Saving Lifetimes with Dr. Mary Brandt

This episode is sponsored by Culligan Water

Dr. Mary Brandt, a highly respected and experienced pediatric surgeon with over 33 years of dedication to her field, engages in a thoroughly captivating conversation with Sandra and Sandy on The Adrenaline Zone podcast this week . Throughout their discussion, several profound themes emerge, offering valuable insights into the world of pediatric surgery and its unique challenges.

Dr. Brandt's journey into surgery is nothing short of fascinating. Initially entering the field as a means to tackle a challenging specialty, she has a transformative experience during her surgical rotation in medical school, sparking an enduring passion for surgery, and highlighting the importance of embracing unexpected opportunities in one's career.

Pediatric surgery, as Dr. Brandt points out, holds a special place in the medical world. Her decision to specialize in pediatrics stems from a deep desire to maintain empathy, emphasizing that children are never to blame for their medical conditions. The field offers the rewarding opportunity to save lifetimes instead of just lives, especially when dealing with young patients with their futures ahead of them. One striking aspect of pediatric surgery is its comprehensiveness. Often referred to as the last general surgery practitioners, pediatric surgeons handle a wide array of procedures covering nearly all aspects of a child's body. This breadth of practice distinguishes pediatric surgery as a vital and distinctive field within medicine.

Dr. Brandt also sheds light on the challenges of surgical training, emphasizing that the traditional time-based approach sees little evolution over the years. She stresses the importance of transitioning to competency-based training to better equip the next generation of surgeons. Dr. Brandt describes the evolution of a surgeon's training, from mastering the basics to becoming a surgical artist. As experience accumulates, surgeons focus on fluidity, efficiency, and the artistry of their movements in the operating room.

In the world of pediatric surgery, effective risk management is paramount. Dr. Brandt underscores the significance of informed consent, ensuring that both patients and their families fully comprehend the risks and benefits of a procedure. This shared understanding forms the foundation of responsible risk management. She also draws parallels with astronauts and fighter pilots, offering a unique perspective on adrenaline management and risk control. 

Given the young age of pediatric patients, emotions play a significant role in this field. Dr. Brandt discusses the delicate balance between empathy and emotional involvement in cases. Surgeons must learn to compartmentalize their emotions while maintaining deep care and concern for their patients.

In conclusion, Dr. Mary Brandt's insightful conversation with Dr. Sandra Magnus and Admiral Sandy Winnefeld provides a unique perspective on the world of pediatric surgery. These themes, from unexpected passion to comprehensive practice, and the emotional complexities of the field, offer a deep understanding of this specialized branch of medicine. Dr. Brandt's dedication serves as an inspiration for aspiring pediatric surgeons worldwide, underscoring the significance of this vital medical profession.

If you enjoyed this episode of The Adrenaline Zone, hit the subscribe button so you never miss another thrilling conversation, and be sure to leave a review to help get the word out to fellow adrenaline junkies.

Transcript

Dr. Mary Brandt: And then there's the fighter pilots, and that's the trauma surgeons, or the surgeons, and all of us have all of us train that way to start with. Every once in a while, you have to return to the training of being a fighter pilot. So if you're in the middle of something and you're about ready to crash, you stop all of the routine stuff and go straight into damage control. You know - jet out of this.

Dr. Sandra Magnus: Doctors bear a lot of responsibility, and none more so than surgeons, who literally have their patients’ lives in their hands. Pediatric surgery, when the patients are children of all ages, adds even more to the mix, both technically and emotionally.

Sandy Winnefeld: Our guest today, Dr. Mary Brandt, has been a pediatric surgeon for over 33 years, as well as a mentor to many up and coming surgeons in the field.

Dr. Sandra Magnus: We talked with Mary about the multitude of risks associated with surgery to the patients and the surgeons both. Even though she recently retired from surgery, she is still very actively engaged in surgeon wellness.

Sandy Winnefeld: Many thanks to our sponsor for this episode, Culligan Water. With Culligan's drinking water systems, you can get the ultra filtered water you need to fuel your high performance lifestyle right on tap. Learn more@culligan.com  

Dr. Sandra Magnus: We caught up with Mary at her home in Houston. 

Dr. Mary Brandt, welcome to the adrenaline zone.

Dr. Mary Brandt: Happy to be here.

