Robert J. Cerfolio, MD

My name is Craig Ferguson. The name of this podcast is Joy. I talked to interest in people about what brings them happiness. Doctor Robert J. Serfolio. We'll call him Surf because that's what he wants. And once you know about this guy, you'll think, you know what, give him everything he wants.

He's an amazing character, wasn't it, this.

Surf? Before we begin, I do want to say one thing to you, which is I want to apologize because you come in and you recorded in an episode of this and then we checked it back and we didn't record it. It's like it's the podcast equivalent of like you doing an operation and cancer leave at least leaving the key, your keys or.

Something in there, or maybe your wallet or your phone.

Like we got the cancer out, everything's good, but I left my phone there, so we got to go back.

You know, I get this a lot from women that I go on dates. They say they accidentally left something back so they have to come back.

You know.

Listen, here's the thing, though, You're just saying, well, are you single? You're not really single? Now you got to go yes. I yeah, that's why that was a joke. Yeah, I like that very Yeah, I get totally understand. It's vibe. So listen, I want to talk to you a little bit because I was just saying to you, I got a screening coming up for an en dusky coming up in about a week, and it's only because they find a little irritation during the last ones. They gave me some PPIs to to treat it.

They found Barrett's spirits.

No, no, it wasn't barrets it was it was it was a lesion, an ulcerated lesion or something like blasia displas.

Yes, right, so listen, I know that.

We're not really on on your dime here, but is that good or bad displays?

It's just a thing could be could be absolutely much better than some other things.

They sure, well they did a biop so you didn't find anything right now.

But they might do now is I don't know if you gonna have an ultrasound done at the same time in multiple quadrant biopsies. Sometimes they do that they get more representative tissue.

Oh yeah, you might do that.

I don't know.

You're going to be chilled down on propofilo.

I'm going to be taking the big sleepy time, which we've established I love too much.

Yes, well, yeah, I love too much.

And that's why you know, I would take an endoscopy once or twice a week if I could, just just for the propofall. So listen, tell me this dude. You are, and we established this before, but you are, to my understanding, the number one robotic surgery guy in the US. Right.

Yes, So that that's just not a measurable metric role, is it, really? You know, it's like saying, I'm I mean, I've done a lot of robotic thoracic surgery, but there are I'm I'm a lung certain of thoracic surgery. I do long lungs, esophagus and thymus, anything in the chest that's really not heart related, though we we can take.

Our parts of the heart.

But we're you know, even though we're boarded as cardio thoracic surgeons, we choose to do thoracic, which is the long the esophagus, the media stye, and the thymus stuff like that.

So is that specialism or is a union? We're going all on. I'll strike tomorrow. It's a matter right now. You big that up could have joined the writers. The writers are.

And the actors are still. But you know, I think as long as the doctor stay in, I'll be all right. So talk me through what a robotic surgery is, because it's not you just programming in a robot, and the ruleboat was ended well to tell me what it is.

It's so interesting.

Even the patient I operated on today, who came from very far away and is super educated, when he came in he looked at the robot.

He said, now you're you're doing it right, not that big machine.

I'm like, listen, bro, we've talked, you've looked at the videos, you've looked.

At everything doesn't even make sense.

But yeah, so what the robot does is we're able instead of making big incisions and spreading the ribs, we're making incisions that are a third of an inch eight millimeters.

We will make three of these.

The old robot actually had five millimeters reports we were making five millimeter incisions, not eight, which I think actually had a real benefit. This new one, I would hope that they're going to miniaturize it a little bit. So you put in these metal ports through these tiny incisions in the chest, and then through the poor come a series of different instruments right, and then they get hooked up to the robot. This great, big, giant mostrosity look like it's over the patient.

Right. Does that have a face on itth it does?

He asked me if I name my robot, I'm like, listen, bro, we don't name the robot. That's not something we do. But then we sit in a console remotely. Now you know, I've operated and I think twenty six countries. In one country, I was a mile away from the patient, which would never happen in the United States. Could never fly in China, right, But they wanted a big room of people. They had eight hundred people, and they wanted me to answer questions as I was operating.

We teaching situation.

Yeah, when I go on these things are always you know, for charity and teaching and a honor to do it.

I love to do it. So it was like a corporate gig for a comedian. Then it's like, hey, I'm very happy to be in China. I'm going to do a little bit of thoracic here for you. I love you guys a little bit. I think they get paid, Yeah, they pay for our flight.

But that's a that's it.

See, you know, I knew being a doctor who was the way to go finance.

You made a good decision when you nail the MCATs, you made a good I.

Tell you I did not make the decision. If I had made the decision, it would be something else. I was dealing with the cards. I was deal So you go in there and you so you work remotely in the sense that is it like a video gamer.

Yes, so we are sitting in a console that has an immersive experience. So it's a three D We put our head into a console like this, and there's all ergonomics. You have your own chair, but there's a giant machine with two hands here, multiple pedals for your left foot, your right foot.

There like six options.

It looks complicated, but it's actually very I mean, I'm doing it, so how hard can it?

Come on? You're trusting yourself.

Done.

No, I'm giving it to you straight. It's it's like an airplane. It looks super complicated, but you know once you get to know it exactly. Yeah, And so you move your left foot and the right foot and in the right chest. You're going to have two left hands, so you can toggle your foot and make your left hand the one here or the one behind it, and.

Assist yourself, so you're like your four hands.

