Ep. 16 | Kimberly Mackey, MD, Neurosurgery, 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 all of our listeners for tuning in today. We have a very special episode with Dr. Kimberly Mackey, who is a neurosurgeon at SGMC Health. Dr. Mackey, what brings you in today?

- Well, Erika and Taylor, thank you for having me on the show today. I'm here to discuss neurosurgery and tell your listeners a little bit about it.

- So that's the common thing is it can't be as hard as brain surgery. You know, either that or rocket science.

- I was gonna say, I use the rocket science one I like, it's not rocket science.

- So tell us a little bit about neurosurgery. One, tell us about your journey first, what led you to become a neurosurgeon?

- Ooh, I have a long journey. So from a very young age, I always wanted to be a physician. I always was attracted to the specialties in medicine that I felt could address things in a quick manner. So in many ways there is a very long healing process for the brain and the spinal cord and the nerves. But you know, you, you, you get in, you do the surgery and you know, you've done the bulk of your work. And I was always interested in that more than primary care, other fields of medicine where you watch things over years and years. Now we do develop relationships with patients for over years and years. But there is something, there's a good appeal to me about getting through with your, your task within a day cycle. I initially wanted to be a plastic surgeon and I wanted to operate on children cleft lip and palate. But through my journey in medical school and beyond, I switched over to neurosurgery. So I'm from Detroit, Michigan. I went to school in Ann Arbor and I went to medical school in Chicago. And then I ultimately did my residency training in, at the University of Pittsburgh in Pennsylvania. And after residency I went out to St. Jude Hospital in Memphis, Tennessee and did my fellowship in pediatric neurosurgery. I very quickly met my husband who is in the US Air Force and he has brought me and our family to Valdosta. So here I focus primarily on general adult neurosurgery, but that is, that is how we got to this point for me

- Today. Well, I'll say you're a special kind of person because I very vividly remember in high school getting on my computer, dialing in and looking up. I wanted to be a plastic surgeon. So I looked up how many years you had to go to school and it didn't take me long to realize I was not gonna be a plastic surgeon. It takes so

- Much fully. It does, it does. All the surgical specialties do take a long time. You know, we like of course we're brain surgeons so we like to brag. Ours takes the longest if you just count the initial training, but yeah, it's about seven years. So we go to four years of, of college, four years of medical school. And then I did eight years of training. I did seven years of neurosurgery residency and then one year in p in a pediatric fellowship. So I say from after high school, it took me 16 years of school to get here. So that is a while. I feel like it's an education

- From your like grade school. Yes.

- I think it makes sense that brain surgery takes the longest.

- Agreed.

- Yeah. Yeah. I don't want the heart surgeons out there to get salty on me for saying that because they take about the same amount of time and stuff, but yeah, it does, does take a while. So it's

- Very important what you're dealing with. So just what are the kind of common things that people would come to see you to consult for?

- Yeah, so general neurosurgery, I think there's a definitely a, maybe a misconception that what, that we do just brain surgery and that's, that's not true. So we actually do a lot with the spine and the peripheral nerves. So we really function in two worlds. So we have the emergency acute inpatient side of things. So that would be patients who have hemorrhagic strokes. So they have a type of stroke where they have bleeding in their brain, where have patients with come in with seizures or headaches or different presentations and they have a brain tumor and people who have cancer and have the cancer having gone to the brain. You know, situations like that. And obviously a big aspect of what we do is operating on trauma. And that would be trauma to the brain or trauma to the spine. The spinal column, which are the bones of the spine or the spinal cord itself. That's sort of the acute emergency deal with within, immediately to a couple days, you know, inpatient side. The other side is our outpatient and, and clinic practice. Yeah. Practice. So that really is ta it is more the core of what we do because we're, we can't plan for emergencies. We can't plan when a brain tumor's gonna pop up. But we have, we develop relationships with patients who are, have issues of, of back pain, of neck pain, back pain, pain running down their leg, which is called sciatica pain, running down their arm, you know, radiculopathy and, and who have peripheral nerve entrapment. So that's diseases you've heard of such as carpal tunnel syndrome, nar, nerve entrapment and issues like that. So it's, it's really two somewhat unique worlds of the emergency inpatient and then the, you know, working with people to manage long-term pain issues in the outpatient. So