Sandy Winnefeld: Hey, Mary, it's really great to have you as a guest. I've heard wonderful things about you from Sandra, but we always like to kind of tee up our guests by asking them, how'd you get started in this career? So what made you decide to go into surgery? And then there are a lot of choices there. How did you decide to specialize in pediatrics?

Dr. Mary Brandt: Well, it's interesting because I had a lot of people ask this question and had to think about it, but in reality, it was a moment. So I did my surgery rotation first in medical school. And for those that don't know, you basically rotate in all of the specialties so you can see them all, and then you decide which one you're going into. And I did surgery first because I was never going to be a surgeon, a pathologist, or a psychiatrist. And actually, it turned out that both pathology and psychiatry were also fascinating, but this first one was surgery to get it out of the way, because I knew it was the hardest especially in that era. And I was just blown away. It's like all of the images people had painted for me about the culture of surgery and how mean they were and how they were kind of the dumb doctors in the hospital. Absolutely not. It was like this paradigm shift in my head, like in the first 48 hours. 

And then day three, and I still have a vivid memory of this. I'm walking in the operating room, getting ready to scrub on a case, and I'm holding my hands out. The nurse puts the gown on, and I'm popping my hands in the glove. And I went, “Oh, shit. This is what I'm going to be doing for the rest of my life.” And it was just like, boom. And then I spent the rest of medical school finding anything else that I felt that way about because it was hard. It was very hard, especially in that era. And I hoped there would be something else. 

Dr. Sandra Magnus: And the pediatrics. 

Dr. Mary Brandt: The pediatrics came about because it's just fascinating. And we have a motto, actually, in one of our organizations, that we save lifetimes instead of lives. But for me, it was one night realizing in the midst of a lot of traumas, where people had been out drinking and hurt other people and hurt themselves. And it was two in the morning. And I was exhausted, that if I did that the rest of my life, I could lose my empathy. And it was extremely important to me that that not be the case, and it is never the child's fault.

Sandy Winnefeld: That is really fascinating to me. I had never thought of it. Not taking anything away from any other kind of surgery. But if you operate on an older person, there's rewards associated with that. But if you save a child's life, you literally are saving decades, potentially, of life in one fell swoop. That's pretty cool.

Dr. Mary Brandt: Yeah. The other part of it that's amazing is we're kind of the last general surgeons. We operate in the entire body, in children, except brain surgery and certain specialties that do unique things that we don't. But unlike our adult counterparts, we can take care of the entire child and all their surgical needs, and that's pretty special, too.

Dr. Sandra Magnus: So talk about the training. You talked about how hard it is, and I know, I mean, being a physician of any kind is super hard, and then the training has probably changed over the years and has a bet for the better or for the worse. So tell us a little bit about that.

Dr. Mary Brandt: Well, that's an interesting question, because one of the other hats I've worn in my whole career is a medical educator, and being very involved in education, it actually hasn't changed. And that's the problem. We still have the traditions and the same kind of time-based training instead of competency-based training that honestly were started by Halstead, who started the whole residency concept at Johns Hopkins in the late 1800s. So that part we definitely need to work on, and I think that's actually our biggest problem right now.

Sandy Winnefeld: Wow. With surgery, you have to do a lot of risk management, right? You have to assess and balance the risk on behalf of the patient. Sometimes right in the middle of an operation. I imagine there's a lot to learn about surgery, the mechanics of it, what's there. But how do you learn to manage those risks real-time?

Dr. Mary Brandt: Well, there is a couple of thoughts that I've had thinking about this a little bit. One, I have this vivid memory of a chief resident bringing all of the junior residents together one day when we had messed up some detail. In the hospital, residents and training have a patient list, and it lists all the patients by floor, and there's notes, what to do and all of that. And he chided us for not knowing some lab or something, and then held it up and said, “The difference between this list and the list of passengers on an airplane is that we kill them one at a time.” And I still obviously remember that, and obviously we don't kill them one at a time. But it was part of his illustration of the responsibility that we have for the patients we take care of. When we're talking about risk of an operation because it's the patient that's taking the risk. It's not really the surgeon that's taking the risk. You're bringing your training in to help them make a decision on what to do. And 100% of the time when I'm getting consent from a patient, I look at them and I say, “What we're talking about here is the risk of not doing this procedure versus the risk of doing the procedure. And we need to go through both sides of that equation so you understand completely what's going on and that we have this common understanding of what the risks are.”

