Ep. 22 | Colby Ruiz, MD, Vascular Surgeon, SGMC Health

Transcript

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- Welcome to another episode of

- What Brings You in Today? I'm Erika Bennett. And I'm Taylor Fisher. And we just wanna thank you for tuning in to our podcast series. If you've not already, please like and subscribe so you can stay in touch with every episode.

- And if you have any questions or topics you would like to hear us talk about, you can submit those at sgmc.org/podcast.

- Today we're here with Colby Ruiz, MD and vascular surgeon at SGMC Health. Dr. Ruiz, what brings you in today?

- Well, I was coming to talk about vascular surgery, but I saw Dr. Hardy already has a really thorough episode on that, so I'm really just here to hang out. I wanna talk a little bit about, you know, coming back home and being a doctor in Valdosta and, you know, all, all things about working here and, and this community that, that we both love so much. So I'm excited to be here. Thank you guys.

- I love it. 'cause you actually have a rich history with our organization. Were you born here by chance? I was actually born in Orlando. Okay. My parents were like moving up here in the process. They waited till I was like three months old and then they moved to Valdosta. So I've been here pretty much my whole life. Yeah. But I can't claim, you know, born here, live here, die here. I wish I could. That'd be a cool, that'd be a cool country song or

- Something. I, I know we do have some physicians that have been born here though. Yeah. Some of 'em that are maybe not maybe just are medical students. Anyways, I digress. Yeah. But tell us about your journey. 'cause you're, you had family that were worked

- Here. Yeah. Yeah. So I grew up here and both my parents are nurses. So they, they both worked at SGMC in different capacities and different roles over the years. But when I was in high school, we were trying to figure out what to do to kind of spend the summer and, and not waste it. You know, I was, was mowing lawns, but you can only do so much of that. So I volunteered, or my dad kind of told me I was gonna volunteer to come and work at the hospital. And I think I was 14 the first summer that I did it. And I was, you know, I was excited until I got to orientation and realized that we

- Were gonna have to wear these pink and white candy stripes and they don't make the volunteers wear that anymore. But it was truly terrible. I need to see photos of this. Yeah. Because I've heard about the candy stripers outfits, but I have not seen

- Yeah,

- The outfits.

- No, it was, it was pretty bad. They were like pink and white vertical stripes.

- Yeah. So it was

- Horrible. So I just basically, I said when we were talking about what the options were, I said, well what can I do and not wear that?

- Yeah. - And they put me in the, in the operating room. So that was really my first exposure to this and how I kind of got my feet wet and became interested in medicine.

- Very cool.

- Yeah,

- I always think it's so important to get our youth involved in the healthcare field. So I interview, we interviewed Dr. Griner on this podcast and he said that his mom had brought him to work and in the hospital a lot. So ever since that episode I've been bringing my children to, to work every day. And like here, you learn about this and you learn about this, but only before they go to school 'cause it's just right across the hall.

- No, I think that's awesome. Yeah.

- Expose 'em to, you know, the different opportunities so it is in your head, right. And something that you think about.

- Yeah. And that's something that, you know, as a kid, as a child, but even later on as a student, when you're trying to think about what you want your life to look like and what kind of career you would want to do. The only, I mean, it's hard to, you don't really know what anybody does right for a day-to-Day work in your day-to-day job. 'cause you don't see it to your point. And so, you know, there's a few jobs people think of and of course like, oh, I wanna be a doctor. That's a pretty common thing. That's one of 'em. But until you have seen it and experienced it, it's really hard to know what you're signing up for. So I think it's, that's a great point. It's really important for kids to be engaged with their parents, to see what their parents do and see what their parents' friends do. And you know, the reality is too, we're a small town. There's a few big industries in town, but you're not gonna see one 10th of the jobs that are available

- Right. In

- The world growing up here. So yeah, it's, it is kind of cool how things come together to lead you down a path. But I, you know, the most important thing for, for anybody that is interested in the medical field, or really this applies to any job, but is to try to get exposure and to have goals and set goals for yourself. And once you start to identify something that you're interested in, you gotta talk to somebody who's in that field and say, yeah, how did you get here? Or how does one get to the place that you're in so you can sit down and make intentional decisions that get you there.

