June 15, 2020

#30: Journeys of a free range surgeon.. With Dr. Bronwyn Fullagar.

#30: Journeys of a free range surgeon.. With Dr. Bronwyn Fullagar.

If you’re anything like us you might have some preconceptions about surgery and surgeons. Our guest for this episode, Dr Bronwyn Fullagar, will flip those ideas of yours on their heads. Bronwyn is a board certified specialist surgeon who has a different take on what it means, and what it takes, to be a surgeon. When there is not a global viral pandemic she travels the world as a locum surgeon, and in between work stints she shares her skills at several charity organisations in some pretty awesome locations. We dig deep into a career in surgery: what it takes, what it looks like - the good and and the bad, including some practical advice on how to become a surgeon . She gives us her tips on how to stop ‘post-op panic’ about things going wrong with your cases, and she shares with us about finding her passion, loving the journey, picking your mentors, how working in the US compares to a career in Australia, and much much more. For the show notes or to check out our guests’ favourite resources, click on the webpage link on the episode page wherever you listen to us, or visit the podcast website at thevetvault.com If you have a question for us we’d like you to leave us a voice message by going to our episode page on the anchor app (https://anchor.fm) and hitting the record button, or via email at thevetvaultpodcast@gmail.com, or just catch up with us on instagram. (https://www.instagram.com/thevetvault/) We’d love to hear from you! If you like what you heard, then please help us to spread the word by subscribing to the podcast (it’s free!), and by telling your friends about us.

Good evening.Ladies and gentlemen, this is Gerardo Poli.And this, sorry.I'm Gerardo Poli.I'm Hubert him strapped, and this is the vent valve.
Before we introduce today's guests, just a reminder that if you want to see a recap of some of the best bits of if each episode or if you want to refer to any of the books or resources that we talked about to our guests, you can check them out at the vet V.com and clicking on the show notes.
And if you know anyone who you think might find Value in what we discussed, then send them a link to the episode and help us spread the love.Now, if you're anything like me, you might have some preconceptions about surgery and surgery.And Al guess this episode.Dr. Bowman full ago, will flip those ideas of yours on their heads.
Brahman is a board certified specialist surgeon, who has a different take and what it means and what it takes to be a surgeon.When there is not a global viral, pandemic.She travels, the world as a Locum surgeon and in between Works dense, she shares her skills at several charity organizations, in some pretty awesome locations.
We dig deep into a career in surgery.What It Takes, what it looks like.The good and the bad, including some practical advice on how to become a surgeon.She gives us her tips on how to stop post a panic about things going wrong with your cases and she shared with us about finding my passion, loving the journey, picking your mentors, how working in the u.s.
Compares to a career in Australia and much much more, please enjoy dr.Bryan Fuller guard.Brandon, welcome to the red felt, thank you so much for joining us.Thank you.I'm really excited to be here.I am going to start straight away, just to just to get to know your do, what to cut me off.
First.You're going to, you're going to jump, you straight away.Yes.To stop to his thumb drive if I'm saying anything because once you start you can't shut him up.Well, we'll start with our new question just to get to know you a little bit about I said to Gerardo, I saw a billboard the other day.
That's all.I'd say it is.Bad decisions lead to good stories and I love that.It kept me thinking for ages.I want to know, do you agree with that?And if you agree, have you got any examples?Yeah, I think it's a it's a great quote and I think as a veterinarian and particularly as a surgeon, we have ample opportunity to make bad decisions and then if we're lucky later on they become a good story that we can laugh about later on.
So I definitely agree and I thought I thought a lot about what example 2.Is I would say that most of my funnier examples happened as a new grad, which I think may be true for most people.And my first job was in a mixed animal practice in North Queensland.
And people who know me now, probably couldn't imagine me doing cuddle or camel, listen, which is what I tend to do.A lot of them.But yeah, my I think my worst worst sort of decisions leading to what now hopefully is a There is a good story was my one of my first weekends on call at Easter time.
So it was Easter and to set the scene a little bit.I'd been in practice for about six weeks or so, very green and our Clinic was on call for a radius of about 3 hour drive from its location.And I was the sole mixed animal practice in our own call, for that radius, for the four-day East, a long weekend, and the series of cases that I received was.
He much every new graduates nightmare.That was, I can still remember some of them.That was a cat and status epilepticus that I could not get to stop having seizures.There was a snake bite, a colic, some sort of foreign body surgery and then on about, I think it was Saturday or Sunday evening.
I've been going pretty much flat out for 36 or 48 hours and one of the clients called and said, ah, I've had I've had another wiener die, you know, we've had these wieners died, four months and my boss had told him that the next time I win a died, didn't matter what time it was.
We were going to go out and do a post-mortem on it.And, you know, it didn't seem like a, an Emergency to me since the winner had already passed away, but it seems like the clients and really felt like it needed to be seen, right then and there.So I thought I'd better go and do this.So, you know, I grabbed a grabbed a snack and put on my coveralls and it was, you know, hot.
Vicki in North Queensland, and I went out and spent several hours doing what I thought was very thorough, post-mortem exam on this.We know collecting all kinds of specimens and small bottles and even got the brain out so proud of myself and by the time I'd finished this it was and I'd been using my car headlights to kind of light my post mortem and so I was covered in slime and goo and all kinds of cow and trails and it was hot.
You can imagine the smell was pretty bad and Or I for the property owner of the farmer left.I said I'll just hang on a sec before you go.I just want to check that my car will start because they had lots of been on a really long time.So I put my hand through the open window of my car and turn the key in the ignition, you know, obviously, terribly bad decision as you'll find out.
So, the car proceeded to entirely sure of the details a little bit of a blur, but essentially, the car proceeded to drive.Away by itself.And I I started to chase the car.It's like terrible decision.Never try and stop a moving car with everybody, but chase the car and was attempting to I think jump through the window to grab the handbrake to try and save my beloved Subaru from certain demise and didn't see a tree because it was dark and the tree kind of came up alongside the car and I got squished between the car in the tree.
So You know, the car proceeded to go and total itself.Fortunately didn't hit anybody, but certainly landed up in a ditch and I was, you know, pretty critical condition.That's this.Funny story.So, not not, not terribly, funny at the time.