You have three hands and a camera, so you're driving your own camera, which is a big advantage over laparoscopy or video assist a throoscopy or arthroscopy, which where they put a scope into joint and you have to hold it here it hooked up to a robot, and as I move my hands and feet, the camera moves where I want to go. Gigantic advancement because when I did these cases with someone driving the camera, I'm like, listen, did you bring the camera?

I don't want to look at it? Move it up.

You know, it's a constant dialogue. If you have great assistance, they.

Know where you want to look, but no one knows where you want to look more than me. So with the robot, I drive the camera. The robot is a slave to my hands. If I don't move my hands to robots, it's still right. If I don't move my feet, the robot doesn't move too. So it doesn't go this patient is It.

Doesn't It doesn't do anything that at some point we will get to where parts of the operation.

I think we'll say to the robot, here's the artery. Here's the vey and here's the Broncus robot. Get around the artery because at some point it's going to be better than us. I firmly believe that, despite what my colleagues say it.

So that's it's like the benefits of AI right that correct.

I was in Italy a couple of days ago lecturing on this, and the people in the audience again were like, you know, sir, if you're you're pushing this, you're gonna get us out of a job.

And I'm giving it's about getting patients better care.

If you're crazy, we know we're not like they did say you're crazy, you're grazez.

You make it the roll. Boy, it's about news one of the role.

But so let me so. But the tack title approach you as a as a surgeon. Now, presumably I would imagine that as you're training and going through building up becoming a surgeon. Right, it's a very tac tale thing. You ran there with the sounds and the smells and you are so boy, you are You're pretty sure you're a pretty smart guy. How did you know that? Yeah? I used to be a doctor used in my mind before ye, well, I'm not a doctor, but I did a yoga class in LA which makes you a doctor.

Such a great question, And again I hate to go back to experiences, but today I have and I'm very honored because they don't come to see me. They come to see NYU and the NYU team. So I have a doctor from Brazil and two from England who were there today. And the case we did is a metasectomy.

So we've come up.

With ways so you do this, But you would have to be a surgeon who's experienced the tag tile, you've been through that to feel that.

I don't think that's a fallacy.

I think to say, hey, you got to open up and do a whole bunch of opens, or go to a lab now and operate on animals and do opens, I don't think so. I think we've gotten so good with simulation and teaching that we can teach the non experience palpader with the tactile so young surgeons who have not opened, because we do everything robotically, everything one hundred percent,

Well, it's not.

Well, don't get a lot of infections, but the pain. So I'm not about to write a paper. I've operated on one hundred and six surgeons. They've all been back in the o R within seven to ten days. So your recovery, because you have tiny little nicks, that's it. And then you know, we we have now we have to make the one incision bigger because we put the tumor which is in a lung and a bag, and

And it does make that sound? Does it really something like that? That's horrifying and awesome at the same time. Now, listen, because I think about this, because I've made a couple of surgeons in my life. You seem very like this to me. They're kind of their jobs, you know. You guys are your competitive, you're sporty. Yep, you're kind of you know. I've met male and female surgeons and they're very similar. There's that real kind of sport mentality.

I played baseball in college, and all three of my boys were captain of their high school baseball teams. And they went on to college and played D one baseball.

Yeah, well, are you boys own medicine?

No?

Well, they were a little too smart.

They thought I worked too hard, and they're doing things that are may be a little bit better for society.

I don't know, but that that kind of drive your father was a doctor. He was, Yeah, it was your father. Very sporty and very he was. He played baseball in college as well. What kind of doctor? What kind was he? A surgeon? Was a surgeony urologist? Oh plenty of I'm fifty one years old. I mean it's like I'm sixty one too, right, Well you know then, yes, now you know as a as a doctor, you're probably a terrible patient, right.

I really am.

I had surgery about nine days ago, right before I flew to Italy days ago, and I was back in the o R two days later.

Can I see what it was?

It was? Yeah?

Because I've done so much surgery, it's a very common for surgeon. As we looked down, I had advancing arthritis in my cervical proteinebro bodies, and so they just pucked a little bit of the bone out with a little incision, took a little the disc out, and I had a little numbus in my finger, which is scary when you're a surgeon, like I kind of need that puppy.

I may not be good, but I'm valuable to me.

Sure. It was like a concert penist or something, and you need that one hundred percent is it demystified for you? Then surgery is like because a lot of people, surgery is like, this is a very big deal.

I'm very frightened. I'm very upset. Doesn't you're like, nah, go ahead, I'll get it done.

I'll bet it's.

Yeah, because I I obviously I know the people who are really good. They did a minimally invasive incision in my neck and I literally was in my office.

Now he told me to take a week off.

I was in my the finished the operation at one, I saw a patient in my office at five, and then I was back in the operating Monday, and I flew to Italy the next day.

See that's see, that's just you know, listening to your dog. Well, it's the amount one hundred percent. But you asked if we're good patients. I was giving an example to Supper. You're just you are.

I just think that my surgeon was so good that you did.

You ever get when you were training right at the start, when you're looking at you know, all the different disasters that can go wrong with the young body, Yeah, did you get them all? Did you become a hypochondriac because you were still? See I would have like even talking to you, I'm thinking, oh my god, I hope i'm catch.

So I hope he's not got anything on his end.

So I did wash my hands and I washed your card for you too, by the way, so you're good.

