(upbeat music) - Hello and welcome to another edition of Surgeon's Lives. I'm your host, John Monson. My guest today is Nat Soper. Nat is currently the chair of surgery at the University of Arizona in Phoenix at Banner Health. And he's been there for coming up to five years now. Prior to that, he was the chair of surgery in the head of the department at Northwestern University in Chicago. And prior to that, he'd been in WashU and spent some time at the Mayo Clinic as an NIH fellow. He's probably best known for being one of the fathers of minimally invasive surgery, laparoscopy, if you like. And as an upper GI in general surgeon, he was there at the very beginning. He's, as you just heard, has moved from one part of the country to the next. And I'm certainly looking forward to hear what he has to say about transitions in lifestyle and changes in career. Don't forget to like and subscribe to the channel and send us comments. But without further ado, let's jump across and hear what our friend Nat Soper has to say. I'm John Monson, and this is Surgeon's Lives. - Hey, John. - Hey, Nat, how are you? - Never better. - Well, we'll take out. - How are things out east? - They're pretty good, thank you. Yeah, it's a pretty reasonable day. And just popped home to listen to the pearls of wisdom and the life lessons and... - Oh, yeah, absolutely. I've got it all solved. - Exactly, exactly. So I don't know, first of all, I should thank you for taking some time out of your day to come and talk nonsense to me today. I don't know whether you've seen any of the previous interviews, but basically what I'm interested in is showing the people that Surgeon's have a bit more to them than just two more papers and three more gold letters. Hence the subtitle of stuff that matters, but maybe we could start, as I usually do, by asking you to tell folks a little bit about not Soper starting with the words, "I was born in." - Okay, so I was born in Iowa City, Iowa. My dad was an academic pediatric surgeon at the University of Iowa, one of the first fellowship trained pediatric surgeons in the States. And in fact, when I was five, we went to Liverpool, England, so that he could do that fellowship at the St. Oransby Hospital, I think it was called. - Yeah, and Boulder Hay. - Boulder Hay. And then we came back to Iowa City, where he was on faculty for the rest of his career. Grew up there. Swore, I didn't want to follow in my father's footsteps. And I was looking at all kinds of state institutions because pediatric surgeons didn't make enough money for me to go to where I wanted to go. And midway through the fall of my senior year, a friend of my dad's who was a general surgeon in Victoria, British Columbia, I came through town and said, "Well, have you thought of UVic?" Well, never having heard of it before, I had not heard it, I had not thought of it, but applied and was accepted much to my surprise. And the concept during the Vietnam War of going to Canada on an island near the mountains coming from Iowa City, Iowa just sounded too good to pass up. And then I received word that in fact, the tuition was $423 a year. And after the first year of undergraduate school, I did well enough that I got a full ride scholarship the rest of my time. So my parents spend $423 on my undergraduate tuition. - It's not bad. - Midway through my third year, I loved biology, but I realized I was headed toward being a high school biology teacher or I had to think of Plan B. So I took the MCATs and did well and was accepted Iowa for medical school, early acceptance. So I was told at UVic that after my first year, I would receive enough credits to get my degree, but midway through the first year, I received a letter from UVic saying, "Oh, we miscalculated." In fact, you'll have to come back here for another semester of school to get a degree. So my CV up until the present time says undergraduate degree, "None received," which is always a little embarrassing when I'm a visiting professor. So anyway, and I swear I would never be a surgeon until my first day of the surgical clerkship and realized that I had to be a surgeon. Did my general surgery residency at the University of Utah where Frank Moody was the chair and John Hunter was a year behind me and they had a bunch of really good GI surgeons there including Bing Rickers and Jim Becker and others like that. And in fact, I decided that's what I wanted to be and went to the Mayo Clinic for two years of research with Keith Kelly in GI Motility. - I know, what year was that? - I was there in the GI unit from 1986 to '88. - Okay, all right. - And that was when Keith was doing gastric pacing and we're doing gastric pacing and investigating the ileal break and things that they've worked with Sid Phillips. And I mean, it was an incredible period and Mike Sarb was another one of my mentors there. And the plan had been to go back to Salt Lake and join Jim Becker on faculty, but after my first year, he went to Wash U and then recruited me there. So my first job was at Wash U where I was hired to do maximally invasive surgery. And basic science research about, and we were doing this research on trying to ablate gallstones in various ways. And in that very short window of the gallbladder lithotrypser, I headed up the Barnes Hospital gallbladder center and I was lecturing in Columbia, Missouri in