But yeah, I definitely ambulances were called, and I landed up in the local hospital.And I think that You know, in the end of easily, everything turned out, okay, but I think the more entertaining parts of the story with it when I having, you know, laying on the ground for 45 minutes, waiting for the waiting for the ambulance to arrive and then being assessed and I was in the ambulance driving 45 minutes back to the main town, the on the phone and proceeded to read.
And like somebody has to answer that, you know, answer it.And, you know, here I am in an ambulance and the paramedic answer the phone and what calls kept coming in and it was a goat that was having trouble breathing, and And, you know, it's like you'll have to call my boss.You're building these color, as I got to the hospital and was obviously covered.
I was wearing overalls which by this stage were covered in blood and all kinds of your own your own blood.There's no no no the cows blood.Okay.So I so I was being wheeled in on the gurney and it was sort of like a scene from my ER, everyone pushes down just like she's covered in blood.
It's not my blood, have you been?So I think I guess bad decision bad outcome except for the fact that I made it.And I think the moral of the story was too, you know, apart from the obvious of not trying to run after cars and never operate your car for an outside.
The vehicle that I think the other take home is if you've been up for 36 hours, you know, know yourself, well enough and and set some boundaries for yourself and instead of be able to say I know, you know, when because no animal emergency is worth risking your own life over.
And so, I think, you know, many people have been in.Yeah, similar situations.Maybe how long ago was this brother?Oh, it's my first year of practice.So it would you look very young.Oh, it was fleeing. 2008 2008.
So we to 12 12 years ago and I love how much detail your material.Like the fact that you can remember all the other cases you saw in the weekend.So it's like really was a very traumatizing it into my memory that whole weekend.Yeah, and I think you know, my poor, my poor boss and my parents, you know, he had to go through all the angst of dealing with that.
But yeah.Fortunately in the end it was a good.It's a good story, but now right apart from 17, titanium implants, and still fragments of tree in your thigh or something.So that's how that that was the start of, you know, that's the start of your journey through mixed practice and then the end of your journey and makes practice to in one weekend.
But when you transition from there, you stay for a bit longer.And then, where did you go from there?Because, and what would you do?Australia question.I might be recovered at home and then I at the hospital and at home and then I purchased another Subaru and I drive it back to the practice and proceeded to work there for another couple of years and I became the story.
Kind of became local folklore amongst the farmers.Your that bet that yourself in that car, blah blah blah, but no since then, so what I do now is I'm a specialist will animal surgeon based in Canada and I work primarily Really as a Locum surgeon, so a relief surgeon and I-10, well, pre covid.
I traveled a lot for work.So I travel between the US, Canada, Australia, and was going to do some work in New Zealand, but things have changed a little with the pandemic and and then on the side or in the times that I'm not in the clinic, I do some public speaking and educational work and surgery.
Do some, I try to do each year some charity or volunteer work with some of the worldwide know that charity organizations as well.That's the coolest word job setup.I've heard of it a long time that that's right.
Yes.Yeah.Yeah.Okay.So talk us through the Journey from from Cavett to globe-trotting specialist surgeon.That's that's incredible.Yeah, so I after a couple of years it makes practice.I finally, you know, listen to myself a little bit and realized that my passion.
And what I really look forward to in work was a small animal side of things rather than the farm animal and the horses as much.So I first embarked on sort of the rite of passage of every Australian veterinarian by going to the UK and actually working as a Locum.
They're in small or practice for a couple of years and some traveling and Really great experience.Lots of you know, fun adventures and then sort of at a Crossroads where I thought, you know, I want to do more with with my job and makes it more of an impact and I've always kind of had this idea that I'd like to work in North America and and specialized and I thought I'll just I'll just check it out and see, you know, what's involved in that.
So I did a lot of reconnaissance work trying to work out how one goes from an Australian.Veterinarian from an unaccredited school through to the US system and being a Locum in the UK allowed me to take some time.
To travel to North America, to do some externships and trips around various schools.I'm just going to enter up to how many years out of uni, are we now in this part of the story?324?Okay, cool, right?Yeah, so not not a long time but a little bit different to what?
What sometimes people say that, you know, you need to do internships straightaway, so I kind of Yes, it went back and did an internship.So applied through the match and match to a practice in Calgary, Alberta Canada.And it I guess it, it does help that I'm a Canadian citizen.
So that kind of was a foot in the door somewhat.And I knew that, if I could get an internship in either Canada or the states and do the rotating internship, then I'd have a better chance of being a candidate for presidency of some kind in North America.And also, you know, Canada and Calgary appealed to me because I love the mountains and it seems like a cool set of adventurous place to go.
So I did an internship there and then went through the match again the next year and was really fortunate to match to a residency at Ohio State.So in surgery, so then I traveled to Columbus Ohio for 3 years.
And yeah, I did a surgical residency and then after that made the move back to Calgary.To start work as a specialist.So the that decision to make the jump to actually doing a residency and specializing.
That's a, that's a big decision.Now, i-i've got to get their address out of there because where you were telling the story of the Subaru.I did actually think that when you, when you were saying the bit about lying in the ambulance, and still being concerned about the phone ringing, you clearly are a kind of committed driven sort of a person if he most people really.
When you bleeding bleeding out of the ambulance, you stop worrying about secrets and stuff like that, but not not Bronwyn.I Ru ba ru very driven.Yeah.Yeah, I think it's I think it's fair to say that I'm very driven and I, for a long time, I had, you know, pretty pretty big long-term goals about where I wanted to land up and like, many others have, you know, reflected some of those goals of have worked out the way that I had hoped and some of them have worked out in completely unexpected ways.
But definitely, once I had decided that I wanted to specialize in something, then I sort of set my mind to it and put Yeah, lots of lots of time and effort into kind of taking all the steps that I could to try and make it happen.The decision to specialize.
I think I think for me it was a couple of things.I wanted to be able to make to be an expert in one particular field to be the, you know, a person that could help others, you know, with cases or to get better to be kind of a go-to person and to understand better.
How things work?I think.And the more you learn about medicine or surgery kind of go down the rabbit hole into, you know, physiology and biomechanics and then it becomes more and more and more.Interesting.The more that, you know, at least it did for me.And so, you know, I see these people who specialist and they weren't just smart and good at whatever they were specialized in there, just all around smart, interesting, people who seem to be top of their game and things.