- Yeah. - And I kind of joke about my dad signing me up for it, but I, I was curious about, you know, medicine and thought it was cool what my parents did. I had been seeing Dr. Grinder as my pediatrician and I kind of always looked up to him. So it's funny you, you mentioned him already. But yeah, it was, there was a lot of things and of course a lot of kids say like, oh I wanna be a doctor, I wanna help people, I wanna do this or that. And so I kind of set out with that as a goal and it really was an intentional decision even though I was 14 to explore it. And it really, I didn't realize at the time how good of a decision it was, but it was a great way to spend my summer. I got all the experience I wanted. I met a lot of people. And what I didn't realize at the time, I mean I knew, and it sounds silly 'cause my parents were nurses, but I didn't realize how much of an army it takes to make the operating room run. And that was actually really valuable for me even when I was getting into medical school and talking about that experience. It's, you know, back in the day everybody kind of not idolized, the surgeons probably idolize themselves. Okay. But you know, you kind of idolize the surgeon and you view them as like the person. And still a lot of our patients view me as the person that fixed, you know, X, Y, Z problem. But what you realize when you actually hit the ground and you're the one like helping to go get patients and helping to mop the floors and carrying stuff around and going run and get this really quick and hurry back. Like you don't do surgery by yourself. It's an entire team. And so being able to talk about that experience, you know, and when you're in your medical school interviews and I,

- I interviewed people for a little while, one of my favorite questions to ask people that wanted to go to medical, it's like, oh well why do you wanna go to medical school? And they always describe something generic. It's like, well I like science and I want to help people. I'm like, okay, well what, what's, what is it about medical school versus nursing school, pharmacy, school, you know, X, Y and Z And I could list off 10 different things. Why don't you wanna be a PA or a pharmacist or an x-ray technologist or whatever And they, you know, kind of look at you. And I got one to say one time, well doctors make more money. And I was like, okay, we'll have have fun. Have fun doing whatever it's you're gonna do with your life. Yeah. Definitely can't go in

- And purchase that. The best answers is when you can explain what it is that, you know, differentiates the role. But I was able to do that because I had seen what everybody did and looked what everybody did. And that

- Was, well especially in surgery because most patients don't even know because you get, a lot of times they're put to sleep and you don't, you, you're never awake in the operating room.

- Yeah. - And so really unless you work in those, I think

- Most of the time you're put to sleep. Right.

- Well I don't know, I think like a cath, like some procedures you're in different rooms and you're not necessarily asleep.

- Everybody, you know, so many

- People, it depends on what the procedure is.

- They come into my clinic and the first thing they ask, we start talking about, you gonna put me to asleep? Right. And I'm like, okay. You know, sometimes like yes obviously we're gonna put you to sleep for this, but actually wait to your point talking about caths and stuff we do, when we do minimally invasive surgery, it's not like, you know, a lot of the general surgeons do laparoscopy and so you're still doing basically the same thing. And so you need the patients to be asleep when you're doing, you know, some types of minimally invasive surgery. We, when we do catheterizations, we can have people under conscious sedation and it's, it is probably about 40% of the procedures I do. The patients can actually be awake and be talking to us through the procedure, which is, which is cool. And we make sure that they're comfortable and

- They don't have any pain. I would not be comfortable.

- Yeah. Well it's nice 'cause you can have them, you know, talk to them, feel better, Hey, how are you feeling? So I feel better just make a difference, blah. Yeah, exactly.

- I would freak out. Yeah, I would. I think I'd love it.

- Yeah. Yeah. Well speaking of now we have medications that calm me down.

- Don't worry about that. I know. I'm familiar. Yeah. Speaking of your, your specialty, what drew you to vascular surgery in particular? Yeah.