four months after I went on faculty and a nurse came up to me after my talk and showed me laser monthly news of publication, I'm sure everybody reads. And it was actually the first publication of the first two patients treated with laparoscopic laser colesostectomy by ADCO retic. - Yeah. - And I thought that sounds like a much better idea than trying gallstone lithotrypsy. So I ended up jumping into it with both feet and did a bunch of animals and worked with a gynecologist and ultimately went down to watch Eddie Jo and Doug Olson do some lap coles and knew that that was gonna be the future. And so tried to buy the equipment from Karl Storks and they didn't have any sets for sale right then. So I had to wait until my set was displayed at the American College of Surgeons meeting in 1989 in Atlanta. And so two weeks after the ACS meeting I did my first lap coli in '89 and I guess (indistinct) - So let me cherry pick a few items along that way which has a distressing similarity to my own career path. (laughing) - So first of all, you said you had never planned to be a surgeon in the early days, et cetera, et cetera. I think, you know, one of the things I sometimes ask people, you know, who was their hero? Who was their idol? Was, you know, where did your dad sit and all of that? I mean, there he was a pediatric surgeon was in the '70s, was he your hero or was he your anti-hero? - Well, he was my hero in many ways but in that period of time it wasn't cool to follow in footsteps. And I wanted to rebel against those sort of things. - Yeah, yeah. - He had been in the Navy and had a bush haircut and he didn't like my hair down to the shoulders and a few little things like that. - Sure, normal, normal stuff and the growing up phase, et cetera. And it's interesting you said about the lithotripsy, you know, about exactly the same time I spent two years doing Goldstone lithotripsy. (laughing) My research fellow was, I don't know, whatever happened to him, a guy called Aaron Darsey. - Oh, I know, Aaron. So where were you when this was going on? - Well, quite bizarrely, I had returned to Dublin to complete my surgical training in 1986. And my boss, and this was a colorectal job, had said to me, so by the way, you've done research, 'cause I'd done a couple of years of research. She said, "I've inherited this research fellow." He said, "But I don't know what to do with him." He said, "Go down and find him." He's playing with a lithotraptor. And, you know, I don't feel sheepish about telling this story about Eric, 'cause he's done pretty well for himself to be there. But I go down and I find this room, I open the door and it's in pitch dark, apart from two things that you can see. One is the little tiny ultrasound screen. And you could hear this clicking noise going on, but you couldn't see it. - I can remember that clicking noise. - And the other thing you could see was the unmistakable orange glow of a cigarette. (laughing) So, Aaron was in there, lithotrapting the gallstones in this lady who was lying on the table while he was having a sneaky molymbra cigarette. (laughing) Every time, so, you know, we met, we became friends, I've been friends with him ever since. And for a time like you, you know, we were stars of stage and screen talking about lithotrapsy of gallstones. And then Eddie Joe comes along and, you know, picks up the story from, you know, a couple of French guys and starts doing it. And a bit like you, you know, I heard about this, I read about it. And I have to say, in my mind, I couldn't understand how they did this. So I got in a plane, I was working in England at this time, and at Imperial College, where I brought Arrow over ultimately. But I got in a plane, I went to Dublin to see a guy who was doing it. Went into the OR with him, I saw him do it, and I went, "That's how they do it." (laughing) - Isn't that the truth? - And I got back in a plane, and I said, "Okay, what I want is a nice thin female patient "with a simple biliary colic, nothing nasty. "Spent about a month, you know, corralling the instruments." 'Cause I had done laparoscopy in the mid-eighties, diagnostic stuff under local. And I found the perfect patient, laparoscopter. The thing was like concrete. (laughing) - Yeah, the first one I did had been waiting for me to get the set. - Yeah. - And had an M.P.A.M. of the golf for four hours. - And we went from there, and a year into this, Aaron, myself, said, "Listen, we're in an academic center. "We can't compete with the private practice guys "who are doing hundreds of gold letters. "What are we gonna do?" And we decided to take the appendix out, see if we could do them all laparoscopically. And we did that for a year. We actually had a bet with a guy that we could do it, and at the end of the year, I spent about two hours one day trying to find the appendix in a kid, perforated retrocecal appendix, and I remember saying to Aaron, "You know, you could take this guy's colon out doing this." And he said, "Yeah, well, why don't we do it next to Monday?" And so we did, and that was the first lap collecting me in the UK, and we had no idea what we were doing, really. We just, you know-- - Well, you were dependent on people, you know, having the right standards, if you like, to not do crazy stuff. - Exactly, and we had good training in open surgery and knew the planes and