And I think the other thing like, why people ask, you know, why surgery, and I think Made surgery, maybe maybe this is not its reputation.But I think the reality of surgery is that you have to kind of do a bit of everything.Like you have to, you have to know about every organ system.
You have to liaise with all the different Specialties in the hospital.You have to understand Cardiology and endocrinology and internal medicine and oncology and all those sorts of things in order to do surgery.And so I felt like it was a happy medium of not sort of.
Giving up on all the rest of the body systems and at the same time still getting to do surgery, which itself is really fun.Like I couldn't imagine my career without doing a skill like like surgery.So I kind of fell into it that way and I think in terms of you know, making a helping people around the world and volunteering in other countries, which is something that I wanted to do for a long time.
I Feel Like a Surgeon is in demand everywhere.It's like, you know, we talked about vet medicine being an essential service and Within vet medicine surgery is an essential service, you know, we all need to know how to do it to some extent will have somebody there to do it.And so I felt like it was a versatile specialty if I was going to, you know, live in either Australia or North America, you know, they'd be options.
So so it's a winner came to Specialty for you and being the expert was it was it sounded like, like, was it like Progressive Mastery?Like his kind of like, you had an interest in it, and you dived into it and then the more you died.Into it, the more rewarding it was so and like that, that Journey Pursuit for Mastery over something.
Was there was that the like the the drive behind it, like some people kind of dance around and get become jack-of-all-trades, right?But then the don't necessarily want to spend and invest the time in one particular area because but then they've because they feel like they're gonna miss out some kind of fear of missing out, right?
If I do this, then I won't ever get to do that ever again, but What it sounds like to me, maybe it correct me if I'm wrong, but the joy that you got from diving deep into one particular area.Was it around kind of Mastery and skill and expertise?
Yeah, a nice treat, not only of the physical skill of doing surgery.But I guess maybe I'm speaking only for myself here, not for all surgeons, but I guess I like the thinking part of surgery as well.I like the Practical logical decision, making side of it.
And yeah, I in general, in general mixed practice.I definitely felt.Like I was okay at a lot of things, but for my particular personality and interests Some things I would rather be better at one area of that.
And I think a common worry about, you know, people when they decide to specialize is old, but I'll never get to do X, Y, and Z again.And I wouldn't say that I really miss the things that I don't get to do.And I think if you asked say an ophthalmologist, do they miss?I don't know treating the hind legs.
They probably say, no.I mean the eyes are so fascinating that, you know, I don't I don't miss it, the knees.Yeah, but that's I love your take on surgery because you're right.There is a well.So I said they have a preconception about surgery being a very narrow chop, chop chop.
I don't care about anything else.I just want to be in.I just don't be offended.It's just, you know, it's obviously an exaggerated way of saying it.But you do think about all the other guys do, everything else.I just stand in my little theater with my scalpel blade and then we'll comes in and I slice it and it's okay.
Handball back to you, not my problem anymore, but the way you describe it.That sounded a hell of a lot more appealing, but I've never been drawn to surgery.I start, I can take it or leave it.But when you describe it, that way, it does sound much nicer.Yeah, I think.I had that same preconception about surgery as a vet student and I always enjoyed it.
But I always thought, oh, I don't want to be that person.That's nobody asks, you know, difficult thinking questions.They only want you to do the sort of Trades person part of surgery, when I did my internship.I was exposed to some, you know, great.
Urgent that I sort of vividly.Remember one day, when a there'd been a sceptic abdomen to, I think I can't remember the exact details, but some sort of intestinal dehiscence and a surgeon had gone in and done a resection and anastomosis.And then she was there the next day kind of modulating the post-operative care of this septic patient and there was it's quite complicated.
Obviously, there's drains and fluid balances and you know various different prokinetic medications and you're thinking about systemic inflammatory response and all this kind of stuff and I was the intern standing there just in awe.This is what surgeons do, like amazing.Like I saw the surgery yesterday.
That was great.And now, you know, you got to treat this patient, you know, it's treat the whole patient and I think you know, I'm very much bias towards a few surgery.I think for that reason, but you know, I love being in the OR but I also like yeah the thinking the sort of practical thinking side of surgery.
Hmm.You said something before and actually no you just highlighted in again.That's what you saw, right?You saw that kind of vision or that that type of surgeon that was not just, you know, what everyone thinks surgeons do, which is literally kind of stand next to the theater.
Scrub, get into a theater and then stand just a little bit out of the theater chain scrub and someone feeds him like a patient after patient, right?But what you saw was this was this holistic surgeon and you sir all aspects of it, right?So I don't know that to me.
It sounds like as if that image.That you do not deserve to be held on to that, but that's kind of the standard that you were actually wanting to achieve for yourself.I was going to ask the same question because I think it does come down to your teachers and your mentors.I think it is.If there's any significant rates of my generation listening to this, I think we can all imagine.
What are the head surgeons at our uni, and he was not like that.He was the surgeon who you ask my post-up question in, like, okay, grass to mating guys know he was a technician.He wasn't actually a doctor.I think there are surgeons out there who really enjoy like the thing that they love most about surgery is, is the technical aspect and I think, you know, maybe I'm generalizing, but I think people who really, really loved Orthopedics.
It's definitely a very, very technical technical Mastery, but I think the American system to like, the one of the reasons that I wanted to specialize in the states at the time that I did was because of the American system.There is this focus on And I can't comment on Australian specialization because of course, I didn't do it.
But at least my what I saw when I visited these us universities and saw the surgery residents and what they were doing house.Like I want to be a surgery resident.Like this just looks like, you know, the greatest thing and obviously, you know, it's really hard as well, that I like clients and you know, I like that side of that too.
So maybe on I'm an unusual surgeon.That that's what I like about it.I think you are around an unusual surgeon, but it's it's it's good to know that you can be that guy.Surgeon, I think that's the point of it.T.The other thing which you said before, and and she would said the word Mentor which was where I was going to head with.
That was that?You said you worked on the surgeons or you spend time with surgeons, right?Who were balanced not saying that there are Surfers out there like they're about to show, they're unbalanced you, you know, it's just that but it's kind of like you picked your mentors, some people look for the mentor who is clinically the best at something, right?
Some people and that's what they do or that's what they want to be liked.But then and then that's the common downfall.I feel if people And select properly - selecting mentors is that if you get the clinical Guru, right, but then there's not well balanced.