But you know, that's something that I think is maybe something about the mindset. Because if you're a jockey, you're sporty, you're a competitive personality. I think that probably helps going in right, because you against the disease.

Right, it is it is.

But uh so you know now, as someone who has an MBA and was of executive VP and COO of a healthcare system and a leader, those are some of the bad things about surgeons. And it has to do with our training. So that's interesting because in college you have to be in the top one percent, so you're kind of hoping a little bit of people around you don't do well.

That's terrible as a leader. And then as you're in.

Medical school, you got to be AOA in the top two percent to get a surgical residency, and then to become a cardiothoracic surgeon, which is one of the hardest besides neurosurgery or ortho. So again you you sort of take resources and can become I always say you can kind of sometimes tell who's going to be the surgeon, who's going to be an interness by looking at people play in the playground at six or seven. And that's but I think if you're going to lead, it's just

So patient is dying, so come in.

You know, when you're a surgical resident you get called once a day, twice a day to a floor and a patient is coding and dying. You have to come and immediately take charge to everybody to shut up. You say, do this, start up in nefferin, we're going to do CPR, and you're barking out orders. Right, So that's a great leadership style for that particular moment.

Do you kind of you kind of get a Russia?

Oh my god, yes, anyone who says you don't you well if the patient does.

Well, yeah, well let me ask you, because that that's that kind of leads me into What I wanted to talk to you about a little bit is the emotional impact of what you do because you're facing literally dead as as your profession, you you face death. It's what you do correct and and you try and head it off of the past or or is there a point where it's too much, where you can't take it.

Maybe because how my father treated me, how he trained me, I saw it well, so I think he made us really tough. His dad was a immigrant from Italy, came over, was a farmer, second grade education, the concept of hard work, and I do think and resilience and toughness and and I love when people say the kids don't have it.

The kids have that cost too.

They're going to and they're gonna be better doctors, better fathers and husbands and daughters and wives and granddaughters and grandsons than we are.

They're going to be sure. The definitely getting better, and they're going to be more resilient. But it's her job as older people to say kids are terrible. There they were better when I was a kid, but they weren't. You and I both know it. They weren't better, awful. But I heard that today.

From the one of our visitors from England and I and I said, listen, I politely disagree with you. These doctors are going to get better outcomes than us because each generation gets better and they may not have the same experience because we spent one hundred and twenty hours in the hospital now a week. Now they can only do eighty hours a week. And it's tough to get good at anything with eighty hours a week. But it

A day is better enough. He's twelve.

It'll get it's pretty good. Yeah, he's committed to it. It'll do. But I mean there's you know, your ten thousand hour rules. It takes time.

So they may have a little delayed gratification, but they're more balanced, they're better in their roles at home and at the end of the day, that may make them a better doctor and a better leader. That has a different leadership style besides authoritative.

So the leadership thing is interesting me because you go back to your dad. Your dad was clearly a now lead oh yeah, and you clearly have that too.

It's like unfortunately.

Leader, I mean you've written books about how to you know, succeed and how to do your best and how to get the best out the things correct, super results, are super achieved for performing.

Thank you for plugging it about. Well, look, it's my job.

It's just like you know, I make the incision. I do a little work. But here's the thing. It seems to me that it is such a competitive environment that is drawing competitive personalities are so drawn to it that at the at the core of it, I wonder if there is if there is a point whenever you lose, because you're going to lose, we will get humbled.

I tell every resident who thinks they're so good, the good Lord is going to humble you at some point.

So just be quiet.

You know, if we're doing well, go home and just look in the mirror and don't don't look at your navel, don't navel gaze too much because bad outcomes are coming. So I totally agree with you. And then you know, as a leader of a department or a division where you may have twenty of those guys, and then a COO of a healthcare system where we had six thousand

What work did you do on your own ego for that, because if you're a young man, you need a little bit of that kind of you know, I'm the cat's pajamas. You're right, you know, you're right.

So, and I've shared this with you before, but you know, my wife, who I was married with twenty one years, got cancer, and then she got a chemotherapy for this breast cancer that should have been cured, and that chemo caused the leukemia. So I felt incredibly guilty and humble about that because I participate in the decision to give her the chemo.

And then for six months I would operate every day.

We had people come from all over the world because we could take their tumors out because we were so good. Yeah, and I got humbled because I would round The last person I round it on was my wife. I I sent my team home and I was spend the night there and sleep. And my kids were in high school and one was at Yale in college, and I'm like, you guys are on your own and I became so humbled. I watched her die. I could do nothing for it but hold her hand and watch Jeopardy.

That's that humbles you.

Fort a clesmic and the the irony on top of the on top of the immense emotional pain of watching some the woman you loved of you fight against all the time.

Correct very humbling. So that was a that was a humility check. And I don't think I was Could.

You work at that point?

Yeah?

I was.

I operated the day she passed away.

I operated, and then that was on really on a Friday, and then we had to actually she had a terrible brain bleed.

We had to end up together.

I flew my kids all in, my son, I just pitched at Harvard that day. They flew on Saturday, and she was declared brain dead. We pulled the ventilator off on Sunday, which was terrible, and I had people from China coming in to watch surgery. I didn't do not break Monday or Tuesday, but Wednesday I went back and operated eight cases on Wednesday.

Didn't you think that helped?

So?