things like that, but it was getting accustomed to the instrumentation and the magnification. That's the other thing with the lap collies. I mean, we'd see this one drop of blood and think the patient was exaggerating. - Yeah, and the thing that I knew, I realized suddenly that I had as a headstart over most people because of what I'd done as a resident, I knew how to put the ports in. - Yeah. - That was a big deal for a lot of people. - Oh, yeah. - Oh, yeah. - Well, in my residency, there was only one guy who did diagnostic laparoscopy, and we all thought he was crazy. - Yeah. - And we drew straws to see who wouldn't go into the operating room with him. So that had been my experience. - Well, I always tell, you know, we used to do them under local for like a sighties and stuff like that. And, you know, you get the person to cough on three for the various needle, et cetera, et cetera, et cetera. The one thing I always tell people is, whatever you do when you're doing a true cut biopsy under local anaesthetic laparoscopically, you know, don't forget to give local in the skin for the true cut. (laughing) - Good point. - Yeah, I did learn that, or I should say the patient learned that, but the hard way. (laughing) - Yep, absolutely. - And you are in WashU being doubtless looked at slightly a scans by a few people wondering, what is this guy doing here? - Yep. - Did you-- - Well, especially, I mean, Sam Wells was chair. - Yeah. - Very much a basic science kind of research guy. And I abandoned my basic science research. And initially, he wasn't too happy about that. - Yeah. - But I convinced him that this was going to be the future of much of surgery in the abdomen. And, you know, in his favor, he then supported me 100%. And so I cannot complain. And we were able to get a bunch of money from industry to help support stuff. I never made a penny myself, but was able to fund a fellow and a lot of pigs. And, you know, that was back in the day where you could do, you know, 10 small bowel resections, and I asked most of these in a pig, and presented at Sages and publish it. And we had engineers from the companies, you know, watching what we do, and helped develop clip-appliers and staplers, and, you know, all kinds of stuff. And nothing's named after me, and I had never made a penny, but it was a surette, a lot of fun. - Yeah, I mean, it's, as Jeff Ponsky always says, every time he arrives home, his wife said, you should have patented the PAG tube, you know. - Yeah, absolutely. - So your next move was to the big smoke? - Who, so my next move was to Northwestern. - Yeah. - Yeah, in Chicago, where I ended up, was recruited to be a vice chair of clinical affairs, and chief of kind of general surgery, and really get their simulation center rolling. And shortly, about a year and a half after I arrived, the chair at that time, Dick Bell, left to take a job at the American Board of Surgery, and I was named Interim Chair, and a year later was named permanent chair. Well, not permanent, but-- - As permanent as a chair. - As permanent as a chair. - Yeah. - Yeah, as permanent as a chair, ever it can be, you know. - Exactly. - Did you, you know, when you were, you know, working your way through bunches of pigs and was you, I mean, was, did you have a burning ambition to be a chair? - I did not. I did not, but I'd had some experience with leaders coming in above me with whom I did not see eye to eye, and realize what implications that could have. And so when the opportunity came to apply for this position, I weighed those things, thinking that yes, I believe I could do the job, and did I want to risk somebody else with a very different set of priorities coming in and telling me what to do. - Yeah, it's a fairly well-trodden path. The combination of a self-protective entity of saying, "I don't want anyone else to do it," and the arrogance of saying, "I can do it." You know, it's a combination. I mean, many, many people tell that story. And so you were 12 years, 12 years a chair? - I was 12 years chair at Northwestern, yeah. And then when those events happen, where somebody comes in above you and things change. - Yeah, I was 15 years a chair and same story. So I'll ask you the question that I asked myself afterwards. Were you a good chair? - I believe I was a better than average chair. We actually did a lot. We grew tremendously in the faculty. We went from 54th in NIH funding to 10th in the country during my tenure. We became much more of an academic department of surgery. And had a really strong surgical residency. So I was overall happy with what we had done. - Yeah, you know, I say to people that, you know, I was 15 years a chair and I think I was a pretty good chair for 12 of them. And it wasn't necessarily the last three, but you know, I've always interested in how individuals sustain their excellence or their efforts or whatever it might be. And it's just a reality, in my opinion. - Yep. - I don't care how famous you are. You're not always on the top of your game. - I take you right. - Did you sense that? - Yes, absolutely, not only that, but the job of a chair very much goes up and down in terms of your engagement depending on what you're doing. The fun part of being a chair is building something and developing things. And when the finances are okay and you can do that and when you're successful at