Then you turn into that kind of person, right?And that could be fine if that's what you want to be.But then, you should also consider a mentors and picking your mentors.Look at the other aspects of their life.Look at the other aspects of how they treat the teams.And so forth, is with any kind of Mentor, right?
That there should be more thought going into selecting Mentor.Not just hey, this This is the best of the best this and I'm going to do that.Then you've got to decide whether you want to be almost the same as every other aspect in their life, you know, because over time you will be will impart in a will rub.
So I just an observation that we you said before but you talk about well-balanced mentors, you talked about the thing that you wanted to see and the image you had and that was really cool for you and and I was just really cool to hear.Yeah, I think I was really fortunate in my residency to have a couple of a couple of really well, several really, really good mentors who kind of epitomized, you know, being excellent surgeons like, you know, really, really top technical surgeons, but also promoted really excellent post-operative care.
And they were good teachers and they were kind, that is nice.They were friendly and kind people, and I think I had some preconceived.Options and maybe you know, surgery is stressful.And so, you know, it can be easy as a surgeon when you're having a stressful day to seem intimidating.
I think.And I think, you know, some people are intimidating or but, but I think you don't have to be.Yeah, I so I guess I was fortunate to sort of work under some surgeons, who managed to be excellent surgeons, but also be great people to work with as well.
So, it's a Tricky one because you it is a to some degree, a little bit of luck of the draw.Because if you it, where you ended up doing your residency, you had by default, good teachers and mentors.But I didn't agree completely with what Gerardo says.
I'm trying to think.How do you put that into practical terms?That it might be a going into who you learn from with a very clear set mindset of what I want to learn from this person and then multiple mentors.So you might end up on a surgical I didn't see any of you got technically, the best player in the world, but you don't want to be that person has to go.
Well Laban, learn surgery from him, but I'm going to pick somebody else in the hospital who I want to model in terms of how to be and how to grow and you know mindset.So it's maybe maybe being I heard a I think it was in another podcast and and the came to the was with the guy right there.
It's dead were dead and he's one lesson.Ask them.If you could leave anyone.Listen, he said he's one.Listen to people is pick your Or teachers.Yeah, I think the idea of learning different things from different people is really important and one of my residents actually pointed that out to me and I was, I was struggling in my first year of residency.
I think a lot of people do, it was a big culture shock to move to the states and it was a very fast-paced and pretty demanding program.And, you know, is getting quite stressed about things and, and, you know, there's lots of different personalities and some of them you work super well with and some of them, you know, for whatever reason, you're just not super well match, but I resonate studies.
That he's like, you know, when you're with, you know, pick what you want to learn from each person and just focus on that, you know, focus on why you're here and and yeah, that that advice definitely helped me quite a lot.No, that's awesome.It's like they're being deliberate around.
Yet what your choice and why?There's those Hard Times where During certain stages of your of your residency.What was the?Because it's a big thing.It's a big daunting thing.I think all the weights or most of us at some point go should I specialize?
And I think for many of us the absolute enormity of it and the overwhelming amount of time and effort that it takes just seems too big a mountain to cross.Was it as hard as you thought.What were the hardest parts?What were the biggest challenges that you face?
During your journey to being super surgeon.I wish I was a super search and it'll be awesome.I think some of the hardest, I thought a lot about I've thought a lot about this and definitely The Residency itself.
I think most people would say it's really hard.You know, it's physically hard.It's mentally draining.It.It really stretches the limits of your mental fortitude, in terms of your expected to often work on quite low amounts of sleep.And there are a lot of of demands placed on you and you hold a lot of responsibility in the hospital.
So, you know, if things don't go well, you're the first person that needs to kind of be there to be responsible for that.So yeah, The Residency was, you know, as challenging as I had expected for a lot of different reasons, but I think the times that I found the toughest, it's been less about the actual work and more about what's going on inside my own head, you know, trying to make the decisions and you know, you said to me how do they make these decisions?
It really wasn't easy.And you know to do a residency, you're definitely committing three or four years or more of your of your life often in your 20s to doing it.So you have to one really have the end goal in mind and you have to actually want to be a resident.
Which fortunately I did, like, I really liked, I liked the learning and we got sort of grilled, a lot of residents.It was very structured and we were expected to know things and we will be questioned on them all the time and it prepared us really well for boards, but it Can also be quite stressful.If you don't like having people quiz you all the time, but I have I learned for the most part.
I like that kind of learning style.I like the structure and I liked that so but I think the decisions too.The decision to do residency, particularly one that's in a foreign countries is really hard.I don't think I've ever I don't think I've ever heard someone say that you have to decide like you have to want to be a resident.
Yeah, you've got to like it.That's gold.I really like that.That's that's super.That's super cool that comes back to what we've talked about before with people saying, it's not about the end goal.It's about struggling.Well, so there is an easy going to be a struggle.But if you just focused on, I just want to get through this and be a specialist, you're gonna be unhappy for that whole time.
Instead of saying this is great and itself.I think I definitely started out with.It's only three years.You can survive anything for three is just get the lettuce behalf DNA.And then, you know, by sort of the end of the first year.I was like, this isn't working.
You know, this.I've got to embrace this residency being a bit more and then things definitely improved when I sort of, you know, enjoyed the journey a little bit more and I think I think it was Robert Webster.One of the other Specialists that I listened to on the podcast said, you know, that the fleeting Joy of achieving letters after your name.
I mean, it's brilliant for, he said, two or three.I would say two or three weeks like definitely felt pretty good.But you've got to be doing it for more than just that day.Yeah, like I could take that Banks.It for myself as far as weight school and then, in terms of what I did wrong because you just look forward to that graduation day today that debut last exam, watch fantasize it for years, and it is disappointing.
I distinctly remember.Finishing, the last are all going.I'm done.I'm done.I'm so happy and then going.Fuck.I've got a headache and I'm tired.I'm going to have an app that was literally the extent of it.I was picturing wild parties and there was a wild parties but first it was just a little bit of oh, well that was it.
It's over and and not actually focusing enough on on enjoying the journey and making the most of where you are at the time.I love the quote.You know, what does it?It's not just a destination.It's a journey, right?And when I was going through, but we'll, I'd like, I was like, ah, so the journey I missed out on the journey, which Partying and having fun, and drinking, and he like, you know, like so I my interpretation of that.