Dr. Sandra Magnus: So is that hard? I mean, personally, you're dealing with children, so that adds that extra emotional component. And, of course, it's always easier to take risks for yourself than risks for other people. And so you comment, the risk is all on the patient side, but yet on the surgeon side, you have to perform at 100% all the time. And so there is a certain amount of risks/responsibility there as well.

Dr. Mary Brandt: You know, one day, I was doing a consent for a little boy who had a malrotation. So it was a chronic thing, not an emergency thing, but we needed to do surgery because his intestines basically had not returned to the abdomen when he was in utero the way they should, and they were essentially twisted. And so there's an operation to do that to help relieve his pain and all of that. And I went through very carefully the informed consent that we do because that's what we're talking about here, is informed consent and including that he could lose intestine and need other operations and have bowel obstructions and I got all done. The mom signed it and looked at me and said, “It must be so hard to do what you do.” And specifically, like talking to parents about all the things that could go wrong. And the truth is that we don't dwell on all the things that could go wrong. Once we explain them and then you have all the training, it's like getting in a cockpit, and you're completely trained to fly the plane, and you're also trained to look for all the things that could go wrong. And you've embarked together on this journey, understanding what those risks are. And so it's not hard once you practice it, it's hard initially.

Sandy Winnefeld: So, I would imagine there's another kind of risk here that's maybe a little more subtle, but maybe even more acute with children because you have so much empathy for a child. And that is, do you ever have a hard time managing the fine line between getting involved enough to help solve this patient's problem without getting too involved that you lose your objectivity because you care so much for this child? Or do you just compartmentalize that away and take it as it is?

Dr. Mary Brandt: I think the key term is compartmentalization, and I think there are a lot of other professions that have to do that as well. It is a skill you have to have, particularly if things are going badly. You really have to shut things out and focus completely on how you're going to get out of that situation and make things better. But I learned, and I think you learn with time and with the right kind of role models showing you how to do this, that it's not either or. You can be completely compartmentalized about the task at hand and what you're doing medically and still be very attached to the patient and empathetic with the patient. You can't cross that line beyond empathy to become personally involved in a way that would be detrimental. I think that's what you're asking, and that comes with practice. It really does.

Dr. Sandra Magnus: How do you learn to recognize when you're at risk of crossing that line? Because I would think you could perform less than optimally if you cross the line and get more emotionally or personally involved. Right?

Dr. Mary Brandt: Yeah. The stereotype of surgeons is often being cold and aloof and all that. I think that is particularly true early in your training. Because when you're learning how to do this, you have to figure out how not to hurt the patient. And if that means that you have to back off a little bit personally, you do. There were years, for example, that in the operating room, which you walk in as a surgeon, you've met with the family, you've met with the kid, you know their name, you know what they look like, but when you walk in the operating room, they're draped. You can't see their face. And most surgeons, especially early on, rarely go into the room when the patient is making that transition from being awake to being asleep and being ready for surgery. And it took me a very long time to be able to take my focus a little bit off of just where I was operating to the where that I was operating on Jemmy. And that was much, much later in my career, probably 10 or 15 years, it took to get there.

Dr. Sandra Magnus: So you keep coming back to this training experience you learned over time, but at some point, you're doing everything for the first time. And what protocols or tricks of the trade or approaches do you learn when you're doing all this for the first time? Because that's an extra angst moment, if you will.

Dr. Mary Brandt: So the actual learning of the operation really is that five-year apprenticeship for general surgery where you're basically doing it with someone who's teaching you to do it. You're actually doing the procedure. So it's sort of like you're flying the plane and the experienced pilot is the co-pilot, always very balanced to what's best for the patient, and the most senior person is the one that's absolutely, ultimately responsible. So by the time you've finished your five years of training, you have probably done the vast majority of the routine cases multiple, multiple times. And you've learned and been tested on all of the things that might go wrong or could go wrong or anatomic differences or things that might be a problem. 

The specialized stuff is in the fellowships, like in pediatric surgery, where you're learning unique anatomy and unique problems. But that being said, particularly in pediatric surgery, I don't think there was ever a month in my entire career that I didn't confront something for the first time. And what you learn is that most of the time it's a variation on a theme of something you've done before because there are very simple moves of taking things out or reconstructing things. Recognizing anatomy, how you get the artery off of everything around it, is the same no matter what artery it is, pretty much. So all of that you can take into this new thing. 