- Yeah. So, well we've already started to talk about, some of it was minimally invasive stuff. But when I was coming up here I was seeing, you know, a group of general surgeons that operated all over the body and that's what I thought I wanted to do. I said that mastery of anatomy is so cool they can fix so many different problems, do so many different things. And once you realize there's really a lot of depth of knowledge that you need to treat disease processes. And in medical school, you know, one of the things I realized is that, you know, you can't be an expert in everything. And I, it's not that people had told me that, but you realize it, the more you start to learn. But

- You still thought you could, you're like,

- Well no I'm not, IM not that arrogant. But no, but you start to see what they mean. Yeah. You know, and you understand what they mean. So when it came, when I was looking at the different surgical specialties, vascular really appealed to me. 'cause we really treat, you know, roughly or four different disease processes that can affect arteries and veins all over the body. And so they have different manifestations of different symptoms. You know, if you have blockage in your leg, it hurts when you walk. If you have a blockage in your carotid artery, you could have a stroke. And that presents very different from a patient standpoint. But the molecular biology of how it happens and et cetera and what medications you need to be on, you know, and antiplatelets antithrombotic, like that's all the same. So you learn this really, you you, you get a lot of depth that covers everything you do.

- So

- In a lot of specialties you, you work closely with like a medical counter counterpart, maybe a minimally invasive counterpart and whatever. So like the cardiac surgeons, they work really close with cardiologists, interventional cardiologists, you know, the thoracic surgeons have pulmonologists that they work really closely with and all this stuff. What I thought was cool about vascular is we kind of get to be in our own little corner, the expert on medical management diagnostic imaging, interpreting our own tests, minimally invasive surgery and catheter-based procedures and open surgery. And so I thought that was really cool. And what it boils down to when you're taking care of your patients is when I'm doing a procedure I don't have to do, you know, x, y or Z is the only option 'cause I have the open surgical and minimally invasive options. We get to really step back and this is, you know, my pitch to, you know, the, for the specialty is that I get to step back and say what's really the best thing for this patient in this situation. So I'm not tempted to push the limits of endovascular and just say, oh look what we could do technically speaking because I can think about what's gonna get this person 10 years down the road, 20 years down the road. And if you're young and healthy and you've got blockages and it hurts when you walk and you got a blockage in your leg, you're gonna do a lot better off sometimes with a bypass than with a stent. And I don't have to do a stent just 'cause I'm there. 'cause I also know how to do bypass surgery. So it's nice to be able to, you know, see a patient and have every option to offer them. And it's not like I'm thinking, I wonder if a surgeon would operate on this person. I get to make that decision and I have that expertise as well to apply to it. So I, I kind of, you know, you treat different patients differently. You may have the same anatomic lesion that you treat three different ways Right. And three different patients because they're at different stages of life. They have a different severity of symptoms. You know, somebody that has such bad blood flow that they have a wound is gonna get a different operation than somebody who just gets pain when they walk. And we get to kind of

- Put it all together. So you like the complexity of it and all the different options. Annoying.

- Yeah, absolutely.

- That's cool.

- Yeah, I remember after we did our podcast with Dr. Hardy, he's obviously so smart and I didn't know anything about vascular surgery and you said that we've already talked about it. We could talk about it again. I couldn't tell you what we talked about last time 'cause I was sitting here like what am I gonna ask him? 'cause I don't even really understand what

- He said. I know it was like very hard to ask him con convers questions because it was mind blowing. He was saying you were like, what? Well I just kind of wanna follow that up with what's your favorite food? Yeah. Just I trust you. I trust you. Sound like you know what you're talking about.

- God, he's a really smart guy. He's great to have as a partner.

- Yeah. - And we've done a lot actually had him help him out with the case this morning. So we worked together a lot. But yeah, I'm here to talk about, you know, the philosophical stuff, the fun stuff. Yeah. I love that it's actually, you know, some entertainment.

