Welcome to the upper hand, where Chuck and Chris talk hand surgery.
We are two hand surgeons at Washington University in St. Louis here to talk about all aspects of hand surgery from technical to personal.
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Oh, hey, Chris.
Hey, Chuck, how are you?
Good. We're back again for another pod.
We are back. It's been a fun weekend. I've really enjoyed it. Hey, let me tell you how I kicked off the weekend. I had a monster clinic. And I saw that there was a WashU basketball playoff game D3 championships. And I'm in the middle clinic and I texted my wife and I said, in an alternate universe, we actually get out of clinic on time, I would love to bring the kids to this basketball game. And lo and behold, actually finished clinic ahead of schedule, got all the dictations done and was in the
car. I was like, holy smokes, we're gonna make it to this game. So we walked to the WashU gym with the kids. And we enjoyed our first D3 basketball game.
That is so awesome. And unfortunately, they lost in the playoffs last night.
But they did they did win that game on Friday night. And it was I mean, I don't I've never been in that arena before. It was raucous. It was pretty loud for being a D3 crowd. It was pretty impressive.
Yeah, I think they do well with crowds in the playoffs regular season, not so much. But it is a very fun environment that basketball is very good. You're right it is it's a it's a not appreciated opportunity in our community to go support WashU basketball.
Oh, it was fantastic. I mean for that to be within walking distance of our house. I didn't realize, you know, my son and I have attended basketball games before for the SLU Billikens which is a different experience in and of itself. But now that he's older, he's into it in I had to explain the rules, which, like, I take it for granted that everybody knows that if you shoot from behind the arc, it's three and if you shoot, because he's like, why did they keep getting so many
points? I thought every every bucket was just one point. Alright we have to do the whole explanation.
That is awesome. So that wasn't the extent of your weekend activity. So last night, you You prepared a feast? I understand.
Oh yeah, that's, uh, you know, so I got this book that specifically pairs you know, usually it's like recipes. And then you're like serve it with this wine. But it's like for this wine, make this dish, which I like marching orders. So I've prepared a bunch of dishes and had had Marty Boyer over and Marshall Burkes came over to and we had a grand time, it was a lot of fun. But yeah, the preceding that, I taught a little grant writing workshop for PGY twos, which was super
fun. I think that not many residency programs have that sort of opportunity.
You know, we talk about exposing trainees and honestly exposing ourselves to different things such as grant writing, such as leadership, the questions always when's the right time, you want to do it, you want to do these things at a time when maybe it's becoming an interest, or maybe it's becoming a requirement. You do it too soon. It's under appreciated. You do it too late, and maybe the opportunity has been missed. What do you think about teaching grant writing skills to PGY twos?
I think that I went into it with the mind state of you know, let me teach them something that they can use. Because yes, our residents have to write a grant. You know, that's so our partner David Brogan has taken over the residence resident Research Program, and it's done a really nice job in terms of creating some, some additional structure around it, taking what Mike Kelly started and really
refining it. And they have to apply for some kind of grant whether it's OREF, Hand society, AOSSM, you know, the various spine societies etc. So it is useful to them, I think, but then also what I had them do was, you know, develop an elevator pitch. So to because I think the best part about grant writing is really refining your idea and making sure you know, it's, it's, it's an important idea, and that you're going to get something out of the
project. So I had them give a 60 second elevator pitch about why their idea is important, because if you can give an elevator pitch and an effective elevator pitch, you can write a grant because the grant is just a way of communicating. It's a piece of marketing. So if we worked on that, and I think that was I think well received. I think everybody had a good time doing it as a way to make it interactive on a Saturday morning.
Yeah, that's awesome. As I said to you before we logged on, I probably could have benefited from that session. But it's really great that you're sharing that that knowledge that information with them. And you know, who knows, you know how many of those eight will pursue academics and pursue academics where they may ultimately become somewhat impactful in the field with grants and the like, but certainly starting them off this way, really sets them on a course to make that possible.
Well, I've said on this podcast before that I don't love working on the weekends, and some may say, What are you doing on the weekend do and all this kind of stuff, but you know, actually gets into what we're going to talk about today.
And I think that those are the moments that allow me to recharge, you know, kind of, for me, like we've talked about in the past, you know, I think for cooking has been something that I've kind of leaned into, because it gives me energy, and it allows me to enjoy the company of other people. And then, you know, the giving that talk was actually really fun. And it again, was re energizing, so is allowing me to refill my cup, so to say.