recruiting, that is fun. I mean, that is the best. But if the budget's not so good or you have some problematic people and division chiefs below you that are causing trouble, or the people acting out that you have to discipline, then that is no fun at all. - Yeah. You know, in a sustained period of 25 years, I made three bad recruits. Well, I was with no names, of course. - Of course. - But those three bad recruits, I ran the risk of those three bad recruits to find me. Because they sucked so much oxygen out of the process. - Absolutely. Is that something that resonates with you? - Absolutely. A bad apple does spoil the bunch. And not only that, it sucks so much of your time away and your emotional energy. And you have to go through all the processes in order to try to do something about it. And sometimes those are foiled by various regulations, you know, in HR or whatever in your institution. So, you know, I sent a number of people to coaching and I would say of the, I think five people I sent to coaching, one was actually rehabilitated and the other four just kept doing exactly what they were doing before. - I asked a very good friend of mine, I won't name him, but he was chair of surgery. He's no longer with us, unfortunately, but he'd had a problem with a heart surgeon who had punched a perfusionist. Which is, you know, not very smart for a heart surgeon to do that, you know. And shall we say, it was not his first encounter with authority. And I said, what did you do with him? And he said, well, he sent him on a six week residential rehab thing at his own cost. And I said, well, what happened there? He says, back at work. You know, he's been back at work for the last year. And I said, well, you know, did it change him? And he said, no, not at all. He said, but he hasn't punched a perfusionist since he's back. And I came to the understanding that's the best I could hope for him. - Uh-huh. - You know, it's-- - Yeah, oh, absolutely. People are people, I guess, you know, et cetera. - Yeah, and often by the age of being an attending surgeon, their personality is pretty much set and there's not much you're gonna be able to do about it. - No, no, no. You know, there is that famous aphorism that, you know, when you're a leader, a third of people love you, a third of people hate you, and a third of people don't care. And, you know, I think that's probably reasonable. - Did you, somebody who fretted over being loved or not? - I didn't fret over it, but I must say, I wanted people not to love me necessarily, but to like me, they didn't think that I was a kind human being. - And did you struggle with the opposite? You know, did it distress you if you realize that suddenly that somebody has been saying bad things about you 'cause that always happens? - Yeah, it bothered me, yes. And I would try to bring that person into the office and talk things through. My guess is that never changed that person's feelings about me, but, you know, we all want to be loved. And, you know, if you want to be loved, you get a dog. And so I've always had dogs. But now I think it's a natural human condition. They want to be liked and to want the people who report up to you to think you're doing a good job and are a reasonable person. - So you alluded to the fact that 12 years in there was what we can call a geopolitical shift. - Yes. - And so suddenly this Midwestern boy is kicking just around in the desert. Tell me about that experience. - Well, I hung around at Northwestern for another year and a half because I was also program director and I did not want to desert the ship right away and wanted there to be some continuity and appointed a new program director and recruited another program director from within the ranks. So I could feel more comfortable that, you know, the place wouldn't have major upheaval. And then it's funny because my previous chief of transplant surgery at Northwestern, a guy by the name of Mike Avicassus had taken the job as dean of the College of Medicine at the University of Arizona College of Medicine in Tucson. - Yeah. - And called me out of the blue and said, hey, they're looking for a new chair of surgery at the University of Arizona College of Medicine in Phoenix. Would you even consider this? And I said, no, I don't think so. And two weeks later, I got a call from another guy who was actually the leader of the physician part of both medical schools who I had worked with previously at Northwestern. And he said, Nat, I really think you should think about this job, you know, it's a startup academic medical center, you know, we think that you could have a positive impact here. And this would be a good place for you to, you know, think about kind of finishing your career over the next, next number of years. And I thought about it and I talked to my wife about it and we had no kids at home at that point. And it sounded like something that might be interesting and exciting. And so I ended up coming and visiting and talking to a bunch of people. And my main question was, does the leadership get long? And is there a common purpose of the people here? And my sense was that, yes, that was the case and there was a lot of optimism about what could be done here. I had both at WashU and at Northwestern, when I had been there, they both moved from being primarily private practice to primarily