I mean that stuff is enjoyable.

Um. But I spend time outside and, and for the most part, being as being a dad especially with two boys, you know, if we go mountain biking, we go, uh, ride dirt bikes, we go backpacking, we go to the shooting range, we do all these things that are fun, that are, and I think are exciting. Um, but I get to do step outside the operating room that I'm just grateful that I'm alive and can do.

So I mean, getting outside is probably the biggest one. Yep. And riding my bike, I mean, that's a big thing too. I just, I've always loved riding my bike and being outside and, you know, I go fishing. I have a lot of outside interests, but, um, but I think, but part of that peak performance too, for me is, is having those things to do. You know, it's just not all monochromatic, you know, I mean, there's gotta be some fun, there's gotta be some, you know, uh, getting away from that environment for a while to keep it in perspective, you know? So I have to take some time off even maybe I don't want to, to do something that's gonna be restful, you know, be good for the soul. And, and that's why it's been nice to be in Oregon. I mean, I go, I've been to other places and done some adventures and like, you know, my son and I just went, uh, scuba diving at the coast last week, you know, which is a rig adventure in the cold water. So dry suit dieting, it's very challenging. The visibility is usually kind of dicey, but it's just the adventure of it, you know?

And I, I enjoy doing that, my son 'cause it's challenging. We're going and doing things that are, are difficult to do, you know, and there's kind of that excitement of getting to see things that other people don't get to, to see, you know, under the ocean and go diving or spearfishing and all these things that, that I've, uh, you know, kind of enjoyed doing and outside here. Yeah. Well you've worked hard. You've had a great, um, career to date and you're focused on the future and, and continuing to head in a, uh, you know, a positive path. Seeking excellence. You're definitely on the pathway to the peak performance continuously, which is cool. It's cool. I really always enjoy spending time with you. Well, thank you. Yeah, yeah, yeah. So thanks for coming in. Hey, my pleasure. Those are great. Thanks, Jock. Awesome. All.