You know, people criticized me for this, but I think it's you know, no one, everyone has lost. Everyone has, and everyone mourns in their own way. My sister's a psychiatrist and said, you know, we didn't do it right. I don't think there's a right or wrong way. It helped me because I got immersed in my work and my world literally my world stopped spinning. I don't know how I'll say if that's how I felt. I remember that night going, it's a terrible story. I bring it.

Everybody down. No, no, no, no, it's a story.

Yeah, it's the So it's the And she hadn't even passed away yet. It was it was Saturday, because that night I spent in the hospital, so I knew in the next day we were going to be pulling the pulling the plug, because it was every neurosurgeon say, she's not recoverable, right, And so I came home and sai, I'm not going to sleep in the hospital.

Nothing's going to happen.

And I sat under her clothes and the smell of the clothes man just set me off and I just was like sobbing.

And no one had really seen me cry, because right, you don't want to cry for it. It's ridiculous, sure, but that was that night.

I just remember saying it was like a surreal thing, like is this really happened our family? Everyone kind of called us like, you know, we had this magic aura that my kids all did well, and my wife was beautiful, and yeah, I mean I'm not beautiful like she is, but we all know.

Yeah.

They called it like a little camelot and it's very funny the humility no camelot when your wife gets a chemotherapy induced cancer called leukemia and then all the chemo on the world couldn't help her, and then she has a massive brain bleed and you know, she was the love of my life. And their kids, my three boys who I drove and drove, lost their mom and so they're all dealing with that nuts ten years and we still talk about it.

Yeah, of course, yeah, and you'll always talk about it. I feel like sometimes whenever I've experienced loss, I mean everyone experiences in their life, I feel like it's kind of like a scar, maybe even from an operation. It's like it's never the scar's never going to go away. I've got a scar on my hand from where I punched a window when I was drunk when I was twenty one years old, and I left a big scar,

But you remember, it reminds you, it reminds me, and it is an evolution. So I've used the same analogy. I call it a wound instead of a scar, and so the wound goes through different layers of healing. There's five layers, but it's never fully healed. And it's obviously much better now than it was ten years.

Right, it's but it's changed you. It changes how you are your experience with your wife. Does that change you as a doctor when you're dealing with someone who's looking at a tough diagnosis or a bad outcome.

I share it all the time, and it's funny. It's made me a much more I think empathize. I think I was empathetic before, but it's made me much more empathetic. When I say to that patient alcohol, you're going to get three cycles of chemo. We call it neo ajumant. Then we're going to resect you robotically. Now I know what they're living through at home. It made me much more sympathetic and much more understanding. And then it's an

A ward that I've had before with cancer, and it is something which I find the idea kind of terrifying because I hate again in the fights.

I've lost a lot of them.

And so when they say, you know, I'm having a fight or a battle, I feel like I would hate to hear that. I would like I'm not prepared. I don't know. This thing is big.

Well you are prepared, though, I mean I think everything you've been through in your life has prepared you, and your experience has prepared you, and your value system, your culture, and you have a beautiful family to support you. There's some people don't have any of that, and even they find some resilience in wasting.

What does that manifest itself? So if you're in a bell, is it about a positive attitude? Is it about changing the way you live? Is about a spiritual anegement, finding a church or a belief system? What is it?

It's a great question I think it's a combination of all those things. And I think it's an individual journey. It's like your own journey to find happiness. It's your journey through a leadership, and it's your journey how you go through grieving, as I explained to my sister, or through adversity. And I think all of us have our own way. So it's not my job to adjudicate if it's right or wrong. It's my job to support that patient.

Both cell phones are as much more a thing though as well, like correct like back in the day, there was a big bux in your car and you.

Leave your car, you're on your own.

That's everywhere. That's when I was a medical student. Yeah, they had cell phones in Alabama. They have running water and all that getting in Alabama just in the last few years. Okay, it's very progressive, but that's a good hospital down there is your universe.

Alabama's fantastic, incredible people, great doctors, and the great culture at UAB.

Yeah, I've always had a good time down there. I like it. I like it down there. So listen, you have the situation where you've dealt with it personally. Yep, you deal with it professionally. You know, the the ultimate reality for all of us. You look at that all the time. So I gotta ask, is there a religious

So it's very interesting, So I will tell you how I share. My own belief is dramatically different in New York that it was in Alabama. So I do personally have a deep faith in something superior to what there is.

I do think there's some life after this. I do think.

And my kids call me crazy because I'm so evidence based and so metric size and everything I do. But I do believe that my wife can see me.

Now. I do believe she sees every little thing I do.

I do believe my dad and my girlfriend and everyone can and my kids can see everything I do.

I firmly believe that. Now, maybe that's a mechanism to keep me straight. I don't know, but I think I'm going to see her after this. So I shared that a lot. Now you go, friend, I'm going to say, well, listen, no, I think I spent ten years.

Yeah. And also, you know what I think I think if it's moving on from the physical realm, I think I think you're okay, you know, you're right.

Yeah, No, I think it'll be all right. I mean, anyway, I'm a little worried about it. Actually, I understand. I feel like she could light me up. So you know, I you know, I just don't know.

And that's a family affair. You guys will do with it. But the time comes.

But for the record, Craig's an affair. Just what that's for the record, because there's no affair. No, no, we were just good friends. No no, So let me so let me ask you this.

Then you you have a situation where you're a younger surgeon, right, yea, and you lose your first patient.

Yeah, terrible.

You remember that?

Oh my god, Yes, I remember the patient like it was yesterday. I remember her name, her husband's name, she had three children. I remember it all terrible.