The other thing I did, and honestly, from my friends, I learned about the pilot's SOP, standard operating procedure. And for myself and as a teacher, I developed those for every case. And I particularly developed them for cases that were unusual or I didn't do very often or if I was doing them the first time. So I really wrote down every possible step from everything I could read, everything that might go wrong and how I was going to manage it.

Sandy Winnefeld: Sounds really familiar or similar to landing on an aircraft carrier. I mean, the first time you do it, you've got all kinds of supervision. You got somebody in your back seat, maybe, and you got people watching you, you still have to do it. And it's really scary as hell, even though you get used to it. Every one of them is different, and every surgery has to have its own unique thing that even as you're teaching it, especially as you're teaching it, you have to recognize and deal with it before it gets out of hand. 

Dr. Mary Brandt: I think so. We've used a lot of pilot analogies in surgery over the last particularly 20 years, and some of them are very good and some of them are not. But the one I do think is true is like a general surgeon, at the end of your five years, you are like a very professional commercial pilot of a 707. If you're a pediatric surgeon, you are still a commercial pilot, but of a highly technical train. So it's transatlantic or whatever. And then there are the fighter pilots, and that's the trauma surgeons or the surgeons. And all of us train that way to start with because every once in a while, you have to kick that gear into mode and kick into that mode. Sorry, I'll repeat that sentence just in case. Every once in a while, you have to return to the training of being a fighter pilot. So if you're in the middle of something and you're about to crash, you stop all of the routine stuff and go straight into damage control. Get out of this.

Sandy Winnefeld: So I have a question for you. My one intersection with your world was when I was privileged to be invited onto an aircraft carrier to watch a hernia operation. I thought I was watching it, but they actually scrubbed me up and I ended up holding a retractor and doing cauterization. I even got asked if I wanted to sew the close. And I came away with the impression that the mechanics of doing this aren't that hard. But looking into that goop and having any idea what I was looking at, that has to be an amazing learning experience. So I wanted to ask you, what for you was the hardest part about surgery in terms of actually doing it?

Dr. Mary Brandt: Well, I think you've sort of identified that there are levels. I mean, you go through levels of expertise. So in medical school and early on, it's very much about, what's the goop? What are we looking at? And then I think the next step is you learn that in a hernia operation, you have to get to the inguinal canal, you have to open it, you have to find the hernia, you have to patch the hernia, and then you have to get out of the inguinal canal. So there are these steps, and you practice them over and over again. I would tell my residents on a regular basis that I wasn't interested in training safe surgeons, I was interested in training master surgeons. So, safe surgeons know you go from A to B to C to D. Master surgeons actually learn how to do that with fluidity and understanding that is almost like a high level of playing a sport. That is the best analogy I use in teaching this because it is about movements, but it's about efficiency and beauty of movement. Those are the surgeons who operate smoothly and skillfully that the patients just do better.

Sandy Winnefeld: So, like Yoda, you can say "the force is strong in this one," right? This one's pretty good.

Dr. Mary Brandt: Well, actually, you can. People joke and say every surgeon thinks they're in the top 5%.

Sandy Winnefeld: So does every fighter pilot.

Dr. Mary Brandt: I think there are some similarities, but there are people who are in the top 5%. The rest of everybody is doing a great job, a safe job. They're able to take off, land, and figure out what they're doing. But when it gets super complex, sometimes it does help to have a little Yoda.

Dr. Sandra Magnus: I want to rewind for a minute because we were talking about the risks that the parents take and the patient taking the risks, right? So is it difficult to communicate the risks? Thinking about the emotions that the surgeon has, that you're compartmentalizing for the parents, they're emotionally engaged and involved. It's their children. So is it difficult to explain the risks to parents and help them walk through that matrix?

Dr. Mary Brandt: I think that it truly is part of the art of medicine, and for routine thing, my standard strategy was, when we got to the point where I had made the decision and told the family, "Yes, I think we need to proceed with the hernia repair," the room gets somber. And then I would look at the kid and say, "Okay, I have two rules. These are really important." And the parents would always say, "Now, listen to her, this is important." And I'd say, "Rule number one is no shots. And rule number two, you get presents." And the kid would beam. But more importantly, the parents relax with that. All of a sudden, it's like we've taken this incredibly serious thing, but look what she just said. And then you turn to them and say, "Look, this is something that we do all the time, we do it safely. But I need to explain to you things that could go wrong, and the likelihood of that is extremely low. But I need to answer all your questions so that we all feel good about going forward." And then that's why I always use the line, "We're talking about the risk of not doing it versus the risk of doing it," because you never decide to do a surgery where the risk of doing it is higher.