- You kind of get the best of both worlds. You get the Yes, definitely the ER side. Yep. But then also the more developing that relationship and figuring out what's wrong with someone

- Who's suffer. Of course we have a relationship with the people that we operate on emergently, but we don't, we don't get, always get that time in the beginning to forge that relationship. It's usually a relationship built on the back end. We know those, you know, we follow our patients for years, obviously, but that they are, they are, they do have a very different feel and I do like that contrast. So it does keep my life, my practice, like my day to day is highly variable. Yes. You never know what's coming in. So yeah.

- That's why we went into marketing because VR our day is never the same.

- You have to deal with all these doctor personalities. Right.

- You flexible. Absolutely. So as far as procedures, I know you've brought a variety of new procedures to SGMC Health, I know the VNS therapy. Maybe tell us a little bit about that or any other ones that you kind of specialize in that's relatively new to our area.

- Yeah, so when I came here, oh man, it's, it's going on five years now and time really flies. It does, has it really been that long? Four. Four. Okay. So I count the years and the years of my husband's military. We as do and commander, and then we kind of can remember how many years have I been here? So I'm going into my fifth year. But we, we came here, we were able to secure a very big purchase for the hospital, which was an image guided system up, you know, the newest cutting edge technology that we're able to use where it's, I describe it to my patients as a GPS or a, a tracker for the inside of your brain. So we get a preoperative image, like a CT or an MRI, and then we have a machine in the operating room that uploads that patient, that particular patient's image. And then we register their skull in their head to the image, the preoperative image. And then we have a pointer. So, you know, everyone thinks it's, it's not brain surgery, but I really tell you we should say it's not rocket science. 'cause I could never imagine being an engineer or a scientist of that capacity. We have a, we have a tool literally that will point for us where the problem is in the brain. And so that's really cool technology that it's not, it's not brand new. It has existed for, for, you know, it was around when I was going into training, which was not that, I'm not that old, it's not that long ago, but we were able to get that here in South Georgia. And that's a, that's a big deal's for a regional hospitals bill