- Yeah. Well let's just touch on just a little bit of what you do treat. 'cause I know we talked about that with Dr. Hardy, but it's good to reiterate what a vascular surgeon normally treats.

- Absolutely. So we, we treat a, basically all of the blood vessels outside of the heart itself and the brain. So, you know, people that smoke or have diabetes can get blockages in their peripheral arteries meaning like in their legs and their arms. And they can have symptoms from not enough blood flow. And that can vary from either not enough blood flow when you're exercising. And so your legs hurt when you're walking. You get this cramping pain in your calves to pain that hurts all the time. And people with severe disease and sometimes even, you know, it gets so bad that the tissue starts to die and you can have ischemic wounds because your blood flow is so bad. And so we treat all of that. And the another cool thing about our specialty is that we have everything in house. So we do the wound care and we treat the, you know, the complex wounds and we treat the blood flow and et cetera. We treat patients with leg swelling and varicose veins and blood clots in their veins as well. And so those frequently affect the veins in the legs, but they can, you know, it can go to your lungs or can involve arteries or veins throughout the body. So we treat patients with, with blood clots, we treat patients who, this is kind of an interesting one who are on hemodialysis and they need access to get the blood circulated in the dialysis machines. So we work really closely with a group of nephrologists in town to make sure that people have a good reliable access. And that's actually a part of my job that I really enjoy. And there's actually there, there's really good scientific data that says that people who dialyze with a catheter are more likely to die sooner than people that have a functioning fistula or graft. And so to take somebody that's catheter dependent and be able to get rid of that is really fulfilling. And it's also more comfortable for the patients. You know, a lot of times they have to take sponge baths and stuff and because you can't get that catheter wax. Yeah. It's such a dangerous thing when they come in and they can shower for the first time. 'cause you got their catheter out after they've been dialyzed on that for like a year, people are happy. Yeah. So I like that reaction a lot. So that's a couple of things we've, we've talked about veins, we've talked about, we've talked about arteries, we've talked in the legs, we've talked about dialysis access. So another common one. We see a lot of patients that have had strokes or are at high risk for stroke who have narrowings in the arteries in their neck. And we have a few different ways that we can clean those out. So that's, that's pretty cool. And then, you know, depending on how bad it is, if they've had a stroke or if they've had many strokes or certain symptoms, we can reduce their stroke risk in the next five years from 25% down to less than 10% by doing that surgery. And if it's somebody that has at asymptomatic blockage, but it's a bad blockage, we can take their risk from about 11% down to less than 5%. So that's one of my favorite operations to do. Yeah. It's stressful, don't get me wrong, to take somebody who hasn't had a stroke and do a surgery that has a very small risk of causing a stroke to prevent them long term. But you know, fortunately we've been very successful. We have a, a very good crowded program here and a great team and and we've had good success with that. So that's another one. And then aneurysms is really complex and it's kind of a hard thing to wrap your mind around. But I, I think of it as like you're blowing up a balloon and as the, as you're putting more pressure, the wall is actually getting weaker because it's getting thinner and it's, the reason it's expanding is to decrease the wall stress that's spread out over any one area. It's kind of some complex physics, but the the point is that as that, as that balloon gets bigger, it's closer and closer to popping. And if you think about a blood vessel and the wall's getting weak and it's getting bigger, it's telling you that it's on its way towards rupture, which can be catastrophic as you could imagine. And so we, we do some minimally invasive procedures and open procedures to repair aneurysms, most commonly involving the aorta, which is the biggest blood vessel in the body. So that, that's pretty exciting surgery and can make a big difference for people. And then we're here for emergencies. So we've, since I've been here, I've been here since July 15th, we have treated four or five patients who actually came in, didn't know they had an aneurysm, came in with a ruptured aneurysm. And so that, that gets a little bit crazy.