employed academics over, you know, a 10-year period of time. This place was largely private practice for many years and now it is part of that evolution into more of an academic mindset and it's a new College of Medicine. And we have a bunch of new chairs who have been recruited who are from academic institutions. And I think we're all kind of pulling together now to see if we can't really develop something special here in the desert. That was my, just me. When you left Chicago, you, I mean, that wasn't plan A, obviously. You hung around for a year and a half, as you say, following. Did you deal with that easily? Did you, you know, everybody says never look back and all of that sort of stuff, but it's easier said than done, you know. - Oh, yeah. - You've basically uprooted your family and yourself from, in a way that you didn't have any plans and the natural senses, you know, that's not my fault. You know, I didn't, did you, how did you deal with that? Was that easy to deal with? Or did you, you're a golfer, I know. And I remember Doug Sanders. If you remember Doug Sanders? - Yeah. - He said to him, you know, you missed the playoff and the British opened by an 18 inch pot. He said, does it bother you? And he said, oh, not at all. He said, you know, some days I go an hour without thinking of us here. (laughing) - Yeah, no, it was hard at first. Certainly it was disappointing. It was unexpected and came out of the blue and sudden. So the dean called me into his office and said, I want your letter of resignation by five o'clock tonight. And I said, why? And he said, I don't need a reason why. - Nice. - And he called an emergency meeting of the faculty for the following morning to let them know that I had resigned. And so I started getting all these texts and phone calls. What do you have, pancreatic cancer? What's, you know, what's going on? And so it was a weird period where for a period of time I felt as though I was kind of licking my wounds, trying to figure out, you know, what would be the next thing. And, you know, I kept saying and my wife kept saying, well, things happen for a reason. And you wonder what that reason is. And in fact, you know, down five years later, whatever it is, it's not a bad reason. - Did you go through a phase of questioning your abilities? You know-- - Of course, of course. - Questioning my leadership. - Yeah. It's a tough thing to do. Large organizations, you know, are not very good with people. (laughs) - Right. - General. And it's a tough experience, I think, for anybody. It's actually, you know, let's assume there are individuals for whom that was the correct choice, namely to separate from them. It's tough for them as well. That doesn't really matter. I mean, it's still a stressful experience. - It's stressful and humbling. And, you know, I mean, there are a hundred emotions that this brought up. - Yeah. - But, you know, as with everything else, you get over it. - Exactly, yeah. So now you are in the desert. And so far, one assumes you have not been bitten by a rattlesnake. - Yep, haven't been bitten by a rattlesnake, have lived through the two hottest summers on record here, which most people can't fully understand, but we just passed 110 days of over a hundred degree weather this summer so far. And thankfully, my wife hates the heat. And so we ended up getting a place up in Flagstaff, which is two hour drive away and 30 degrees cooler. And she's up there from April through November. And I go up on the weekends and hang out with her and the four-legged kids. - Yeah, I like Flagstaff, it's nice. - Yeah. - And it's where they used to have one of the headquarters of Gore-Tex. - Of Gore, yep, absolutely. - If I recall. So not that you're proposing to disappear today or tomorrow, hopefully. - What's your view about being remembered? Is that something that interests you? Are you interested in legacy? Do you, how do you think people should want to be remembered? - I want to be remembered as an individual who did have an influence on surgery during my life, during my career. But probably more importantly, that I was an outstanding citizen, honest, didn't rip off patients or anything took good care of patients and was a kind individual. - Do you think that's changed over the years? As in, have you added more to the latter and eased off the former? - A little bit, yeah. And what's funny is now, at least here, and I think many places in the country, general surgery is going full bore robotics. - Yeah. - And I've made the conscious decision not to do that. And so next time I'm asked to give grand rounds, the title is gonna be minimally invasive surgery colon from revolutionary to dinosaur in one career. - Exactly, yeah. - But it's amazing how much has changed in the last 35, 36 years. - So that's as though there was a script in front of you 'cause one of the things I will ask, I often ask people is, and it seems blindingly obvious in your case, but what has been the biggest change for the better that you've seen? And then of course, the flip to that question. - Well, I honestly believe that the development of laparoscopy was revolutionary, and I think it did markedly help patients. I think robotics is just another step along the minimally invasive surgery continuum, and I think that there's some really good things about it, but I think we need to balance the cost