- A little bit more

- Secure, you know, I mean, yeah, for sure. Like I even say, even if I don't know where I'm going, the machine can get it wrong. So, you know, that is really nice. It's, of course we base the surgery on our own expertise, but it is, it is a fail safe. It is, you know, just another extra security and check in the process. So that's nice to have. We did reinvigorate, we did bring vagal nerve stimulation to this hospital that is also not brand new technology. I, I, this is not gonna be factual correct, but I would probably say it's existed maybe 20 years someone will be able to correct me on the exact date. But in terms of bringing it, you know, and that is in the world that has existed. But in terms of bringing it to a hospital such as South Georgia, that was something we were able to do. And so that is great treatment for our epilepsy patients. So people who have seizure disorder that is refractory to treatment or maybe they just are on too many seizure medications and they're looking to get off of 'em. Vagal nerve stimulation is really picking up in the world in treatment for some psychiatric disorders and whatnot. Now it's the same, it's the same surgery, it's the same implant. A lot of things have to do with FDA approval and whatnot. But even that technology from the research is really advancing. And as those advances happen, we have everything set up to incorporate that here in South Georgia. The third thing I would like to talk about in terms of what I can think of, what have I uniquely brought a co I think a, I know a month or so ago you had my colleague Dr. Curtly on the show. I saw his episode. I know he was excited to be here, but I he did, he talked about the knee procedure and that is a procedure that we are able to, he is able to block a particular sensory nerve in the knee, the medial, the inside, the inside part of the knee called the infra patella saphenous nerve. And that is a nerve that God put in there that tells us if we have pain. So it's not there to move our leg or move our knee. It gives us some of the sensation if you touch, but it's really there to be a signal to our brain that, oh, something bad happened to the knee. You know, I got hit with a baseball bat in my knee. I don't know why that would happen, but if it did, and then my brain says, oh, you gotta run away. Right? So that's the only reason we have that nerve. So some people have, as we age, or maybe not, if we've had a prior injury or even prior, you know, total knee surgery, we knee, knee replacement, there can be pain associated with that nerve and people just have to live with that. So Dr. Kirtley is able to get these patients into clinic, block them with a medication, and if they have a positive response. So if they say, you know what, you hit the spot. That's that, that's right. That's it. That took away a big portion of my pain. We like to see an 80% reduction in pain. So what I tell patients is, if you have 10 outta 10 pain in your right knee before sur before, and then Dr. Kirtley does the block and it comes down to, you know, a two outta 10 or a three outta 10, then you would come meet with me and we would talk about doing a very straightforward surgery where we go in with the ultrasound, we identify the nerve in the operating room, and I'm able to cut the nerve so that nerve is, is gone. Okay. So if it gets blocked, that block is gonna wear off after a couple days. So people are thrilled for, you know, 48 hours and then they wake up and their pain has come back and that's 'cause the medication has worn off. So we can go in and make that permanent. We always say we are not orthopedic surgeons. We, they, they are the boss of the knee. They are the ones who make these determinations about what surgery is needed. I'm not a a knee joint surgeon at all. I'm a brain and spine doctor. But for these, a lot of our referrals come from the orthopedic surgeons who say, Hey, we did all we could, what about a consideration for a a a a nerve, a nerve surgery because Dr. Kirtley and I, we are nerve doctors. So that's a really cool procedure that's not actually done anywhere. And I think people think we're they, don't, they, they they have a hard time I think trusting that, trusting that or something. Yeah. It's like really, like a surgery is being invented at South Georgia Medical Center, you know, at SGMC Health. Right. Like that's happening here. And, and, and I, you know, we were not the first people to find this nerve. Most of anatomy has been defined at this point, you know, for over hundreds of years. We, we weren't the first people to cut this nerve. Some of that technology or that findings were pioneered at Johns Hopkins University by a plastic surgeon decades ago. But it wasn't expanded to this patient population and it wasn't done in this minimally invasive ultrasound way. They were doing large dissections, you know, 10, 10 inch incisions and opening up the whole leg. And this is just, we find it, we make a one, one or two centimeter incision and we're able to go down and cut it. So there's some literature out of some hospitals in other countries. There's a hospital in Israel also doing a large surgery that we have found. But we are the first place to do this. And it has a lot to do with the unique partnership that Dr. Kirtley and I have. So that I have with a lot of physicians here. You know, a lot of the pain management doctors. So, you know, I work closely with Dr. Kirtley and Dr. Bailey, two of our great pain management doctors we have here. So in working with them with, when we work closely, we can have this multidisciplinary approach that, you know, a lot of places, I've been a lot of places at this point 'cause of the military. I've moved around a lot of hospitals and we, you just don't always see that those relationships fostered in that way. Well I think

- That's what's I've enjoyed watching over the past couple of years, specifically as we've started to grow our physician network and bring on new specialists, a lot of younger specialists that are coming out just outta training with that fresh, you know, all these new ideas. And to be able to have the caliber of physicians such as you and Dr. Kirtley and kind of see what you can do. I think it's, it's really cool that that's happening here in our area.

- Yeah, definitely. I had no idea we even had a neurosurgeon here until I started working here and I was like, our only neurosurgeon is the female neurosurgeon. And I thought that was the coolest thing ever. Yeah,

- Because they're very rare, right. To have.