Jesus going to 10, 15 years ago, right?Was that actually I should have had more fun, but they're now, I reflected, like, I should have just loved it.You know, like it like I should just, you know, the opportunities that I had the people that I met, the things that we did, the stuff that I learned like that was honoring and enjoying the journey not necessarily.
What I thought it was, which was drinking and partying and stuff like that because I didn't do enough of that.That's for sure.I think that is.I think there's both I certainly had a good time in vet school.Definitely enjoyed that Journey, kind of line and I think in Columbus what really saved me in my residency was actually starting to enjoy Columbus the place a little bit more.
So finding some friends outside of that outside of the vet school.I joined a running club and they became a really close group of friends and then Had a reason to be there as well.You know, it's like I can't wait for Thursday afternoon.I'm gonna go running club.You know, I'm here.I'm actually enjoying life here a little bit more and that was that was super helpful.
But yeah, definitely residencies are hard.I so, I think you need to want to do it.And yeah, I know people that have started a residency and then decided not to finish that one and pick a different specialty or decided not to do a residency at all, or they've finished their residency and decide.
I'm not to be a clinical specialist like all these Journeys are fine, you know, there's but I think ultimately yeah one wanting to do it pretty pretty strongly as kind of a prerequisite.Bernie said before that you were that you fly around hmm, flying specialist surgeon, right?
What are the things that are different between Australia Canada and the US or, you know, how do you adapt?Yeah.I think I think adaptability is the keyword.If you're going to be any sort of Locum.You need to be open-minded and adaptable, but I think There's not that I was actually surprised when I returned to Australia after working in the States and Canada for a number of years as a specialist, how similar it actually is.
So I think the biggest differences, there's not that much difference in the standard of care.I would say, I think Australian, you know, referral hospitals, do a do a really good job there.Tend to be, I think more smaller specialty hospitals, perhaps in Australia with fewer types of specialists in each Compared to North I could will because it's more corporate.
I think in North America.There are more hospitals that have kind of more of a full complement of Specialists particularly within the internal medicine side of things.So they might have a neurologist and an oncologist and an internal medicine at a cardiologist.Whereas in Australia, your Internal Medicine Department, might kind of yeah campus all of those things.
And then more people, I think, overall have insurance at least in Canada, more pet owners, have pet insurance, which as a specialist.Obviously makes a huge difference to the the level of care that you can provide.I think the coffee is definitely better in Australia, like really so so much better like yeah.
Best part about locally in Australia is one of the best parts is yeah, great.Great coffee shops. 100% agree with you.Like like the first thing I did was go back to straight as a coffee is like, Absolutely.
I mean there is I'm a bit of a sleuth.I can find pretty good coffee.No matter where I go, but it does take a fair bit of trial and error.A lot of research, but that know the other, I think the other thing is in Australia, there's a little bit more of it, especially in surgery, the kind of two-tiered referral system.
I think a lot more GPS or membership, trained vets are doing more surgery.And in North America, at least in the cities that I've worked in many more GPS will refer those same sorts of procedures, which For me as someone who loves soft tissue, you know, send me all your soft tissue things.
That's great.Well, that's, that's, that's interesting.So you saying your general GP clinic in the states and in Canada will do will do fewer of the, of the fun surgeries.What depends what you define as Frank said.Yeah, like, what?Like, it's not uncommon for me as a specialist to be referred assists, Ptolemy in where I've worked in North America?
Or you know, gastrointestinal surgery.God bless.Sells some of which can be, you know, some some GI surgery, some gold on music sales of hard, you know, and they do require a certain level of post-op care and things but I think.Yeah, that's that's one difference that I noticed.
And and then in our higher, I mean people bring you food all the time.I mean, it's amazing.The cookies.Oh good.Yeah, like we had other higher state like yeah, we're kind of right now just a surgery residents.We kind of troll.Hospital looking for who brought the cookies that day and we kind of love it.
There in gp2.Do you go around and find them?But, no, we had a client once she dropped her head office in X-rays and me, and the student had seen her and she came back with a whole cheesecake because she said we looked hungry.It was great, please.
Yeah, this is this is this makes decision making very hard.I'm trying to put myself back in.Y 25 year old self going.Okay would I can reconsider things.So from what you're talking about initially our I thought yeah, we should have looked at America and then you said about the coffee and I do.
Okay, now good decision.America's out I can.But now you took my cookies, not like maybe it is with, I think, I think the good news is Australian Australian coffee or Australia.New Zealand Coffee Culture is really taking off now in the US and Canada coming.
A real Boutique thing.So if you Google it you look at like the website and the decor and the way they do their flat white.You can kind of work out where the good ones.Okay?Yeah.Yeah.Yeah.I was I was 15 years ago.The first one went to the states and went through and I was like black stuff pulled out and slightly.
They have this stuff all the time in movies.Got to try some of the stuff.I didn't know, I didn't know.It was I thought it was like hot burn like, so someone's trying to clean a dirty.Like chocolate part and then then use that as coffee because I just like, I was just like, what is this stuff?
And it was, it's everyone.You would you like someone like, no, I think you would you like some cream with that.Oh, I got try cream.Oh, that's even worse.Yeah.I think it's a surgery resident.You couldn't be too picky about the coffee, you know, coffee was coffee.It was, it's always good.
So, but I know you got me.You got me all excited, about Vegas urgent.Now, it's never been anything that I was particularly interested in.But you make it sound really nice.One of the downsides.What is clearly?A lot of very cool stuff about it, but there's got to be a downside.
Yeah.Well, so it's a good question.And you know, I love being a surgeon and I for me it's worked out really well, but I think there's some definite downsides that I think maybe you don't think about when you first think about being a surgeon.So one of the things I think to consider, when you're charting your journey, through your vet, Korea, is Are you okay with being on call?
And in the sense of being a surgeon are you okay with forever being on call pretty much.I mean it's maybe not forever.There's certain places where you don't need to be on call but part of the job as a surgeon is some expectation.Usually the you'll be on call.And at first you think oh, it's not so bad, you know, everyone's on call when they first start that but as you progress in your career many other people many other Specialties or types of veterinarians can can get out of it.
And if you're lucky search and you can get out of it, but I think I think understanding that that's going to be part of your job.And I think the other thing is that It's a very it's a tough specialty because when you make a mistake, it's exposed to the world.You know, it's really it's there for all of you and complications are just the worst and they happen to everybody and they can be really sort of sold a story and I think as a surgeon, you know, if you make a mistake, your mistake is going to walk up the Hall of the hospital and everyone's going to stare at it.