and the utility and I think there's some cases that probably shouldn't be done robotically just because of the cost. Certainly, I was also involved in some of those clinical forays into natural orifice surgery and things, which I was kind of crazy. At the time, it seemed like a good idea, but after doing a few cases in humans, I realized that probably didn't make a lot of sense except that it got us into interluminal or intramural surgery, which I think there's early things that can be done best using that technology. I do worry a little bit about the trainees today. We asked one of our graduates a year after he'd graduated and went into private practice to come back and talk about his first year in practice at Grand Rounds, and he talked about, he's a general surgeon, two-thirds of his case has been robotic, and he talked about a case, he had a tough gallbladder that he couldn't do robotically, so he just stopped the operation and sent him to our hospital for an open colus mastectomy 'cause he didn't feel comfortable. - Yeah. - I'm concerned about that. And we have the advantage of having been brought up in the open era. I'm hoping that the kids today get enough trauma experience and things so they can do that, but it's clear that many of the undersurgeons don't feel comfortable converting to open non-colus mastectomies and things. - Yeah, it's interesting. You know, everybody, that concern has been articulated for probably 20 plus years. - Since the early 90s. - Yeah. - You asked about training in open colus. - Yeah, and my experience was that if you converted for a trainee, when it was converted, they knew how to take the gallbladder out. What they did not know how to set up was the setup of an open colus mastectomy, which was-- - The tracking and the retracting. - You know, and who stands there? I mean, it's kind of a set piece dance, you know, with the retractor here and the hand here and the pack there. They had no clue how to do that. - Right. - If you got that for them, then they could take the gallbladder out, you know? Which is kind of interesting. Yeah, I mean, I agree with you on the notes. I remember having a conversation with somebody who said to me, "Well, why wouldn't you do this?" And I said, "You know, I worry greatly about my anastomosis falling apart, you know, in any form of reconstructive surgery. Why would I punch a hole in a perfectly healthy stomach to take a gallbladder out, you know? It's the one thing I'm trying not to do, you know? - Right, right. - And it's, you know, a little Neanderthal, but nonetheless, I think-- - Well, we punched a few holes in stomachs, and we punched a few holes in vaginas and-- - Yeah, exactly. - And, you know, I thought it was cool, and obviously reported it, and then pretty rapidly said, "This is crazy. I don't know why we ever thought this was a good idea." - Yeah, yeah. So if a young faculty comes to see you on Monday morning and says, "So, Dr. Soper, you are a man of enormous wisdom and experience, and I'm just starting in my career, but I need to ask you what is it that really matters?" - What is it that really matters? Well, as a surgeon and I think in an academic center or not, I think that one must be a good technical surgeon, one must care about his patients and their welfare, one must be willing to mentor those below him or her, such that they can also achieve those same qualities, and one must help give back to the profession in one way or another so that it can improve. So be that teaching trainees, be that doing some kind of stuff where you push the field forward, be it, I mean, they're being it, joining the American College of Surgeons and things. I think there are lots of things that we can do for our specialty, and I think it's important we do that. - So those are all laudable aspirations, and I don't disagree with any of them. I strongly agree with them. But you know, as well as I do, there are faculty members walking your hallways and my hallways that don't take all of those boxes. They may take two, they may take three. The rare person is the quadruple threat, but so-- - Almost never anymore. - Yeah, exactly. So what is it that really matters? Ah, that's funny. So what I tell all the junior faculty who come to me for advice is they need to take care of themselves, they need to take care of their family and significant others. - Anybody ever tell you that when you were starting as? - Oh, hell no. No, and in fact, my wife still has problems with how I dealt with family early in my career. And the younger surgeons aren't willing to do that. And sometimes I'm not happy with that 'cause they're not finishing a chapter or a paper or something. But it's, in many ways, it's understandable. And the ones who are actually willing to do stuff at night and on the weekends are unicorns. - So you're 60-something now? What's the plan? - What's the plan, Stan? - Yeah. - The plan is when I feel as though I have probably done as much as I can, and probably more importantly, I have recruited a number of very good young faculty that I want to see and feel comfortable that they are on their way to a successful career, it'll be time to go. And that could be in a year or two and that could be in five. But given the fact that I've had a number of acquaintances who had health problems of late, I'm thinking probably sooner rather than