- Yeah. So tell us about Yeah, so I I I am employed, I work with SGMC Health, there is a, a private neurosurgeon in town, Dr. Khalil, and he has been in practice, it's very hard to do this specialty on your own. So it it, you know, I I'm sure it came as a relief to Dr. Khalil to have another person to help shoulder the burden and is a, you know, like we, so I talked about there's a lot of acute problems. There's a lot of 2:00 AM you know, phone calls and, and unfortunately people, people cannot plan when they get in an accident. You know, or if they could, they would avoid it. Right? So, you know, we're we're there as a, as that hopefully we can be that security blanket to people that we're, we're, we're in our houses 10, five minutes away, 10 minutes up the road and we're there if you need you, you know, if, if you need us. So I'm the, I'm the SGMC health employed neurosurgeon. But, you know, it it, yeah. So I think that just knowing that we, we can be here and we can be in this community and be there for everybody is, is really important and very meaningful for me. You know, there's always these, everybody talks about find something fulfilling in life. It's not about money, it's not know, it's not about life. And, and you know, I I feel like I live in a, a world where that is so true. You know, I'm not when if you can help people like you will just go to bed more fulfilled in your life every day. You know, it just feels better to look in the mirror every day. So I have an opportunity to do that here. And that's, that's truly a

- Great thing. I was gonna say, what's the most gratifying thing that, about your job that you found?

- You know, I would say what gets me the most excited is two things. One is doing a surgery and then often we do a spine surgery. And when then we check on the patient, you know, there's anesthesia if we call 'em in the morning or we, we are ready to discharge them the next morning. If they did stay the night in the one night in the hospital or, or whatnot and saying, did your pain, is your pain gone? Does that leg feel better? Can you tell we got the pressure off the nerve. Like it's that. And they, they get up with the physical therapist or they get up to walk to the bathroom for the first time and they say, oh my gosh, it's gone. You know? Yeah. So that, and then you're like, yes, you know, we got it right. We were able to do something that these people have maybe for years, maybe for decades, been living with a certain pain. So to know that that thing that they feel every time they move, you know, that Yeah. Has totally changed their life. That then you have taken away, you know, or you've helped or, you know, maybe not fixed completely, but helped significantly. That feels really cool. You know, that when you know there's nobody else who is able to achieve that, you know, that you're, you're here in order to do that. And the second thing is, when you, is that second aspect of my job, which is the emergency. When you have a person who is so ill, you know, they're in the emergency department, they're likely being put on a ventilator. We just, you know, we just don't know what's gonna come out of it. And we're able to take them emergently to the operating room. We have such a good operating room. We have so many good nurses and technologists in that operating room to get those cases accomplished. And then to see the patient wake up and recover.

- Yeah. One of those that, I mean we can talk about because they've given us permission to talk about was the, the gentleman during Hurricane Ilia who was the tree fell on him, I think. And he had a very serious brain injury. And it was staying, I think at our hospital, what, like three weeks or three months maybe.

- He stayed months. Yeah, yeah. And then, I don't know if it was three months, but it was more than three weeks. Yeah, yeah,

- Yeah. It was, it was months. And then he got, you know, well enough to be able to go do his rehab. You know, it was a very specific type of rehab he had to go do somewhere else. Yeah. But I mean, his family was so grateful for the team and just knowing that we're here when something like that happens. 'cause like you said, that's a, you know, freak accident. Yeah. And you can't plan for those.

- Yeah. Yeah. That young man is in his early twenties and he, he stopped to help. I mean, he was driving and he saw them trying to move a,

- A tree,

- A big tree that had fallen in the road and there was an off a police officer there who also a hero, you know, out there helping people. And this, this young man, he's a big guy, you know, he is like a strong, strong kid. And so he got out to help and unfortunately it was a terrible storm, you know, thank God we didn't have it that bad this year, but it, that year, that storm was just trees everywhere. So he was very badly injured. But I have since seen him back and he's, he's flourishing, so he's doing very well. So came to return him to the community and to his parents who, you know, from northern Georgia that he lived, the patient lives down here, but they came down for his whole hospitalization and just at his bedside and to be able to watch him as he woke up and recovered. And he's done extremely well. So, yeah. That's cool. Yeah.

- Kind of relating to that, what would you say is one of the most challenging procedures or surgeries that you've been a part of since, I guess since you've became a brain surgeon?