You know, your complications are right out there for people to see and and Need to make those split-second decisions.Sometimes on the spot.You don't always get a like, internal medicine, or if you choose the wrong diagnostic test.
You can kind of just do the right one tomorrow.And yeah, wiser.I totally see that.I actually, if I say, I was never that drawn to surgery.I actually like doing surgery.Hmm.Enjoy the process, but that was actually my big thing is, I don't worry about always be used especially of Is this about the case afterwards?
A lot?What you go over your head?Did I do that, right?That I do that properly and is it going to be okay?And I only fully relaxed a week after the surgery, when everything seems to be going.Well, how do you deal with that?What's your mental armor against those soul-destroying thought processes and then worrying about your cases too much.
Yeah, I've definitely been guilty about worrying about my cases too much.I think it's just part of my my personality and I think if you're going to be a successful surgeon, you need to get that under control pretty early in your career.And so I guess my My tactics are just sort of trying to the absolute best that I can in the OR and feel comfortable when I'm closing that.
I've done everything that I can.And then if I'm sort of struggling to sleep at night, because I'm worried about my patient.I try and think to myself.Is there anything that I could do now that could make things better?And usually there's not.Usually it means that, you know, you go into the next morning and nine times out of ten.
The thing that you've been most worried about hasn't actually happened yet.So, trying, not To worry about the stuff that hasn't happened yet.And then I found that when something does go wrong, when there is a complication oftentimes dealing with the complication is not as bad as The Angst and worry that led up to it because, you know, there's a complication, I know how to deal with those things.
That's what I got trained for in my residency.So if something does happen which, you know, fortunately doesn't happen that often.But when it does, it's like, okay, we have a plan.This is what we're going to do.And you know, most of the time, they're not life and death complications, most of the time they're writing and potentially expensive but not, Yeah, I think it's just something that comes.
You get it gets easier with time.But but certainly I'm someone who, you know, initially even as a specialist would worry a lot about some about my patients.Good to know that this bit, I suppose, this I was going to say it's good to know that the specialist worried as well.But you did probably worried more because there's even more, you're not supposed to be the one who messes up.
We write as a GP V, 25, if I make a mistake.Oh, yeah.Well, I'm not a, I'm not a surgeon.But for you, it's almost harder what you said, that reminds me.That supposed to be a Mark Twain quote.That says, if I've had a lot of worries in my life, most of which never happened that, that's exactly that you couldn't worry so much about it.
And then and then you wasted all that emotional energy fighting about something that doesn't happen.Yeah.I think I think the hardest ones are when you've kind of had a moment in surgery where you think especially, you know, some of them are challenging, you know, soft tissue cases, where you're dissecting out a tumor and there's all kinds of important structures around.
There's lots of things that are large and white and you know, that you're not supposed to hit the really important one, but some of them have to be sacrificed and then you're not going to know whether the thing that you cut was the important structure necessarily until the next day, when the patient's either, you know, doing well or not.And I think, you know, most of the time, the patient next day, gets up and walks around, and it's all good.
It's all five.But definitely, it can cause them some aced.Yeah, they say there's an exercise, I've heard of before.What's the worst-case scenario exercise?Where we Institute when trying to deal with these things.Mentally and emotionally is a temptation to go.
Look, it'll be fine.Don't worry about it.Don't worry about it.But then you can convince yourself.Or this is me, at least.It is a voice in your head that says, yeah, but is it gonna be fine?It's really going to be fine because what if it's not, so sometimes it's actually good to win.You I find if I'm stuck in those sort of negative thought processes to go.
Alright, let's look at what's going to happen.If it's not fine, let's picture that.Let's actually go through the worst case scenario.So Say, I go in tomorrow, and as exactly what you say, you're going to go.Okay, it has gone wrong.I've done an interact to me.It's the hist.It's got a safety peritonitis.So, what am I going to do?I do have a plan.
I know what I'm going to do, but I there's a follow-up.So then your mind can go.Okay, cool.I'm going to stop worrying and worrying about it so much because I have a plan.What is going to happen?If it doesn't go right now, I can stop worrying about it and it's probably going to be fine.But if it's not, then I have my next actions in place and exactly what to do.
I do that.I definitely think of the worst case scenario, and most of the time there is a way to deal with that even though it's, you know, frustrating or embarrassing or costly or all three.But there's always a way there's usually a way to, you know, to get around it.
And yeah, I think well, I can say is that it gets your attitude towards it gets easier with time, but I think the more you've been doing surgery, the heart of the surgeries that you do and so there's always going to be one.So it's like all I've actually never done this before.For I've only done it once and I'm really quite nervous about it.
I hope it goes.Okay, and then you've got to rely on, you know, sort of trust yourself a little bit.Yeah.Did you find that that your expectations and then also the expectations that you said to the Jews a client changes as you as you get better because when you, when you new to surgery or medicine or anything like that, you might think I look there's a when I do this, I have to fix it and the owner believes that I've sort of guarantee.
The only that we're going to fix it.Not going to be any problems.So that then when there's a complication it is a big stress because they expect expectations were wrong.Have you learned over time to go?You know, the expectation is not always a guaranteed fixed and you communicate that well from the start so that everybody's expectations are within reason.
So when things go wrong, nobody's that upset because you can help that was half expected.Yeah.I think I think my I certainly like to have a long conversation with every client before I take Take their pet to surgery, and I think most said to the same, you know, even if somebody else is already diagnose, the problem, you're just doing the surgery, It's always important to kind of have that conversation as the surgeon because you're the one that's going to have to deal with things if they don't go as planned.
So it's good to have had that conversation before hand.And you know, I do try and make it fairly positive.I talked about, you know, the likelihood is that this is all you know, we're going to be able to fix your pet or improve your pad or whatever, but I think having some some literature behind you.
In some numbers and an understanding of how how these things work.So you can tell them, look, you know, the incidence of aspiration pneumonia after laryngeal.Paralysis surgery is around 15%.So, you know, so if your dog gets aspiration pneumonia, that might be life-threatening.