Sandy Winnefeld: So, Mary, I'm talking to two very accomplished women in their own fields here, and I know you two have had several discussions about safety and managing risks in the operating room and the similarities to how astronauts and their support teams approach risk management in space. So tell us about those conversations. Tell us about how you, in the past, compared the two.

Dr. Mary Brandt: One of the things I began to realize as Sandra and I talked about this is if you think about an operation like a mission, the steps are kind of the same. You got to have the training, you got to have the place, and the support team to do it. But where the analogy stops then, is that a single flight to space is a mission that takes years and years and years and is a one-time thing. Whereas even though we have the same structure of how we train and prepare and look for unexpected things that might happen, we're doing it 10 times a day sometimes. So it's a magnitude of difference in terms of danger, first of all, but also the complexity. And so it's similar, but not.

Dr. Sandra Magnus: Yeah, you remember some of our conversations. Just to pull on that thread, we were talking about the dynamics in mission control versus the dynamics in an operating room, and having very clear roles, responsibilities, and procedures. We came up with a lot of parallels there, I think.

Dr. Mary Brandt: Yeah, I think in the operating room, it really is a team. And it's much more of a team now than it was when I first started training. When I first started training, there was the surgeon who was in charge. Now it's much, much more of a team. And I think that's kind of the same analogy when you have the people in mission control who are providing all of the support in a very active way. It's a lot like the anesthesiologist, nurses, and the people that are providing instruments and even some of the very highly technical instruments need to have experts come in and help us troubleshoot them. So that’s the similarity.

Sandy Winnefeld: I would think that there's another similarity. When you light off the rocket, the solid boosters and that thing starts to leave the pad, there's no going back. And when you get out there, if something goes wrong with your spacecraft, you're kind of on your own. You have to fix it. And I would imagine the same thing is true in an operating room. Once the incision is made and you're deeply into the operation and you find something you didn't expect, it's not like you can, “Oh, I want to start over on this thing.” Or, “I want to call in some other people in here.”  I guess you could do that. But there's sort of that stepping off the cliff aspect, I would think, to both of them.

Dr. Mary Brandt: Yeah. And I think when I was talking about the trauma surgeons earlier, I think that that's the group of people. And for all of us, in the middle of the night, if there's somebody who's been shot or in a horrible car accident and you open and it's a disaster, that really is that moment of adrenaline that you have to learn how to manage and you have to get out of that situation.

Dr. Sandra Magnus: So how do you manage that kind of adrenaline in the middle of an operation?

Dr. Mary Brandt: One of the things I actually taught out loud and that no one ever taught me this, but I would watch people I was working with, and when you're first starting that adrenaline is there when you're learning how to make a skin incision.

Dr. Sandra Magnus: Right.

Dr. Mary Brandt: And what happens is their shoulders go up to their ears and they start breathing fast. And I actually would start telling them, "Look, you have just totally launched your sympathetic nervous system, and that is going to completely block your ability to think and do things. So I want you to lower your shoulders and take three deep breaths and watch what happens." And it works every single time. What happens with time is you begin to channel it more and you learn automatically how to control it so that you're not trembling and having all of the force of adrenaline behind the decisions you're making and what you're actually doing.

Sandy Winnefeld: And you recognize when it's happening.

Dr. Sandra Magnus: Yeah, that's know to know when it's happening.

Dr. Mary Brandt: Exactly. So I do have a story about learning about this and thinking about this. And Sandra knows a good friend of ours, that after I'd known her a couple of years, and for people that aren't astronauts to ask astronauty questions of their friends is always kind of hard. But I asked her, I said, "Listen, you're going out in the shuttle missions in that point, going out, you're getting sent up to the top. You're laying there on your back for two, three, four hours, like, what are you doing?" And she said, "Well, the first time I flew, I was a rookie, so I was just checking my checklist over and over and over again because I didn't want to screw up." And the second time I flew, I went to sleep. And I won't say verbatim what I said, but I basically looked at her and said, "You're on top of a friggin bomb. And you went to sleep." And she just looked at me kind of like a little baffled and said, "Well, I was the night shift. I had to be rested." And that's when it clicked that when I have to rush a child who has been shot or something in two minutes up to the operating room and get them open and get the bleeding stopped, that's an impossible thing for her to understand, but I was a night shift.