- Well, I used to do a lot of pediatric neurosurgery, SGMC health. And at this time we do not have the facility set up to have a pediatric intensive care unit, and which is what pediatric neurosurgeon needs. We need the, all the support system of that. So we're just not there yet. I do foresee this hospital getting there, but not, not today. And so I used to do pretty complex brain tumors on children. I would say here the, the, the toughest case is when you have a patient who has, who has cancer in the brain and or a, a tumor, maybe even a benign tumor growing in the brain, and they don't have a neurologic problem, they just maybe have headaches. They maybe have a seizure disorder, but they don't, they don't have a, what we call a neurologic deficit. Okay. So they don't, they don't have paralysis. They don't have numbness. They, they can still speak, they can, they, you do a surgery and even if the surgery goes perfectly, the brain is so finicky. That's the hard thing. Yeah. I, i, I wish people could, everybody could come in the operating room with me. It, it's a lot less about technique. It's a lot of how a particular person's brain is just gonna respond. You know, there's an old saying when the air hits the brain, right? Like God did not intend maybe to have our skulls opened, right? Yeah. Like it was a brain, the brain was supposed to be left in there. And so when we're forced to go in there because of a head trauma, because of a brain TA tumor that's growing in the brain, you know, because of bleeding in the brain for some reason it, it's fraught with complications some often out of our control. And to have that happen and to have to, you know, see that aftermath sometimes and or if a patient suffers a stroke after surgery or a complication from surgery. So in that regard, I would say any sort of deep seated by which I mean pla you know, deep in the deep within the brain type of malignancy, tumor cancer is generally the most difficult. And the same applies for the spinal cord. It's, it's more straightforward to remove something that is growing in, that is pushing on the spinal cord. We can release that than it is to actually take something out of the middle of the spinal cord. So tho those are the, those are the cases that, that keep us up at night.

- Yeah. So I guess you always kind of have to determine with the, the deep ones whether or not you're gonna do more good than harm

- By removing them. It's absolutely right. Yes. So you're absolutely right. So that's the, that's the risk benefit. So much of my conversation with families, and sometimes we have to say it very quickly 'cause it's an emergency and sometimes we can talk about it over multiple clinic visits over months, even sometimes is what are the risks and benefits? You know, you may get better, but you may have an injury that is, makes it worse. So there, there are not a lot of large trials and studies in neurosurgery because it's very hard to get a, a institution to have thousands. It's not like treating high blood pressure where we could have a sample of hundreds of thousands of patients. You know, neurosurgery is, are more rare and a lot of places have one or two or three neurosurgeons as opposed to, you know, dozens, a dozen and dozens. A dozen. Yeah. I mean, so, you know, so getting that, getting large studies is difficult. But some of the recent studies, very recent studies are addressing taking out deep seated brain hemorrhages and, you know, do, are we doing any help? And, you know, what is the benefit? So with neurosurgery, we're just with all fields of medicine, but in my field in particular, we are always keeping track of any new updates that are coming out. Any new studies that maybe would tell us, Hey, we've looked at 200 patients who did have a deep seated bleed to your question, Taylor, and is it better to go in or is it better sometimes to just let things be and let God in time heal it, you know, and just see where we go. So we definitely, you know, it, it's, it's always, it's always a risk benefit, you know, that, that what's the pluses and you know, what are the pluses and what are the minuses? Do

- You see any preventative scans or like screenings that, you know, cancer screenings, we have so many of those from breast cancer to prostate to oral cancer. But is there any type of, do you see that in the future for looking for