Yeah, it's been there's been a lot of work on burnout. And one of the simplistic things I've read recently, and I think we all appreciate this is, if weekends are designed, or if weekends become a time for you to catch up on all your work every weekend. That's a problem. It you know, because that's not what weekends should be. And granted, we all work on the weekends and the like, and, but it really is about using the weekends and hopefully during the week as well, to find those
things that give you energy. And that's been a theme on this podcast, because honestly, I think we both feel the podcast is one of those things, despite being the work but I like how you said that and, and sharing your grant writing skills is, is awesome.
So let's talk about we haven't done a leadership article in a while. And you have pointed me towards this gem from HBR in 2001, called the making of a corporate athlete. And we've talked a little bit between the two of us about how perhaps we should think of ourselves as athletes. And yes, there may be some eye rolls, you know that we're not really athletes.
There are definitely eye rolls out there.
Some some some would say. But, you know, I think I think there's a lot of really good stuff in this article. And so the the authors are Jim Loehr and Tony Schwartz. It's an HBR article from 2001. We'll put it in the show notes. But I think it's an interesting idea. And they talk about finding your ideal performance state. How do you how do you approach this kind of thing from your perspective, Chuck?
Well, I think the article is really, really good. And the fact that it was written 20 years ago, it hits a lot of the topics that we're talking about today. Now, granted, these are age old topics that bring the mind, body and spirit to kind of peak performance level. That's not new, I do think it's more accepted. I'm guessing in 2001, there wasn't a lot of talk, or nearly as much talk about burnout and performance and kind of making holistic improvements to self to you know, do a better
job and the like. So I think there's a lot of really good points in this. And a lot of them really hit home for me. So I think we should dive in and kind of touch touch on at least some, if not many of the points they raise.
Well, you know, they talk about finding this ideal performance state. And it's finding a rhythm in which you're recovering, you're seeing the stress during, you know, the workweek, or whatever from the job, but then also finding moments of renewal. And they talk about how at least in the athlete, those that are most successful, have rituals in which they will recover and re energize between moments of
stress. So for example, say you're a tennis player between points, you have some kind of ritual where you're fidgeting with your racket strings or something like that, allowing you to bring your heart rate down recovery, and then you're able to, to get back into something super intense. I can't say that I have rituals like that, but I certainly have found ways in which to recharge. And you know, they talk a little bit about kind of physically, I mean, to me, that is the the
workout. And that's why I think the the morning thing is super important to me.
Yeah, so I think the tennis player examples are interesting, because they're going through this process of stress recovery, stress, recovery, stress recovery very quickly. Whereas for you or I or a corporate athlete, it's a
different process. But I think one of the important points they make and we've talked about this on this podcast, and it's no mystery is that and they say, We have learned we learned that the real enemy of high performance is not stress, which paradoxical as it may seem, is actually the stimulus for growth. Rather, the problem is the absence of disciplined intermittent recovery. And my gosh, does that
ring true? And I think all All of us understand that recovery for you versus me versus the next person is going to look different. But we all have to recover. We all have to recharge, so that we can, you know, do more, and not shying away from the stressful from the stressful moments. I think that's really important.
What are the things that you do to recharge? And has that changed as you've taken on more responsibility? I mean, you know, you initially obviously started as a surgical resident and you're doing cases and then now you have evolved into taking on a lot more administrative responsibility in which you see a lot of stress and a different way, has your well how is your recharging or re energizing routine changed?
I think one of the dangers of corporate or academic or non academic life is, you know, if I, if I look at my life today, what I accomplished in any given day or any given week, and think about whether this would have been possible as I started my career, 20 years ago, I would I think I would look at what I accomplished in a day to be physically impossible. And the reason that it's obviously not is that we all become more efficient to get better at what
we do over time. And so I think I am far more efficient and effective today than I was in the past. And I have to say, though, the danger of this adding responsibilities, which is part of, you know, development in any corporate structure, is you get tasks, you get more you do a good job, you get more thrown on your plate, the danger is that we stopped taking care of ourselves to get the work done. And I have to
say, I'm guilty. And it's only been the last few years that I've really recommitted to, you know, taking care of myself, exercising more, doing things that kind of mentally help. For me, I recharge in a few ways, probably have some some that are similar to you some that are very different. Certainly spending time with the family is
part of it. sports in general, and basketball in specific, unfortunately, my advanced age watching less than playing or watching more than playing and doing things where I can't, I don't want to say don't, but I can't think about work. And that's really hard. So I think we're also into our job, it keeps kind of coming back. And you know, if you go for a run, you have plenty of time to thank you enough thinking about work.