And that's something that we need to be okay with going into this, and then if the dog gets aspiration pneumonia, it's it's, you know, really frustrating and it, maybe it's life-threatening.But, you know, you've had that conversation.And so, you know, people are sort of, hopefully, if they've understood.And then then at least you've kind of communicated that and they can make their own decision about whether they accept those risks or not.
Yeah, strange times in the drain.Yeah, how was your day to day?Life working life.Been affected through through the whole covid covid crisis.Yeah.I mean, I think he, he said at the start that, you know, envied my lifestyle.
And I think what I've discovered recently, is that being a Locum who travels on an airplane, for their livelihood is kind of a tenuous occupation to have during a pandemic.So, So I've had to do a lot of f a bit of rethinking recently and I think the I'm trying to learn to embrace uncertainty.
Like I think we all are and and that's, you know, one of the reasons why I'm looking more into you know, how can I make it impact more through education and online learning and how can I you know get skills out there that people are going to be able to use in the community and surgery and then also thinking, you know in the short To medium term International locally.
It's just not a thing right now, you know, it's not something that's feasible with these two week granting periods.And so yeah, it'll be an interesting few months and I guess I'm excited to see what happens.I can't I don't I don't know what's going to happen yet.But yeah, maybe some changes coming soon.Well, this is no change is coming.
How's it going to ask you what changes for you or changes for everybody?They certainly a lot of changes for everybody.What are you most excited about?What are you thinking will come out of this for run run that except that really excites you?I think it'll be a chance to finally look more closely at this, the online and and telemedicine and online learning side of things.
I mean, I've met and become a to contact with so many people during this pandemic that I never would have had a chance to come into contact with and some of that's through social media.And even you guys, like I never would have reached out to Dorado and or any of that had it not been for the pandemic.
And I think one thing about surgery is that it's not a specialty that lends itself well to remote work, another other key downside of surgery, but I think there's been some pretty ingenious people out there.Who are who are starting to create?
You know, how can we actually use the technology that we have at least at each surgery or to help people with surgery, you know, if we're not treating the physical patients, but we can still use our expertise, you know, to do that.So kind of branching out in my career into a little bit of that as well as clinical surgery.
And I think the unfortunate to still have some work here close to home.So I'm not.Yeah, unemployed.Not not unemployed, but still Yeah, still looking at options for sure.The there are I said earlier about your charity work and the staff is doing not a specialist, centres tell us more about that.
So, how did I haven't done a lot of charity work?I would like to do more.I was scheduled to do some more this year that obviously covid is put a little bit of a stop to that but I've done.I've worked with two different, oses charities, who run pretty.Similarly, there's one called World vets.
Which runs out of Central and South America and they do a few different things.They kind of have community population control programs and they have training centers where they help to train local vets and how to do space and M because they don't get a lot of surgery training.I think sometimes.
And they also have programs where they take, they allow Veterinary students from North America to come through a two-week rotation.And the veterinary students do the spay and neuter under the direction of instructors.And so the students learn, you know, A good spy Nita skills over the week, the pets, get neutered or spayed for free.
And the tuition that students pay for the program.Kind of helps to fund the program.So I volunteered for a couple of those programs as an instructor, which I thought was great because I love teaching.So I had like surgery to.But in terms of Spain, you don't like I'd much rather teach Spain, you know, then then be the one doing the spending because I feel like it's way more valuable to you.
Like I can make a bigger impact by teaching a bunch of people how to do it.But I can there's a limit it's like scalability.Like you were talking about before there's a limit to how much you can physically do yourself.And so there's a vet called.Dr. Steve Krasinski.I may have mispronounced his last name who works for well Vet, Central America.
He's kind of the veterinary officer.And so he he lives down there.It does a lot of great work with, you know, surgical education for that students and things.So that's been great.And then the other kind of cool trip that I Had a chance to go on was after the Northwest Territories of Canada.
So the University of Calgary sends a group of Veterinary students in 4th year and some faculty up to communities, really, really remote communities in the Northwest Territories.And these communities are accessible only by plane in the summer because the ground up there is very marshy and swampy, but in the wintertime, they're accessible by road, because everything freezes.
And so they These ice roads.So you drive across frozen lakes and cross sort of Frozen marshes and you're able to access by Road.And so the team puts together a vet clinic in these trucks and we drive them from Yellowknife or up from Norman.
Well, sorry up into you know the far north and that was very cool.So you're going up in the in in the in the winter when it's everything.Yeah.In February Community work still.Yeah.Yeah.So so we end up setting up vet clinics in All classrooms, which is wow.
This is pretty crazy.So we had, you know, grade 5 and then the students come in and watch the about like grade 5 class and they've got to stand behind a particular line of tape on the side of the room that I, wow.This is so cool.Pretty neat for the for the students, the school students, as well as the vet students throughout their kind of learning Spain either.
So I was a helped out as an instructor with that too.So that was kind of again just like a really neat experience that you have to be quite resourceful.You have to deal with, you know, With your generator, or your truck breaking down in minus 40 or not have any lights or stuff like that?
That sounds incredible.I love that.It was, it was very cool.Like really, really fast.Like if you ever have the chance to visit the far far north in the Arctic.Essentially.I was just below the Arctic Circle, but essentially essentially the Arctic, I've never experienced anything like it was really neat.
Johno.Any we going Lombok sounds better me.But yeah, I wanted to, I wanted to, I heard that you guys go to release.You.He regret Indonesia.Yeah, I've a similar thing.It's similar thing.I'm the they there's a big program or there's a few programs that run in Bali, lombok on the L.
And it just just next door to Bali has a bad stray, dog problem that the government really does want to address.They it actually negatively influence some of the some of the tourism.So I was trying to There are some people who work there but isn't it is no big programs.
Really?There's some days, a couple of experts who set up some spike clinics and try to find it privately, but I was, I am the prices I was in the process of getting involved in that.But same think of it, sort of put the brakes on.I'm actually just wait this week.I started thinking again about.
Do I start trying to dig again?There's a few limitations with that.I'm trying to overcome for for being able to do great work.They legally as a non Indonesian resident.White founders of solution for that yet.I think I have but I'm not 100% sure.The bureaucracy there is clear as mud.
It's very hard to get to the actual fact of anything, what's legal and what's not legal, but I'm sitting here, listening to you going.It's surgical instructor who likes to travel.I'm gonna come.Yeah, they're deeper down the volunteering.