- What are this, I mean, so what do they come, what does a ruptured aneurysm do? What, how does that present? Well, I mean obviously the,

- This the sad part what's happen, the part, the sad statistic is that 80% of people that have ruptured aneurysm in the involving the aorta don't even survive to the hospital. Right. So we get the people that have survived to the hospital and they're coming here either transferred from another institution or occasionally they're, they'll show up in our er, but a lot of times it's either severe chest pain or abdominal pain and then they'll pass out. And that's how, you know, 'cause your blood pressure just dropped. And so the faster they could get here the better. And ideally we like to find it before it gets to that point. Right. You know, and I, we can talk a little bit about other reasons. I like vascular surgery, but, but without going on a tangent about me focusing on the patients is really important for people that have ever smoked, especially men. But it, the disease occurs in men and women to get screened when they turn 65 on their welcome to Medicare exam. And so Medicare will pay for it definitely in male patients and then in female patients where our society is still working with CMS to get that approved. 'cause women have aneurysms too. It's just a slightly lower rate than men. But they basically, they say if you've smoked a hundred in your life, when you turn 65, you should be screened because CMS and all the major surgical societies that that work with us has identified that this is a very, you know, high risk of mortality and it's a common enough disease process that it, it merits a screening exam to get checked. Yeah. So that's the best thing I could tell people listening is if you fall into those categories, it's where the screen and then people that have family members with aneurysms or you know, a family member that's had a rupture or something like that, they need to be screened at a younger age. And I would say, you know, there's no guidelines so to speak, but you know, you should be screened five to 10 years before your sibling or one of your parents, you know, develop

- The process. How does that process, how does that screening work? Is it like a full body scan or do you Oh, it's

- Very simple. They just come in. We actually do it in the office. It's an ultrasound.

- So - Just like, you know, looking for a baby in there. They just put the ultrasound probe on, do a quick skin of the aorta and people are in and out in 15 minutes. Wow. So it's, it's a really simple thing that can save you from a bad problem.

- Yeah, well especially like you said, 'cause it is hard to, to come back from that because it's such a Yeah,

- Absolutely.

- Yeah.

- And I like our specialty 'cause there's so much you, you know, you get the variety. So there's some cases that come in. I really enjoy the planning and you can spend hours with a CT scan thinking about every meticulous detail of how you're gonna fix something, what order you're gonna do things, how you might vary from your usual routine and how you need to set up to be prepared to do that. And then somebody comes in ruptured, you have 13 seconds to look at the scan and make a plan. And so you have to be so good at it that you could do it that fast. But it is, I like it better when, you know

- Yeah, - They're elective and you can take your time and really make sure you nail it and get everything perfect. Not that we

- Can't fix the rupture, but they can this and Grey's Anatomy.

- Yeah.

- There, there were several, I think they called them aaas of Dom Aortic Aneurysm.

- Aneurysm. There you go.

- And that was always a big deal in Grey's Anatomy. Like they never thought that they were gonna save that person. So it's kind of the same thing. Good. 'cause I've watched Grey's Anatomy, so I kind of

- Yeah,

- Yeah, obviously

- That's right. That's right. Well you got it. We're on the same page talking about this. It's a big deal. No, but we are, you know, we do have a very successful, you know, track record in treating those. Yeah. And the, the surgery is so simple to fix it. You'd be shocked if you have one. And we talk about it, it's technically complex, but it works really well and people are back to, you know, back to work or back to their activities within six, you know, not even six weeks, four weeks most of the time. So I, I like doing that.

- Well, thinking about your career and or you're getting to where you're starting your career, you just, you knew you were gonna be a physician and then, I mean that's a long school, you know. Yeah. Lot of education. Right. And now that you've finally kind of tell us how many years now that you're here Yes. How does it feel to be able to be, you know, really getting into the

- Yeah.

- Grind of things.

- Well the feeling on this side is awesome and every time I think I'm having a bad day or a tough day, I look back. Actually my little brother is doing the same thing as me. So I'll call him and hear about what he's doing and I'm like, oh man, thank goodness I'm not in residency. You

- Survived.