- Things? Yeah, that's a, that's a complicated question and I'm not a complete expert on the full answer, but you will see on social media, some, some of the influencers we call them, or, you know, I don't follow it too closely, but there is a recent push in getting whole body MRIs. Now insurance is not gonna cover that. Right. And really, should we be, should we be asking patients, you know, or telling patients that should they be spending their own money to go out and, and we really don't have the proof for that, right? Yeah, there really is no, any screening test has a flip side, right? Because you might find something that doesn't matter. You might find a spot on the brain that maybe you've had your whole life. Yeah. And it was, you were gonna live to be a hundred and it doesn't matter. So the biggest, the biggest breakthroughs in screening are typically in things that are more common than brain, than brain tumors. So you see brain tumors to some extent pancreatic. These are more rare cancers that we don't do screening for because the, the, the incidents and prevalence in the society is not as high. So lots of people unfortunately get breast cancer. A lot of people unfortunately get colon cancer. So these lung cancer in people who've smoked, there is a screening test, you know, that it's done and you know, so there, there that is always changing. But at this time, we do not do preemptive screening. We do, if people have had multiple family members who have had aneurysmal ruptures. So an aneurysm is an abnormal blood vessel in the brain. Then there is some literature that suggests we do screening on those people. But you have to have first degree relatives, right. Who have, you know, and multiple, so makes sense. There's gotta be a lot in your history. We wouldn't just take, you know, everybody and ask them to get that screening. So if you unfortunately are suffering and being treated with cancer, your oncologist will decide if you need a screening test of the brain, which often is done just to look to see if it's gone up to the brain. So,

- So do you have to have a referral to come to you and like who do most of your referrals come from? Like primary care or orthopedic or?

- Yep, yep. So a lot of our referrals come, we through pain management from people who, you know, pain management should always be the first stop. We very rarely have to jump to surgery as the first stop. So pain management, all our pain management physicians in town refer to our clinic. And it, we have a wonderful relationship with them spanning from Dr. Ellison and Dr. Palo at Care Medical to our very own SGMC health physicians, Dr. Bailey and Dr. Curley primary physicians, a lot of times, yes, primary physicians, very common. You know, we have such a great group of, of private and SGMC health primary doctors and they're working their butts off, right? And sometimes they find things on imaging when they're looking for something and they, they need to defer to the specialists. So we get a lot of referrals from them. A, a fair amount of what I see again is people who just had an emergency and they needed to come in. Maybe that's what I would thinking. And then we get a relationship with them and then we say, Hey, I need to, I need to know you now, you know, you're my patient now, I need to follow you for years or now or maybe, maybe not for years, but maybe for months or so we say, Hey, you need to come over to the clinic as well. And we get them plugged in. So that is how we, that is what makes up our clinic. Yeah,

- I feel like Grey's Anatomy has led me to believe the aneurysms are very common. Are they common or No, I

- Have not seen a lot.

- I was gonna say you probably don't even watch those, but us people that don't actually do surgeries do enjoy a good Grey's Anatomy or the resident. I've seen them all

- Grey's. I have not seen the resident. Grey's Anatomy was a big show when I was in medical school in Chicago. They would have watch, we'd have watch parties. I think we were very naive and we're like, oh my gosh, are there this many cute guys we're gonna get? Yeah. Right. And it turns out there's not just, so that whole social aspect is completely not true. We, you know, we, yeah, we're not, that is funny. We're not fraternizing with each other into that capacity whatsoever. And if there is, I miss that vote, but that's not happening. So the, the, they are not, they are not common. Okay. I mean, they're not common in a general population, but they're common for a neurosurgeon because those are the things we see. So when they do come in, you know, all comers to the emergency department, very small number are gonna have a brain aneurysm. But when they do, they're very sick and they need us. And they, you know, they get, they have a long, long road to recovery. So a lot of aneurysms are very small and they have not been, they had, they haven't bled. And sometimes they're found what's called incidentally. So the, your primary doc's looking for why you have headaches, and lo and behold there's little aneurysm that's two millimeters and we don't have to do anything about that. But you do need to be, get surveillance with a neurosurgeon every, every year, every couple years with imaging. So there's a large subset of aneurysms that are never gonna cause a problem that we just, we just, we just observe. No,

- We don't have much time left. And I know you gotta get to your clinic, but talk a little bit about, you know, SGMC health just recently, relatively recently became, you know, a level three trauma center and what does that mean from a trauma center aspect and neurosurgery and as far as care for patients?