You said.Why did you actually do it?Why did you actually choose to do, volunteer?Cheering.So, I think, as veterinarians who have trained in a, you know, any sort of developed country where we've got veterinary medicine, that is at a high enough level to rival human medicine with, you know, we're so lucky to get trained and they will leave these skills.
And, you know, there's many parts of the world where veterinarians don't really get much surgical training particularly, but, you know, don't have the opportunity to train the way that we have and in those parts of the world.Also, you know.May rely a lot more heavily on animals for their livelihood and they have a lot more animals that they interact with on a daily basis.
And so, two things.One of them is, you know, training other veterinarians on how to better manage both Animal Health and Welfare, but also, it feeds back into public health.So you get to really have more of an impact in one health or or Global health and to just kind of giving back some of the skills that, you know, we've been fortunate enough to learn in Australia or the u.s.
Giving them back to Unity's where, you know, in some some of the places that I've worked, the human Hospital didn't even have an x-ray machine.So, you know, the fact that we have digital x-ray available to a Veterinary patients is is really, you know, a huge privilege.
So it gives you a bit of perspective, doesn't it?I'm but yeah, I think perspective is the perspective is the keyword.Yeah, and I think it also teaches you to be, you know, adaptable and resourceful and and make the best with what you've got.But also make decisions based on What's feasible within the constructs of what's there?
So, you know, certain surgeries, we just can't do in those locations.You know, it's not, it's not some not feasible for Animal.Welfare reasons.We don't have the capability.And so, making those decisions are being like, no.Sorry.We can't, but we can do these other things that really helps.Oh, yeah.So when you say you're teaching people to surgical skills are these local vets for vets students as well?
And then do you get American law, international people come along on the program and Practice their surgical skills there.Yeah.So the two programs that I volunteered in the worldwide vet service in Thailand and the world vets in Nicaragua.It was a combination.
So the program that specific program that I was teaching was students from either Australia or the US who are coming in to learn surgery, but then the people working in the clinic, you know, day-to-day the regular Veterinary staff were a local veterinarians and local veterinary nurses.
And so those people were doing Almost like an internship learning in the clinic from us and learning along with that students.And then, I think there's other times of year when they don't have international students come in where the instructors from the charity, teach the local veterinarians kind of the same thing.
But because I don't speak Spanish or Thai.I'm not as useful to their local veterinarians.Obviously, although I can help in some way.I'm they have Yeah, you would the the language.Yeah, becomes a challenge.
But definitely there were some veterinarians particularly in the Thailand program who did speak good English and they were really Keen to learn how we did things differently, and they're really interested in surgery.And so we did like a limb amputation, one day and a couple of them scrubbed in and we talked through the whole thing.And, you know, it's great.
They're like, oh, this is so useful, you know, we often need to amputate dog, Limbs.And so now we actually know how to do it in a way, that's, you know, safe within the construct of what we've got.So there's wrap up.That couple of standard questions Runner.Are you a podcast listener?I am.
Yeah, so, I travel a lot and I drive a lot for work, and I drive a lot for fun to lots of long road trip to the mountains.And so, my favorite podcast is hidden brain from NPR has a marvelous.Host, whose name is Shankar, vedantam, whose voice I could.
Just listen to you all day, and it's a really interesting podcast based on psychology.So kind of teaching us why We think the way we think and going through different human behavior, interesting quirks of human behavior.And then they get a psychologist on there and talk about why we do what we do.
So, I think that's really interesting.And I also like the other one from NPR that I enjoys Planet money because I like many veterinarians have zero background in economics, Finance business.And so it just explains things that are really interesting interesting way, but I think, yeah, if you haven't already checked out hidden brain, I'd give it a Awesome.
Alright, and then our last question that we always wrap up with you're at a conference or let's say, you take a digital event where you are talking to all of the veterans, a new graduates in the world and you have just a couple of minutes to give them one message.The one thing that Bronwyn wants to tell the weight of the world.
I had so many messages.I was this is it, this was a tricky question, but I think ultimately believe in yourself, you know, don't let what you do be defined by.Other people's expectations, what other people tell you that you should do or that, you feel like you should do and, you know, find out what it is, that makes you have a great day, you know, in Batman and try and do more of that.
So even if that means switching up, what you're doing something completely different after a couple of years or changing, don't be afraid to do something a little bit off the beaten path, or we're not doing things, the traditional way.I've certainly taken something would say I've done everything the hard way.
So But but I think it's, you know, everyone has their own kind of journey.And the other thing that I feel pretty strongly about is, you know, creating a life for yourself outside of work, that gives you a reason to leave the clinic every day.So, you know, don't forget to find you.
No meaning and joy and things outside of work and I the guys have done a lot of talking about work-life balance and whether that's the right term for it or not, but I think you know finding some things in your life that you that you have passion for that.You love to do that.When it's 6 p.m.
And you've trying to get medical records done, if you have something going on that, you want to go to that clinic, you going to be so much more efficient.You're going to have so much better time at work.If you've got other stuff going on that, you know, that balances it out.Yeah.Well you certainly seem to have symptoms smashed it is if they have figured it out to a very large degree.
I love I love looking through your Instagram feed and photos of running in the mountains and Hiking but then also also having that exceptional career that I've talked about it before when I feel Like, it can be easy to lead to too far towards the balance pot and actually neglect.
The work by a little bit in because I'm so focused on having all the fun and doing all the great things.And I love how you've managed to, to really learn become exceptional at your work.And then also have this Really?Let's at least from the outside, really incredible.
Looking Bell as part of your life as well.I think it I think it's an ongoing struggle for everybody.So I'm certainly trying.And yeah, but I don't think anyone has.It's quite that.It's a journey.The journey for sure.Yeah.Brightener.
And that was incredible.I have you've completely changed my perception on what it means to be a surgeon and what it means to be in America, a little part of me wishes.I could go back in time and And live your life.That's a good one.Thank you so much for the time spinning with us.
And I think you've inspired quite a few people to think a little bit differently about the way they're going with it with a careers now.Thank you too.And like that, that little Golden Nugget for me, which was the choosing to be a resident.You know, that I did.That was I'm not, I've never going to do it, but I thought that was actually beautiful.
So thank you so much as well.Great.Yeah, thank you for having me.It's been, it's been really fun.Thank you for listening.Remember to go check out the show notes at Vivid world.com for a summary of, some of the best bits from the episodes and our guests favorite resources.
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