Sandy Winnefeld: So we've talked a lot about analogies between fighter pilots, astronauts, surgeons. Are there any other disciplines because humans do best when they learn horizontally as well as vertically. Are there any other professions, disciplines, where you've learned something that helped you be a better surgeon?

Dr. Mary Brandt: Wow, that's a great question. I think, honestly, I'm sitting here thinking and I think what it is is more about the ability to not act in the stereotype of a surgeon, which is how I was trained. And if I look at nurses and other healers that are not as technically stressed, I guess, is the way I'd put it, I think they've taught me so much about those things we were talking about earlier about how do you talk to patients. How do you help people deal with their own risk and their own fears? So at the top of my head, that would probably be the one, I would say.

Dr. Sandra Magnus: All right, well, shifting gears yet again because I'm curious, managing risks in the operating room, that's part of the facet of being an operating team. So how has technology impacted your ability to manage risks, for better or for worse, in the operation, in an operating room, over the course of your career?

Dr. Mary Brandt: Oh, it's been profound, and I think it's mostly in monitoring, and I would say mostly on the anesthesia side. The field of anesthesia has just expanded and developed magnificently over the last 20 or 30 years with more and more monitors, more and more ways to take care of very critically ill patients. I think the other thing on the technical surgical side certainly, is the minimally invasive and robotic surgeries, the new instruments, able to do things that they weren’t able to do before in a very safe manner, which that's pretty spectacular, too.

Dr. Sandra Magnus: It's all about the sensors.

Sandy Winnefeld: Interesting what you say about anesthesiology because people say, among the most important inventions of mankind, the wheel, fire, whatever. Anesthesia, which actually permitted surgery, was one of the most important but little heralded advances in human history. Right?

Dr. Mary Brandt: Absolutely.

Sandy Winnefeld: Interesting. So back into the training pipeline and the profession itself. I know from our research that you have some concerns about how the traditional approach to training might actually be creating situations that are more risky rather than less risky. Do you have any thoughts on that?

Dr. Mary Brandt: So from a purely educational point of view, what's happening in the United States is that, as I said before, we're still basically in the model we had for the last hundred years. We have one more big problem in the United States that other countries don't, which is the financing of our trainees. So people who are training in surgery have a salary that is a relatively low salary that is paid by the hospitals and not by the schools that are training them. And what that means is they can only be placed in hospitals that have a salary. In addition to that, though, the number of positions was capped a long time ago. And so if you look at the federal government, and if you look now, about half of residents in the United States are being paid for in cash by the hospital, not reimbursed by the government. So they view unequivocally the residents as employees. They're being paid money and they're doing work which is very detrimental to their training because we can only place them where there's a salary, first of all. But it's very hard to dictate how much work versus learning they're doing when basically the people teaching them are not controlling their salary.

Sandy Winnefeld: So it sounds like somebody once said, we have paleolithic emotions, medieval institutions, and godlike technology. It sounds like the medieval institution piece is still hanging in there in this profession.

Dr. Mary Brandt: It is. It's a big source of discussion right now in all areas of surgical education. And in Canada, for example, they are moving to a truly competency-based model, which I think is much more like what NASA does. Which is you really have to learn and master this initial skill before you go on to the second more complicated skill. In surgery, you just basically go with the surgeon who you're assigned to and help them do whatever you're capable of helping them with, which is very different.

Sandy Winnefeld: It is different. I mean, in the world I grew up in, you had gates you had to pass through, and if you were not good enough to get through the gate, they weren't going to let you through because there was too much at stake.

Dr. Mary Brandt: Well, we sort of put you in the pasture and there's a bunch of gates all over the place, and you have to get through all of them eventually. But different people own the pastures, so we can't control it as well as we'd like to.

Dr. Sandra Magnus: So what's an alternative approach to that? I mean, is the government paying the salaries or schools having stipends or how do you fix that?

Dr. Mary Brandt: Well, so most countries, and again, this goes back to a third big issue with medical training, but also with medical practice right now, which is how corporate it's become in the United States. If you're driving people to work because of the profit they're going to make for the institution they work in, you create a very different work model than having the mission of providing health care to a country. And we are the only industrialized country that does not have universal health care. And it's going to have to go to universal health care if we're going to get out of this quandary because right now we have the highest burnout rate, suicide rate, you name the parameter. Doctors, healers of all kinds, nurses, everybody are suffering under this system. So that's going to be the real linchpin. The big change that's going to happen in the next generation has to be taking some of this profit motive out of medicine so that everyone can get basic health care. And the people who are trying to provide it are not experiencing this moral distress of being employed by someone who is a corporation, but working for our patients.