That's the danger, but doing things where I can't think about work, because I'm thinking about other things is important. So talk a little about yourself, obviously, cooking family. How do you think about recovery periods?
Well, before we get into that, I did want to mention that your name has come up several times when you know, we talk about basketball in the you know, I'm in South County clinic. I'm talking to Jeremy Hartman about going to this
basketball game. And then we're talking about how one of our physiatry partners Nate Olson played ball when he was at Cornell College and apparently the physiatry team can they can hoop and they are willing to take on the rest of the department and everybody said, hey, you know, Goldfarb can hope to so I think there's you know, while we don't want any Achilles tendon injuries from the old man, it would be great to get
you back on the court. You know, I'm sure there's a there's an open gym somewhere where we could see what you got.
You know, I, I love basketball. I love playing basketball. And I think as I've said, Here, basketball is the sport where you are incapable of doing anything else, or at least I am incapable of doing anything else other than thinking about basketball, which is part of the reason I loved it. I like the competition. I don't I don't know if I would survive. But if the old adage holds true, you know, your first time back on the court in a while you're gonna shoot well, then I'm willing to find out.
I've never heard that adage. But if maybe it's a self fulfilling prophecy. Yeah, me, for me, it's it. You know, the physical recovery is obviously important. We're not stressed in the same way that, you know, actual athletes are, but it is the emotional recovery. And, you know, I think for me, the exercise stuff is obviously about taking care of your body. But then that's all honestly the only time that I kind of really
get to my to myself, right? I mean, sometimes, you know, inevitably you do think about work. But sometimes you have some clarity when it's just you doing something and having the time to think about I remember as a resident going on runs in Central Park and coming up with some really great research
ideas. Because I just had the time to think and I think that the time to think is something that is completely underrated and anybody who's interested in an academic career if you're a trainee, if you're real serious, you needed some You need to build in some time to think. Because otherwise, you're going to get pulled into all the other things, like you mentioned earlier. You know, so that's something they mentioned in this article here about, you know, taking care of yourself
physically. But then they also mentioned, you know, one of the anecdotes they have is that, you know, somebody mentioned that they now exercise for their mind as much as for their body. So I think, for me, it is a combination of the two, and then, obviously, getting to spend time with the kids where I tried to, I'm trying to be better about this, but really play like, you know, not like, Hey, I got to do but good, not making it so much, let's spend
some time together. But I got to get to this next thing, like actually doing the things that they're doing, because I'm realizing that those moments are passing me by.
Yes, those moments will pass you by quickly and truly engaging, is something you don't want to miss. You're exactly right. And the fact that you appreciate it is, is something in this, this paper talks about four different parts of the of the pyramid, and they literally have a pyramid. And the base of the pyramid is physical capacity, you know, to build endurance and promote mental and emotional recovery. And that's, that's what we've been hitting on. And I think, you know, you're certainly
really good at that. I try to be good at that. But it's not just the working out. It's, it's it's sleep, and eating right, and all those things. And again, increasingly, in 2022, we understand the importance of both of those additional factors.
So there they go next to the next rung up on the pyramid is emotional capacity. You know, so what I found is that sometimes when there are stressors, frustration, anger, that kind of thing, it really does drain energy. You know, I remember having a difficult time with some scheduling stuff in the OR, and it just affected me in so many ways. And I didn't like how I felt about things. It was very pervasive. And that was
a struggle for me. And I think I've gotten on the other side of that, but it showed people could tell I was not myself, you know, and that's not something that that that I like, so that, you know, that's one way that in that, that resonated with me.
Oh, for sure, it, it. Those types of factors, whether it's a difficult relationship at work, whether you're not able to accomplish what you think because of a some type of bottleneck or roadblock, those are really important things. And what's interesting is, and what I highlighted from this section, is the following. close relationships are perhaps the most powerful means for prompting positive emotion and
effective recovery. And that's where we started this episode, right is how do you engage into tip you know, could be family could be friends, but those relationships, and for me, it's, it's almost never around work friends. Because I feel like I need to extricate myself from the work environment. So I don't go back and talk about work. And so if we can do it in different ways, but to friendships are incredibly important way to recover.