It isn't that.

Funny because I've done, you know, nineteen thousand operations, and the only ones you remember the ones that don't do them. That's true of every surgeon. That's not true of me, that's true of almost every surgeon I know. We lament our failures and rarely toast our successes.

That's very interesting because it I think that maybe you expect to win. Oh my god.

Sure we're all I don't want to say, uh, egocentric, but we're all very well trained.

That's good.

I want a guy like that.

You on me.

I don't want the guy thinks, well, I hope, I want to know.

I'm scared. I was like, right, I'm going to fucking fix this, exactly right, fucking fix this.

So what I say is, when I step between that line, no one is better than me. We have a line of the red line when you get in the O R. And the second I step back that I'm going home. I'm taking out the garbage. I'm you know, no different anybody else. And actually it's a big chapter in my book. It's called staying in the zone. And the zone means yeah, I want you to be confident, have a big ego. But the second you walk out of the operatunom you

You're just the person.

But one of the reasons why I enjoy talking to you is that. And I am fascinated by the fact that you have such a sense of joy as revive a life force, you know, and yet you deal with pretty much the hardest thing that people are dealing with, which lung cancer. Yeah, it's a real I mean lung cancer. I mean it's not what it was thirty years ago.

Dramatically.

Yeah, And I want to give a shout out to the oncologist because really the oncologist sees the patient was Staged four stage three advanced cancer, and more of their patients passed away. It's one of the reasons I went into surgery. Probably wasn't secure enough in my own own skill on my own that I didn't want to deal with nihilism. I didn't want to deal with bad outcomes. I wanted to feel great about myself and look at

I like that. No, that that comes from guess that comes from your dad, right, That is you and your dad a little bit, because he got you into like your Your first surgical procedure was with your father, right.

You remember that?

Yes?

Remember?

But our dog in the basement, it's it's freaking kookie. It was the dog in the basement, it's Cookie. Who would do that? So my dad had done a year or two of research on animals.

Well, let's me. He was a surgeon anyway, right, Yeah, he was a surgeon.

But who says, I don't want to vet doing My dog's just directed me. I'm better than him now, credit he operates there every day. But when I think about it, now, you know, I was eleven years old. I'm not much smarter now, but a little bit. But he did his own anesthetic made We made a board with little velkros. We did it in the basement. He cut it out, he made the whole thing. He brought home an end

I have to be able to learn how to do. Now.

It's fascinating to me because you get beloved family pet. Yeah, you know, knock out this lovely dog, eagle spot to be because this little bagle and she's gonna have the hysterectomy. And suddenly you're seeing the inside of and.

See my father navigate the moguls and the eurydor and all these other anatomy which I really didn't know what it was. And the dog was pregnant, so there were little tiny puppies in the uterus at the time, and that actually upset me a little bit. And my mom was like, you shouldn't have had him down there. I'm like, because you saw these things were they look like little tiny puppy. They were, you know, maybe an inch, but it was there was like six of them, five or six of them in her uterus at the.

Time, and that you had to clean all of that out because.

Sure, yeah, he took the uterus out and they all expired, but he carey quickly covered that off.

You know, that was a surprise. Oh so he didn't know that until he was in there. You No, we didn't. He didn't. He didn't do a pre op pregnancy test like.

We do, Like you do that with me, just in case if you're pregnant. I'm very worthy. Well that's a different operation. But what is there ever? Does that happen with frequency that you go in, because you're not going to get that same if you're going to like good in the keyhole robotic surgery. Yeah, you know, creating that landscape and going, hey there's a tumer over here. I didn't even see that thing. Well no, but you can pull back. I call it stadium view. You pull your

Look at what's called the plural of the diaphragm, the lining of the heart to pair of card and make sure there's no metastatic disease. So we could pull the camera back even though it's ten times three D. You can pull back and get a global view of the just easy, and then you get so zoomed in. I'll like tell you I how to tell the resident pull

She was too zoomed in.

That's gonna happen. Yeah, So you go in there and you find something that you weren't expecting get do you make the decision on the spot. We'll get it out. No, I'm not going to talk to anybody. Get it out.

So I'll tell you what I did.

I could show you my phone, but I talked to the patient's family. Because when you're on a robot, you're not sterile. You're sitting in a console.

Right.

You want to bring a new instrument in, or something's happening. I have maybe a twenty second to lay. I'll text him and say, hey, we're doing this, we're doing that. Everything's going well. He's asleep, We've painted the skin, the instruments are in. We're just taken the lymph notes. If I signed something abnormal. Now what I do is I will call the doctors and cologists, and I will call the family member and I have them often participate.

Now you can get next to ken to say yeah, go ahead, I'll say, listen, here's what I think we should do.

They usually say, what do you recommend? But I've had some people, so now I want you to stop. And I said, well, we'll probably we want you and that's fine, but it allows them to participate in the conversation. And then now you can even use the oncologist and give them information. Just last week, I had a very unusual finding of giant lymph notes or a metastatic because this patient came from another country, the scan was only three weeks old. Maybe it wasn't perfect quality. Lymph notes had

I would do. What do you want me to do?

He said, yeah, I want you to stop and we'll give chemo. And I involved the family man the patients failure. Mam was a doctor, so it made it easier chemo.

It must be a kind of a mixed bag a little bit. We're giving your own experience because you know obviously your late wife's story with the chemo, I mean.