- Well, you know, I'm gonna, I'm gonna be honest with you, Erika, we've been taking care of those patients, right? Regardless, I mean, this was the first stop for a lot of patients. The change in the status did not change who I what could see, right? I mean, we were seeing any range from motor vehicle and, and motorcycle accidents to unfortunately gunshot injuries. You know, I mean, just, you know, we, we were, we were, we were getting it. What it has changed for SGMC Health, from my standpoint, from what I see now, I'm, I'm not the person in charge of these changes, but I'm a, I'm a mem a willing member of any changes in any growth. I'd love to see us progress to a level two or a level one. I mean, you need a, the one big thing often stopping a place is having, right? We gotta neurosurg have neurosurg. Yeah. And, and we're here. So we, you know, we could be the highest level of trauma if, if that, you know, if that's where the continue to grow institution can go when it's time. And for me it's, it's, it's getting the resources right. I mean SGMC health, you know, takes care of everybody and, and, and you know, independent of paying status and what people can pay for their health and healthcare is very expensive. Unfortunately not to do with anything. Anybody here in South Georgia has to do with the way the system is set up, you know? And so the ability to have more resources that quite honestly, it's a financial thing, right? To help shoulder the financial burden and that the state at a state, the state of Georgia recognizes that we're taking care of these patients. And so that, that is a huge, that's the huge change. But yeah, I mean we've been a, we were, yeah, doing,

- Yeah, we already cared

- For regardless. We already cared for him. We were doing, had great trauma before, but now we just, we just really have it formalized. You know, we have the recognition now behind it and that was well deserved and, you know, has was there, it was happening beforehand. Yeah. So, yeah.

- Well, good. All right, well we're at, time is up. We do have one more question that Teyl always ask at the end. I

- Do - No more Grey's Anatomy questions, please.

- Oh, shoot. Well, I don't know how much you get to eat with your busy day, but I always like to ask what people's favorite meal is here. Unlike our food in the spice or in the cafeteria.

- I I love the taco bowls. Oh, I'm not gonna lie. Taco Tuesday. Is that, is that everybody's answer?

- Actually don't.

- That is the favorite here

- Room. You know, Erika was talking, you guys get the taco, you always, always get it too. They have this salmon bowl. They do intermittently. I've been, I've been with you when you, we've both ordered it before, but sometimes, I don't know. I, but I, you're right. I mean, I would come here as a restaurant. This is the best cafeteria I've been at like, probably 10 to 12 hospitals between, you know, some of the pediatric hospitals have some pretty good food, I'm not gonna lie, but St. Jude had some good food. But we, this, this is the best food I've ever had. So I am, sometimes the highlight of my day is like, when can I get lunch between cases? 'cause I want the taco bowls. What's the

- Highlight of our day sometimes too. It's all, we all, we look forward to.

- I should be saying like the salad, right? Like I, I want the green salad with no dressing. That's the, but I won't lie. I do, I do love it on a Tuesday. That's one of my big surgery days. So if I have time between cases or my nurse practitioner, Stacy, who's lovely, sometimes she'll, I'll come out of a surgery and the cafeteria is closed and she'll have a taco bowl waiting for me. So there you go.

- You gotta be careful, you know, the freshman 15, I think the, when you start working at SGMC, you can also gain the SGMC 15 if you're not careful. But that's why you gotta walk and you know, keep your exercise

- Exercise. Yep, yep. For sure. For sure. No, you're absolutely right. There's also a lot of really good cakes and cookies that they leave in the physician's lounge and I just, sometimes I'm like, Kim, just eat the frosting today. Not the whole cake or whatever. But yes there, there is that 15 for sure. So

- Nice. Nice. You operate on brains. I think you deserve the cake.

- Yeah, I have the cake to eat it too. Alright, well anyways, we just wanna thank you so much for sitting down with us. I know we've been trying to get you for a while, but I know you are busy woman, so we're glad to have you with us and if anybody has any questions or wants more information, we'll be sure to provide that in the links below.

- And thank everyone for watching and please subscribe and leave us a review.

- Thank you for having me.