I agree entirely, but it, it's interesting how much that we missed, I think during the pandemic, or the earlier parts of the pandemic. You know, we joked on our last episode with Steve Moran, about, you know, being an introvert and that kind of stuff, but I think, you know, when I interviewed people, for when I did my interview for the fellowships, you know, I was in a different room than you one of the questions that I asked was, you know, how do you feel like you have changed during the
pandemic? Or what did you find out about yourself that surprised you? And there were a fair number of people that said, I realized I'm more introverted than I thought, in they were like, I'm glad that I'm okay with that. And I think people have tighter circles now. And I think those relationships mean more to them, especially when we have that taken away from us for so long. And hopefully now we're on the other end of it. So at least going the right direction.
If we one thing that you a couple of paragraphs before it was music, and I really appreciate it as much as I joke with our trainees about music and stuff in the OR, it really does put me in the right headspace. You know, and it's one of the things where, like, you just listen to songs that you had you were listening to when you were growing up. And that just puts me in a different
place. Whereas like, I know that if I'm about to enter a very tough part of the case, if the right kind of music is on it's just gonna go that much better. I don't know. Do you feel that connection to music and the OR it's very different for some people, I think.
You know, it's it is interesting hearing psychologists talk about different things, whether it smells or sounds, or things that I guess take you to a different place, and music is certainly one of those. I think it's less vital for me. Although I would only agree that you know, music is incredibly important and In this article they talk about, of course, athletes when they're trying to get ready for performance. Music is always a big part of that. So yeah, I
really like that. I think it's important.
The the OR knows when they need to put on different different music. I did, I will say I had one patient who had, we were doing attendant transfer with her awake. And she picked Stevie Wonder, as her station of choice. I thought that was fantastic. I forgot how much I love Stevie Wonder. And musically, it's kind of perfect for the OR. So the next next level of the pyramid was mental capacity. And I admit, I'm not great at some of the stuff they
talk about here. They focus a lot on meditation, and I'm just not good at that.
Yeah, I am with you have totally with you. And yet, I feel like I'm missing something I really do. Because, again, with so much burnout discussion over the last few years, there have become increased tech, you know, technological solutions that offer meditation space, and easy ways to engage. I don't do it. Although I would tell you that it is the athletic stuff that God gives me the same. I don't think you can separate athletic engagement and meditation to me, they're, they can be one in the
same. And maybe that's a cop out on my part, because I don't do the formal meditation. But I've tried, it just didn't work very well for me. Have you tried?
Superficial attempts. So to say, I ended up just falling asleep. To be honest with you. To be very honest. There's something in here though I liked that I actually have incorporated consciously or unconsciously is going on walks. You know, I don't know how much of that was, you know, seasonal affective stuff here in St. Louis. But when we would have this kind of, you know, random 60 degree days, over the last couple of months, I would
definitely go for a walk. And one thing that I want to do more is just go for a quick lap in my neighborhood, and come back, because that does make me feel better, for sure. So maybe Maybe that's my way of rationalizing, I don't meditate, but going for walks, it's helpful.
It's funny, because Talia and I are doing more than same. And I'll do you know, sometimes we'll walk and listen to a podcast, I don't know that that's exactly the same, but it is time away time to yourself. Which which is which is important. Again, these are all ritualistic. And that's what this article emphasizes is kind of the things you do over and over, in all different states to, to help. Like the
comment from Jack Nicklaus. In this section where he talks about, you know, the fact that he performed, you know, obviously, under intense pressure, and he says, I'm Jack Nicklaus said, I've developed a regimen that allows me to move from peaks with concentration into valleys of relaxation and back again as necessary. You know, that's, that's the result is not really how it got there. But it's, that's the goal. That's absolutely the goal to be at a transition.
Yeah, and I think the thing that they mentioned here about visualization is obviously very relevant to the surgeons that are listening, especially the trainees and me I try to ask our trainees, you know, how do you see this case going, like, what's the flow here? And you know, some of it is very
tactical and logistical. Like, for example, I did some median to radial nerve transfers the other day, and I literally wrote out on the drapes, you know, here's what we need to do, because I had to, we have to do this before tourniquet related ischemia kicks in, and we can't use a nerve stimulator anymore. And the trainee commented that, you know, he liked seeing that kind of laid out. And oftentimes, I will ask them, okay, so what's the flow for this case? Like, what are we
going to do? And how are we going to do it? And what are the priorities, and I think going through that exercise is useful, because both of us will then visualize how the case is going to go, and then it just becomes a lot easier. So spending a couple of minutes, you know, either at the scrub sink, or what you know, less so now that we have all the different
solutions we can use. But you know, right before you let the turn, put tourniquet up, I think pays off in dividends from a very tactical perspective.