Caused her cancer, right, and then caused her to bleed into her brain because she had thrombocytepedia low platelets and bled. So the chemo caused her cancer, her leukemia, and then caused her to die. And yet I tell every patient this about this my own bias, but we recommend chemo all the time to people adjuvantly and agually means after surgery and neo adjuvantly.

Before sir, My mother, my late mother about twenty years ago got actually no more thirty years ago. She got non Hodgkins lymphoma. And she had been receiving experimental treatment for arthritis because she had very bad at right that.

Could make that take off like wildfire.

So she had non Hodgeglimbs lymphuona. She was getting some weird gold treatment I don't know what it was for us writis and she had a very compromised immune system and they started giving her chemo. So at a certain point we're in the intensive care in it, and the doctor who was lovely women come up and said, look, the outcoming here is not going to be good. Yeah, and I think you guys should say goodbye.

How old were you at the time. I was thirty.

It's tough. Yeah, it's bad. But here's the thing, because this is an important part. Sorry you went through that, but that that is really tough. I'm sorry you went through that. But here's the end of the story. Is very different because they say it's time as say goodbye. I know, okay, so we all say goodbye, and my mother's not a brand. Isn't gone right, They're just the look, there's nothing. You know, this is going to be bad when you take the breathing and two boat, it's going

That's a twisting. Yeah, fifteen years. Fifteen years she recovered because they stopped. I hope you ke the hell out of that.

But see, you see what it was? Was it?

I think they never really quite understood what they did.

But in a socialized mandisine environment, there's no people are not suing each other, people are not you know, so.

Better better is it?

I don't know.

It's there's good and bad everywhere. Sustained.

I would say, maybe they stopped your immuneo compromising gold therapy. That letter her immune system to kick in, because most people don't have that many problems with not hod film right, Yeah, that's right. It was when when the chemo started. It when really stop the chemost and stop her arthritic medicine which immuno compromised her about her own immune system to check right.

She never really had film mobility again because of the aarthritis, because he couldn't treat. It's tough, but she was mentally with us. She was mainly fining. She got around the wheelchair. She did, she did what she did.

Had to watch your career.

She got to watch me career. She got to see her grandkidsy born. I mean she she saw that.

You know.

No, it was it was, It was good.

But I think that the thing that terrifies me about it is I think there comes a point in life when you realize doctors are human. Oh my god, yes, I see.

I could have told you that with the second I walked in the door and tripped.

On the Yeah. But garbet you, But you know not for what I mean, for a lot of us, and particularly I think my parents' generation, maybe your parents' generation too.

The doctor knew everything, and the doctor was going to make it all.

Okay, I'm very proud to be in a refreshion that still has the highest respect from the public, you know, doctors.

And I didn't it. I do think it's well earned.

Having said that, you know, we're knuckleheads and we make mistakes all the time, and we're human, and I think that keeps our ego in checking. And it's that desire to get better, which is so ingrained me. Every day I kind of wake up, what are we going to do today that's better than tomorrow.

We're always innovating and getting better.

And I think most physicians, most people out of the way, but especially physicians, we really want to learn from our colleagues and get better.

So in the extremely advanced technological world that you're in, where you're looking at a situation where you can get is there a future where you say, well, it looks like we have some cancer here, so I'll put in an E forty three program, slide them in the door, and it should be fine.

So when you mean slide them in the door, well, you know, put them in the machine and you go and say down the little rowboat does all the work for you, and you just so I do.

But I'm the exception to that. And I think the reason and this came up a little bit in Italy. I mean, I just seen what's happened in my lifetime, and there's no question that artificial intelligence and robotics is going to give our patients better care. And the doctors should not worry about protecting their trade. What we should do is wake up every day and say how can the patient get better experience and a better care?

And you know NYU has really done that.

I mean Nyu Langone hospital with doctor Grossman and all the other people there have We wake up every day, how can we give the patient better quality and better experience? And I think we use AI all the time, so it's going to do that. At some point they will slide into a machine. But I don't know if it'll be surgical. I think it'll be more molecular. They'll be able to ree it's not just it may be prevention.

That's my hope. What are the cancers right now? You think we're just not getting anywhere with us.

Well, so your cancer is such a diverse thing. Look at lung cancer. That's a big, big, seven different subjects. Someone asked me I was doing this this show, they said, we're going to cure cancer. I'm like, hang on, hang on a minute, man, you want, I'll talk about add no carcinoma.

The long you talk about squam and s old carcinoid small, So what do you want to talk about. It's like saying, when will we cure illness? Yeah, it's exactly doesn't even make sense.

So I think, all yeah, and there's there's new cancers coming and there's some that are going away. So I mean, I think all together, if you look at the results of what we've done in the improved survival of lung cancer, of breast cancer, of colon cancer, and you know though,

It's finally coming down. But that was still true a few years.

What is that smoking?

Like twenty five percent of the women I operate and never touched a cigarette, and fifteen percent of men never touch a cigarette.

It's uh, has to.

Do with genetics and maybe pollution, maybe environmental I don't know, Wow, but that number is growing and malignancy and non smokers.

So what do you do in your own little tabernacle like your body?

No tabernacle. So I'm you know, I'm a certified personal trainer.

I work really. Yeah, I lifted weights. I'm a big believer in that.

The guy I couldn't sleep man, but I'm eight days postop, so I lifted a little bit. I hope by neurosurgeon's not listening. It's only twenty pounds.