- No. So I, I did everything that I could to get here as quickly as I could because I kind of knew what I wanted to do. And then at towards the end, I knew Dr. Hardy was here and I knew he was ramping things up and that I could had the potential opportunity to come and join him. So that was kind of in the back of my mind the whole time. But I graduated high school and then I did, I went to University of Georgia. So I was four years in the University of Georgia and I studied in the agricultural school, biological science of agriculture. So that was, that was cool. That was a great experience. Georgia did a lot to get me set up for success in medical school. You know, like I said, you have to be intentional and you have to know what goal you're trying to get to. But the opportunities are, you know, huge there. So I went there, had a couple options. I chose to go to the University of North Carolina for medical school and I had a really good experience there. And that was another four years. So that's, you know, we're at eight now after high school. And then I was looking at residency options and there's two ways to become a vascular surgeon. You can do five years of general surgery and then a two year fellowship. Or they have an integrated training program where you do five years to do vascular and it's, it's similar like your first three years you do a lot of general surgery rotation. So you still get a lot of the relevant experience from general surgery that applies to vascular. But you spend a lot more time on vascular the whole time. So, you know, in my first year it's called your intern year. I think I did four or five months on the vascular surgery service. And then the rest of my time was various rotations that are in general surgery that are relevant to what we do. And then my second year it was six months, then my third year it was like seven months of vascular. And then my last two years I was basically the equivalent of a vascular fellowship. So I did five years after that. So all in all, it's really, if anybody's interested, it's the best deal in surgery because most people do a fellowship after their general surgery training. So I shaved off two years Yeah. Doing it this way. And it was 13 in total. Yeah. So eight plus five.

- I was sitting here trying to add that together. I'm not good at math.

- I was like, that's how we can't tell any children though how long it takes to become a daughter. 'cause I know they will not. But

- I'll tell you, I, it seems

- So long, but mean obviously

- You have

- To do it that long to get good at it, to be able to feel good about it when those emergency situations come in.

- Yeah. And it really all boils down to those last couple years when you're doing vascular surgery every day and you're doing more and more independently and being at a good training program, I was very fortunate to be able to be with some really good vascular surgeons that I look up to a lot in a lot of different ways. But that was really, you know, the meat and potatoes of training is the last two years you have to spend all this time, like if you go sign up to work, you know you wanna work in a five star restaurant or whatever, three Michelin star restaurant, there's no five stars, three star restaurant and you walk into the kitchen on your first day, you gotta show 'em that you know how to, you know, chop carrots and onions, proficiently, make stuff look pretty before they're gonna let you start plating before you ever touch anything in the kitchen where you're cooking, you know, before you're ever designing a menu. So you have to have like hundreds and hundreds of basic skills and a knowledge base to take care of patients before you start to actually get to, you know, yeah. Do anything. So the, the last two years really culminates the, the training. But fast forward to coming down here. Obviously it's nerve wracking Because you're like the balls of your court's all your responsibility now. But I was so thankful when I got here. I'll tell a quick story about Hardy since he's not here. Since

- He's not here to defend

- Himself. Yeah, that's right. No, so he was in clinic, it was a Monday, it was by, so I got here on a Wednesday, it was my first day

- And

- I had like go around and meet some people, get my badge, see where the scrubs are, you know, stuff that I kind of knew 'cause I was here, but I had to like retrain. And so that was Wednesday, Thursday, Friday, I think Friday. I like scrubbed in on one of Hardy's cases and helped him out for five minutes. It was fun. I was like, okay, this is gonna be nice. I'm just easing my way into it. Monday he had clinic, he was on call, I'm in the office like just looking up patients to get ready for my Tuesday clinic and he, at lunchtime he called me, he was like, Hey, I'm down here in the er, I'm seeing somebody I think probably needs surgery. I was gonna cancel all my afternoon patients, but if you wanna take care of it, that'd be great. And I was like, yeah sure. What's like, what's going on? He was like, just, just come down here. Doctor's getting doctor doctors are np, he's like doctor's getting him set up. I get down there. It was an absolute disaster. This poor man had like ruptured infected femoral artery aneurysm. I actually just saw him this week and he's just now completely recovered from this. Okay. It took a long time.