later, but I don't want to say on air when that would be. - Of course. Do you have, amongst the people I've spoken to over the last year and a half, Jeff Matthews is one of the first and Barry Solke echoed this as well. Do you have somebody where you have a spoken or unspoken deal who tap you on the shoulder and say, "Not it's time." - I don't, unless it's my wife. - Yeah, she's been saying that for years probably. But should we, should we all? - That's an interesting question. If there were somebody near my age, maybe a little bit younger who I really trusted, then yeah, I could see doing that. Because I've actually pulled back my practice somewhat. So now, as I said, I'm the dinosaur. I'm doing open hernia repairs and laparoscopic collies and lap hernia repairs and stuff. And the chief residents want to operate with me to learn how to do those things, which is really fun. But they're also not terribly complex or time consuming. I think I can do that for a little bit longer without being too worried about my technical skills. If my wife tells me that my mental skills are deteriorating then that will end that. But I think that's a very fascinating question and the answer is no, I don't have that person. - Yeah, I don't. I'm in the same position as you. Jeff's view was that he thinks surgeons should undergo psychomotor incognative testing on a regular basis beyond the age of 60 something, whatever you want to choose. - Right. - Barry, who spent like 140 years in Mount Sinai had a deal with a partner that they, a mutual deal. And he describes it in his interview with me. A mutual deal that they would both agree to say to each other, you might want to. And I interviewed a colleague of mine in England who is a head and neck surgeon. And he's a guy I recruited to be head of head and neck surgery when I was chair there. And he was a young attending, helping his mentor who I knew was a very senior, very well-known guy. And it was the exact opposite. The guy was doing a pharyngeal pouch. And I mean, he describes this in the interview. It was making a bit of a mess of it. And, you know, the young guy says to him, you know, would you like me to take over? And he said to his enormous credit, he said, oh, would you? That would, you know, thank you, would you? Because he, as he said, his great skill at that moment was the recognition that he wasn't doing a good job. Yeah. And that's, you know, we've all seen the opposite to that. Absolutely. So. And that would be horrible to have that be ultimately your own legacy is that you stayed on long and screwed up. Yeah. Wouldn't be the first time that you know that. So that's, I don't want to finish our conversation on a sort of a sadish note. So I'm going to ask you some much more searching questions. These are very brief questions and equally brief answers, but they are sometimes what matters in life. What's your favorite movie? What is my favorite movie? Oh my goodness. There's several of these, by the way. So. Yeah, that, no, that is a hard one. So. I would say bridge over the river quiet. Oh, wow. I like kennis and okay. Okay. What's the best book you ever read? The Lord of the Rings. You know, I've never read that book. That's terrible. I was reading it aloud to my grandson last week. I've never read it. You know, I've never seen Harry Potter movies. All right, I have any favorite food. I would say, I'm an Iowa boy. So I'd say a good ribeye steak. Okay. Do you have any animal phobias? No. No scariest animal. Not really. What happens when we die? I believe that your spirit does leave your body and go somewhere. It's here in the ethos somewhere. And I fully believe that that spirit is kept alive by others remembering them. Have you ever asked anyone for an autograph? No. There's time. (laughing) Who would it be? Who would I, I would have said Willie Mays, but he just passed. He did, too nice, yeah. So who, having been in Chicago, Michael Jordan's would be a good one. Okay. And last question is, it's a Friday night tonight. You have a dinner at home, you're organized, and you suddenly discover you have two spare seats at the table for dinner guests, and you can invite anyone from history, dead or alive. Who is that couple or a pair of individuals that you invite? Well, because my wife would be at the dinner table with me, it would be the Obamas. Ah, and that would get you brownie points. That would get me brownie points, and I think it would be fascinating. Yeah, exactly. At the end of your time, Tom Varghese recently, he said he wanted to invite Nelson Mandela and Mahatma Gandhi. Um, I said, you know, the only worry about that would be if a fight broke out, you know. Yes. Between the two pacifists. You know. (laughing) Well, listen, Nat, I really am appreciative. I think it's been a fascinating conversation. I hope other people will find it fascinating, and I really appreciate you being so willing to chat about the ups and downs of your career. I think it's important for people to tell the truth about stuff sometime, because it's there in everybody's life. So I really appreciate your time. Thank you. Well, John, I appreciate you asking me to be involved, and if you could send me a link to the podcast or whatever, that would be great. 100%. I'll do that. Okay. Well, the best of luck to you. Thank you. (upbeat music) (upbeat music) (upbeat music)