Pro don't work.

No, I sleep like everybody else, and we're very efficient and so I'm very, very rigorous like most surgeons, like, I'm sure you are most extensive. People are rigorous and they fit time in. So I love to work out.

I love the feeling of having worked out.

Yes, I feel like having worked is one of the greatest feelings in the world.

Before working, I'm like, I want to do this. I think the key is to remember.

I always tell my kids, put this feeling in a bottle and then you just sprinkle over your head, because if you come home from wor can sit in the couch, you are dead meat.

It's over. So you got to sprinkle that little bottle. How does it feel?

Let's go, don't even get comfortable, and that's what that's really.

So you you'll come out of a surgery a long day and you'll do it. How long would you do with the gym or then? Yeah, so an hour and twelve minutes a little program on your phone and you do all the little lifts and I deep and.

Then do it again, and I lift three days a week, and then you cardio and then you know, I told you I'm in this singles pickleball thing. Now gotten really into that. I gotta let my neck heel up from this operation. But in another week or two, I'm back playing golf and pickleball.

What would you say, like if you were stand in front of a bunch of people, say, we go to Danny's in Alabama, right, And we go to Danny's and Alabama and everybody's in there and everybody's having the stuff, and we all decide, look, we want to talk to Sarah about how we can avoid hands. What would be the first thing you would say to it just a random group of people, no surgeons, no personal trainers.

The first thing I'd do is keep my mouth shut. Is so we come down to one of two things. Right, It's either you stop smoking, or you stop drinking, or you lose weight. Those I said two, but those three things would predominantly I have to pick one, and Chinea, I'd say stop smoking. I was just there fifty percent in Italy. I was there a few days ago, forty pers everywhere.

There were people still smoking.

In Italy.

There were doctors, cardiothoracic surgeons coming out of the damn meeting at the break smoking outside. It's crazy to me, It's absurdity. How could you be a leader? So I might put smoking, although I don't know now. It might be out, it might be drinking, it might be obesity. Although with a zempic that is going to change the landscape.

Talk to me about the zampick. Is that is that because people are taking it for you know, chronicle vicity and that I mean, okay, taking it just for the hell of it. Yeah, I think that's what I might be asking you, So listen.

The professorial answer is we don't have long term follow up.

We don't.

The reality is I know two or three people banana for two three years and they have lost fifteen twenty pounds day love it. They now those people, I think they inject themselves. I don't think they don't take it by mouth. I think they injected. The patient told me she injects it subcutaneously, maybe once every two weeks or maybe once a week, and it's expensive, but somehow she gets it because they're rich.

But she loves it and has had no problem. That's the majority of most patients. What does it do?

By the way, so it's a.

Lucagen inhibitor, but the reality is it will reduce your level of glucose and amazing, maybe lets food stay more in your GI track and cause constipation.

It slows down your GI track. You're absorbing less time. I want to slow down my GI track. I'm taking fucking heroin.

I'm going to get something enjoyable.

It takes so you know, it makes you constipated and you don't even feel the base. No, no, thank you.

Don't share that with your endessties just before your dscopy next yek, I just.

Say that out. Yeah, you know, it's funny, like I'm very free with the fact I know that I have. I mean, I've been sober for thirty one years, which is incredible, thank you and I And it is an interesting thing because sobriety, I feel like is largely misunderstood by your profession. I think you're right.

You give everybody perseverance. Yeah, and you have a different view.

I do a little bit in the sense that you know, people say, you know, why, well, why can't you just stop? You go, Well, if I could just stop, it wouldn't be a problem, would it, of course? And then the whole idea of it having a spiritual component. Now, I think with you, sir, if I don't think it's a problem. You are a spiritual human being. You happen to be, you know, a doctor, a surgeon, a very good one,

And I don't share it with them, and they're going to hear it now. But I don't wear that on my sleeve or discuss it because it's not really admissible in what we do. We're evidence based. We're a meritocracy and it's not there.

Then let me give you some evidence. Okay, right, until I dealt with the spiritual nature of the its physical and mental, no doubt. But until I embraced the spiritual nature of the malady I had, I couldn't stop drink.

That's interesting, that's the evidence of it. It is, and I know a lot of people with similar experiences.

And it's kind of you know, well, I mean, obviously he's had a goodal because it's one guy. But but I think at the same time, I find it fascinating.

Do you ever look at Carl Jung's work at all?

I can't imagine it would enter your world much, but just a young, very you know, as one of the founding fathers of your sister's profession. It was very much you know about religion, religious symbols, religious symbolism, and I think was very involved at the beginning of what is now I guess the sobriety movement, at the beginning of AA he was very you know, he was very connected

Yeah.

Well, and I have seen things that you cannot explain. We've seen tumors, oh my goodness. We've seen tumors regress, spontaneous regression of melanomas and lung cancers. And there's there's a thing called a scopeull the fact that I can give you all the medical explanations, but some of these things you just can't explain.

And I just don't think we're that smart. I have great humility.

I know there's there are things and powers much smarter and more important than me that I don't fully understand that have influence in our world.

But I think that's interesting to men. And I don't want to Yeah, I don't want to push it on you, but I think it's partially and it's why I'm so taken with you and your story is about your humility, because I don't think humility is I don't know. I think humility is I understand where I am in the universe, right, I know where.