- Yeah.

- So I got down there, I was like, man, this is gonna be a problem. So we, we ran to the OR and it was an absolute, you know, it it was a life-threatening situation. Yeah. It was, it was basically a ruptured aneurysm in the groin rather than in the belly. But there was also the infection component. So it was, you know, several hours of surgery getting that all repaired, getting him to the ICU, getting him better. The next day we took him back and did some complex stuff to get the wound to close and heal and he just, yeah, he came into clinic Tuesday and just completely recovered, which was a long road for him. Yeah. But that was my introduction to South Georgia Medical Center. Yeah. And I ran into Dr. Ziegler in the lounge afterwards and he was like, Hey, how's it going? What you been up to? I was like, I just did something I have, I've never seen before. Yeah. I've had a case I've never seen before. He is like, you better get used to that buddy. This is Valdosta.

- And that's how we recruit a lot of our physicians because we, you do have the opportunity to see so many different things because of our population that we have here. So, but I

- Mean, yeah. But it's not that, I guess to the point, I guess to finish the thought there before we move on, I say I've never seen that before. I've seen a lot of similar to things and you have this skillset, you have, you know, a toolbox where it's like, I know how to do this. I know how to do this. I know how to do this, I know how to do that. You got all these options and things you can do and you know, what's, what's good in which situation. That's one of the really fun things about what we do. It's, it's very common to do something that you've never done before. I did that this morning at, when I was running over here. It's about like I've done every piece of it before so I can put it together to do what the patient needs. And so that's what it was when I got through that case. I was like, this is actually gonna be pretty fun. Yeah. And it has been. And so I, I've had a lot of really good support from Dr. Hardy and from my other partners in the cardiovascular group. I've got, you know, built some really good relationships with the physicians that are here and it's, it's growing and that they're keeping us busy. And you know, the cool thing is that now, you know, I've been here a short amount of time, we're already seeing substantially more patients than Dr. Hardy was able to see on his own. And so we really are starting to grow it and being able to get to people faster and it's just an, an exciting time.

- That's exactly what I was gonna say is the fact that he didn't have to cancel his patients. Yeah. And you were able to, you know, step right in because his clinic is

- Booked out six weeks if you're a new patient, you know, well both of us, if you're a new patient you wanna see us, it might take four to six weeks to get you in a to get you in a slot that's come down since I got here substantially. But at the time it was like we're just

- Right.

- It, it really,

- Yeah. The needs

- Kills the system. Right. It really hurts people. Those patients that are waiting to see him. If we, if we don't keep moving, so now that there's two of us, every emergency doesn't derail your entire day. We can take turns cover for each other and it really makes it function more efficiently. So

- Very

- Good. It's good to be here.

- Very

- Good.

- I think that's wonderful. I think we've covered so much. I did wanna ask if you had a memorable like patient story or anything that sticks out to you that you've seen that was maybe rare or just interesting. Yeah. Or something like that.