Dr. Sandra Magnus: It's interesting, all the conversations about universal health care focus on the patient. I think this is the first time I've heard it from the healthcare professional side about, it's just an interesting lens on it that's not discussed.

Sandy Winnefeld: It's almost, what you're describing, Mary, is almost like a newsroom where you may have an owner of a newspaper that has political views and all that kind of stuff, and there's an editorial page for that. But in the newsroom, you're expected to be in that different culture. It's almost as though you're asking the medical professional, “Hey, we need to have people who are surgeons first and they're compensated that way. The culture is that way, and they're not necessarily working for the corporate entity. Is that a fair encapsulation?”

Dr. Mary Brandt: Yeah. Well, yes, and I don't think people really understand how intensely this has changed. I mean, I was talking to someone today who was a chief of a group in a hospital that I won't name, who basically had the administrators of the hospital come to this surgeon, so it's a surgical specialty, and say that they really wanted the nurse practitioners to see every patient in clinic, no doctors in clinic. They wanted the nurse practitioners to choose which patients needed surgery and have the doctors perform the surgery because that would be more cost-effective. And I wish that was an exception. But that's the sort of thing that's happening now everywhere and until, I think, there's going to be a huge grassroots revolution in this. I think that people who go into medicine to heal other human beings have finally just had it. 

Dr. Sandra Magnus: Wow, interesting.

Sandy Winnefeld: So I don't want to date you, Mary, but my understanding is you might have been one of the early women in this field, which shocked me when I heard about that. I would have just guessed that women have been in this field for a long, long time. So what was that like? Was it hard? And have things changed for young women coming into this profession?

Dr. Mary Brandt: So I trained at Baylor College of Medicine, where Michael DeBakey was the chief, and I actually ended up ranking it the highest in the match because as a woman in that era, if you went to an easy program, you basically were discounted. And Baylor at that time, under DeBakey, had the reputation of being one of the hardest programs in the country. So I matched there, and I was the third woman who ever finished that residency, and I was the only woman for all five years I was there. It was both magnificent because the training was incredible, but it was like being in an emotional and technical combat zone all the time. There was no, hardly any downside ever for five years. I joke that I don't remember my internship, but it's actually pretty much true because for eight months out of those twelve months, I was on every other night call, which meant I had 12 hours off every 48 and was working straight through the other 36. 

Sandy Winnefeld: That's another problem. 

Dr. Mary Brandt: Yeah. And all of that, the duty hours that were put in place for resident training have improved that. The whole culture has absolutely been improved, but we're only one generation away from that. And so there's still huge cultural gaps that we're working on and making better. But right now it's about 50% of residents in surgery are women.

Dr. Sandra Magnus: Oh, that's a huge increase, actually. So what advice would you give to someone who's interested in going into medicine and even surgery in particular, given all of the things that we've been talking about?

Dr. Mary Brandt: Oh, I still think, and I do believe that this current generation that's in medical school, residency, young faculty, young surgeons and doctors are going to change the system because ultimately we can't have a civilization where we don't take care of people's health issues. And occasionally it has to kind of crash before you build it up again. And I think that's what's going to happen.

Dr. Mary Brandt: It is still an incredible profession, but they have a big task ahead of them, which we desperately need them to do.

Dr. Sandra Magnus: So do you tell them to go for it?

Dr. Mary Brandt: Absolutely.

Dr. Sandra Magnus: Get ready to reform.

Dr. Mary Brandt: Well, but the other part, and I have often said this to a lot of people because I am very involved in a lot of thinking about education and policy. And so I think in that sphere, but on the day-to-day sphere, there is not another human being or any policy that can take away my ability to sit in a room with another human being and talk about what I need to do to help heal them. And that is so powerful and rewarding that you can get by a lot of other stuff to be able to have that privilege.

Dr. Sandra Magnus: Well, that's a good note to end on, Mary, the uplifting power of the medical profession to help people. And we really appreciate you being a guest on The Adrenaline Zone. I really enjoyed the conversation and learned a few things that I didn't know from having other conversations with you before.

Sandy Winnefeld: I really enjoyed it. It was fantastic. Thanks for being with us.

Dr. Mary Brandt: Well, thank you so much for having me, and I really appreciate it.

Sandy Winnefeld: All right.