I am, right, you know, and really how incredibly small that I am. And I've gotten so many kinds of and invited to so many places to operate and to teach, and I always learn a little bit more than I teach.

I don't really want to say that because they're inviting me.

But there's always something to learn, every culture doing something better than us. Like, for instance, the first time I went to Italy, he went to operate. I got there at seven am. I go in there and I go in there and this guy going, hey, what are you doing?

What are you doing?

And he's smoking a cigarette. There's oxygen tanks. Oh my god. He goes, who are you? And I said, I'm the visiting PREFSS. He goes, they won't be here for two hours. So it's two hours. They didn't start in the hour till nine o'clock.

And so everyone criticizes that, but you know what, maybe they're happier that way. Maybe they don't mind working from nine to four or five and being inefficient because that would drive it drives me crazy.

Is stressed carcinogenic?

Uh?

I think? Oh, equivocally, I think it is.

Yesh. Yeah, So I mean I wonder if if that's a thing that you know, if you look at the idea, the idea that someone in your position will say, there are things that we can't explain, right, I think that that is beautiful. I think it's beautiful that you will say, well, I like AI. I'm thinking if it makes people better

You're gonna have some wine, we're gonna have some fun, and we did.

Do you ever think I can'd of that wine? I kind of that pasta because I'm gonna get fat, and.

I do You're careful hundred percent. I have one drink and that's it. I'm the one drink they all wanted. And I just listen, I'm not an alcoholic. Just this is what I do because I'm working out. I had a little more pasta than I weigh myself every morning like a nut.

So I'm very regiment.

That's interesting. Do you have the the what's that little band of people that was like a watch thing?

Woop? What's it called?

The Whoop?

I got it?

Now?

What does that do? What does it it tell you?

It's so it's like, yeah, but I can show you my workout that I did, and I can show you how well I slept right here, take a look, and it says that, so my strain for the day is what I did with my exercise or just the amount of stress that you're under.

So you can see.

You can go to my activity here today and you can see I did a high intensity workout and lifted today. You see the exact time my strain was seven point three and then during that time, you can click into well, I'm not on an airqua to give you your heart rate, your blood pressure, all these other things, and it looks how well you see your blood pressure from that little thing on your wrist, not exactly your blood pressure, but

I needed nine. But that's my usual what you need it it's usually that's all I need during.

If if I if I feel like if I'm looking at an app and it says you only had fifty two percent of I'm like, hey, I'm going back to bed, or if I know if I can't sleep, I'm going to woke around feeling ashamed all day.

So funny so I'm in three groups of this and and of course I got a lot of the I have a place up at Silo Ridge, which a discovery land in upstate New York and very wonder for people. So I've got some of the younger thirty year old men wearing the whoop and we compare and they're like, well, stuff's going to see my chair. And I've had a wife from up to me and say, listen, you're killing my sex life.

You're killing how much fun I've had.

And she made the guy get rid of the whoop because it would drink, because you don't sleep as.

Well if you have just one drink. Well that I know, Yeah, that I know. I like if I have one drink, I don't do anything. So well, yeah, correct for a while, it's an interest. Let me talk to you just a little bit. I mean, we're almost done, and I know you're a busy man, but because I'm fascinated by my own pathology, I'm going to talk to you a little bit about my pathology is worse on the same I

I'm impressed on how well you understand yourself. I haven't heard it a while.

Well, I haven't heard too many alcoholics ever say that like an allergy, and I think you're exactly right. It does set off a cascade of events that you can no longer control.

Drive.

And the key is you're not driving there it is. And the key is not to get behind wheel in the first place. You just don't start. I mean, it was actually drink guy.

It was poor crust. But that's the thing.

You can be a one drink I have to be a I think the difference between an alcoholic and a non alcoholic, it's a non alcoholic can be a one drink guy.

I have to be a no drink. That's probably right.

It was poer forward to be fair. I think it was jelly Neck in the nineteenth century came up with the idea of the allergy, or certainly William Silkworth. I was going to give it to you.

Those guys are gone. Yeah, word still where was the silkworm?

Silkworm Silkworth at the Town's Hospital at New York City in the nineteen thirties, you know, he said, you know, he's looking at alcoholics. And he said to Bill Wilson, who eventually founded Alcoholics Anonymous or co founded that name right now, Yeah, and Bill William Silkworth was working at Town's Hospital and and he eventually Yeah, it's an incredible story because whats is that Bill Wilson is in there, right And William Silkworth says to his wife Lewis, he says, look.

His wife's name was Lewis, Lewis Lewis, Okay.

Lewis, that's not it wouldn't matter if it was Lewis, that there's anything wrong with that exactly. But he says to Lewis, he says, look, I don't think there's that I can do. I think he's just We're going to have to put him in a straight jacket, keep him in here. And Bill Wilson has a god show. He has a he has a profound experience epiphany right now. He thinks that it is maybe delirium tremens or something, and that's what that's what Bill thinks. And he asks

Stop and stuff. It's a joy to talk to you.

Man.

I'm so happy you're here.

And I continues happiness, continue success, and whatever you're doing, Jesus Christ, keep doing it.

We're enjoying my honor to spend time with you again. And uh, let's let's do once you let's do once you have dinner or something. Yeah, that's what even, all right, I'll have the wine.

You can't.

You have the one.

You can have all the wine, and I'll have I'll have a lot of past that I didn't go for a big long walk.

That's I love to walk after different paper. All right, thank you, thank you,