- Yeah, well we kind of, so we cut off, we talked about probably 80% of stuff that we do. So I'll say there was that, you know, kind of talking about other things that you wouldn't expect a vascular surgeon to necessarily do or whatever. We had a patient that was here that was really sick with a GI bleed and they, we tried everything medically to try to get it to stop. They were doing a really good job at give, you know, requiring a lot of blood transfusions just to keep 'em alive. And it was like, hey, we're at a point where this isn't sustainable and we're reaching the end of what we can do. So they called me and we had a CT scan, we couldn't see where it was bleeding. So I worked with the ICU, worked with the GI medicine team, worked with the medicine team. We got 'em stabilized to the point that they could do an endoscopy the next day. And so they took him, did an endoscopy and they said, Hey, there's this huge blood clot sitting on this duana ulcer. We can't take it off to go see what's underneath it. 'cause we're scared that if we, if we do that, it could be a really big problem we can't fix. So we just left it. That's what he's got. So I sat down, looked at the CT scan and I tossed with Dr. Hardy to talked about the case. We talk about, you know, 80% of the patients that either one of us operates on. We have a conversation about, which is a really cool part of being part of a small group Because we're so close. We talk about everything. We bounce ideas off of each other. We're, I'm surprised at how much we're on the same page. And it's cool to see the, you know, common threads in training, which we can. We have one guy that trained both of us that we took a lot away from. So that's part of it. But talked to him about the case that here's what I see, you know, blah blah blah blah blah. And this is a Sunday night at 7:00 PM And I said this is what I think I need to do. I'm, when I try to go get in this branch that feeds that area and embolize it or shut it down basically with these little coils. And he was like, well I'm not doing anything. I'll come up there and give you a second set of eyes. Take a set of hands if you want. So he came in and watched me do it and we were like, you know, hanging out and talking the whole time as we're we're working and I was able to get into this small branch and I said, what catheter would you use here? And he told me and I put it in, it just went right where we wanted it to go. We dropped the coils and then the guy was, he has not required another unit of blood since then.

- Wow. - He is actually leaving the hospital today. He been a week and a half ago. So that was pretty cool. So there's all kind of interesting situations that we can get involved in that you wouldn't expect, but Yeah.

- But isn't it cool to be able to work with good people and

- Oh yeah.

- I mean that, I think that makes you spend so much time at your job and in your career and I think when you have the right team in place

- Yeah.

- It just makes the world of difference for everyone. So I think that's cool.

- So, and our, our quality of life has gone up too. I know he was just like working around the clock and you know, this is a great place to work, it's a great place to live. And the last week I think I've missed dinner one time to be up here working. So it's, it's really kind of everything that I wanted out of a practice. I've got great support from the hospital and from my, my partners and colleagues. It's a really solid group of physicians working here.

- Yeah. And we're growing. We've got a lot of new specialties coming in and stuff, so it's an exciting time to be a part of this organization.

- Yeah. And then all the training we're doing too, I mean we have the, the residencies about to graduate their first class. We've got more and more students now. We have one to two students every week working with me and Dr. Hardy. We're just one little island in this big hospital.

- Yeah.

- So it's cool to see that aspect growing. None of that was here right when I left 13 years ago. Yeah. Yeah. I was like, you know, so it probably me meant I got more attention as a volunteer 'cause I was like very curious. But

- Anyway. Well I think we're at our time limit. It went by fast. Yeah. But I do wanna say just for anybody that is interested for the, we call it the canopy of care now. Yeah. Which is the program that Dr. Ruiz is mentioning, but it's, I think it's 14 to 17 year olds and they can volunteer like six or seven weeks throughout the summer. So if that is something you're interested in, we will link the application or at least the page for that below and they can apply for that to participate during the summer. So it is a

- Good, it very well could be the most valuable thing you do all

- Summer. You might, you might need to talk so you kid, kid into doing it. 'cause you know you might, might turn into be a vascular surgeon.

- So Yeah. You can come hang out with us. He or you.

- There you go. Well I also wanna ask, since you are so familiar with this place, what is your favorite meal to eat here?

- Oh, every Wednesday it's fried chicken, banana pudding. Easiest question I've had all day.

- Yes. That that's a fan favorite for, for some people. Yeah. I feel like some of the physicians don't wanna admit that they eat the fried chicken.

- I'll say

- It. So I try to think of like a healthy option.

- Yeah. There are healthy options, which I appreciate. But Wednesdays I don't mess with 'em.

- Yeah. Can eat, you can eat fried chicken a week. Wednesdays. Yeah.

- We week. Yeah, exactly.

- Good. Alright, well thank you so much for joining us today.

- Absolutely.

- Thank you to all of our listeners for joining us and we just appreciate it if you like and subscribe and get the episodes downloaded every time we release them. And if you have any questions, you can submit them at sgmc.org/podcast.