Yeah, visualization is incredibly powerful. It does get it does get spoken about more in the true sports arena. It's you know, how are you you know, seeing yourself taking that shot and watching it go in the net, whatever the sport may be. I think visualization I do. I like what you said for sure. I think of visualization they are, it can be step planning and kind of visualizing all the steps of the surgery. It can be really
effective. If for example, you're thinking about putting a perfect K wire center center in the scaphoid. That before you start, you take in your surroundings and you take in kind of this specifics of the Anatomy of the patient you're considering, and you visualize how that's going to go. So it can be a broad sense of visualization, planning, or can be a very specific step. And I think either of those can be really helpful.
But Chuck, do you consider yourself a spiritual person?
The answer that is no, I do not. But, you know, I think this article does a nice job of saying that spiritual does not equal religious, spiritual will mean different things to different people. And if I can, I'll quote them one more time. So let's be clear by spiritual capacity, which is their fourth level, we simply mean the energy that is unleashed by tapping into one's deepest values and defining a
strong sense of purpose. This capacity we have found serves as sustenance in the face of adversity as a powerful source of motivation, focus, determination, and resilience. That's, that's pretty powerful.
Agreed. And I like the distinction between, you know, people will react a certain way, when you say spiritual, I think it really is just defining that sense of purpose. I mean, why are you doing it? You know, one of the books that I read last year that I like a lot is Simon Sinek, start with why. And I talked about that when I gave
Grand Rounds. That because I think it's a super important concept to have a compass to have a, you know, a core of why you're doing what we're doing, why we're grinding day in day out, in some circumstances. Because if you don't understand that, and you don't take the time to reflect upon it, it's just a treadmill.
Yeah, and they actually get into that I like, I think they're two examples are both really good. The first is that about is about a woman, they call and who had been trying to stop smoking couldn't do it couldn't do it. But when she became pregnant, it gave her a higher level drive to stop smoking. And that's a simple example. But it was more than about her. It's about her values. It's about the importance of her unborn child, etc. I thought that example was
good. And then the last example was probably more powerful, and also perhaps one that may hit home to people like us a little more about Richard, the stockbroker from New York City.
Yeah, I mean, you know, he was clearly in a grind, and was commuting and, you know, classic New York situation in which you know, he would leave early, come home late, missed his kids. And just, you know, he was caught in this trap of not understanding why he was doing what he's doing. He essentially had a breakdown. And in a way, it allowed him to reset, and think about what really matters
what's important. You know, because I think that what I've been guilty of is not taking enough time to take stock again, and again and again. And I think I'm going to try to be better about that, and making sure that I understand, you know, here's the here's what brings me joy, here's why I'm doing what I'm
doing. And you know, let's make sure to focus energy on that, as opposed to getting caught into how many patients am I seeing, how many papers am my writing, how many cases am I doing, all that kind of stuff?
Yeah, really well said. And that's exactly right. And I think that's always the goal. And you know, if you get stuck on some of the stuff that are, I guess, quantifiable factors, and you lose sight of the less quantifiable and more subjective factors, it can be hard. And I think, therefore, this paper is a good one. It really it really does. And it doesn't hit you over the head with fighting burnout it. But it does get to a lot of things, which I think will impact how I think about each day.
And it did hit you over the head with that because it came out before burnout was coined, that was a thing. So that that is a useful, useful reason. So Chuck, we have to end with the win. We haven't done this in a couple of weeks. So what's your what's your win for the last week?
My win is that I've had to work related social interaction opportunities, which felt great. One we had on our last podcast when I was with Steve at a at a question writing session for hand boards. Another was an anatomy session. And both of those felt great just interacting with people in a way that I haven't done during the pandemic. It is incredibly reenergized incredibly so and I didn't realize I thought I missed it, but I didn't realize how much I missed it though. I
had it again. What about you?
A recent when we had our fellowship interviews a couple of weeks ago and Emily Camden our coordinator did a fantastic job coordinating all of it went off really well. The survey we sent applicants afterwards got a lot of responses very positive. So that was a lot of work going into that and I'm very Are you happy that that went off? Well, so that's a work related win for me.
Yeah, no, that's it. That's, that's a great one. And it was a, as we've talked about was a great day and they're looking forward to that match.
Alright. Well, we'll see you next time.
All right. Have a good day. Hey, Chris, that was fun. Let's do it again real soon.
Sounds good. Well, be sure to check us out on Twitter @handpodcast. Hey, Chuck, what's your Twitter handle?
Mine is @congenital hand. What about you?
Mine is @ChrisDyMD spelled dy. If you'd like to email us, you can reach us at handpodcast@gmail.com.
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