Dr. Farokh R. Demehri - Pediatric Surgery Fellowship In Review

Philotron I am the engineer management of You're going to build your body. That's it. Did you get on with it? You changed the situation. He wasn't sure. He didn't have to do anything. He didn't have to do anything. He didn't lie. What we have for us is that the seismology walk through space. Yeah. Oh, yeah. That's what I was excited about. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. I hope you have that. I sure. Yeah. What? Yeah. Yeah. Yeah. Feeling ashamed. We feel like all those black people are always coming from you. They're smart. But I have to stop it. One-one-one-one. I don't know if I want to stop it. Oh, Good morning, everyone. It's an absolute privilege to introduce Dr. Faroq to Mary today, our graduating senior fellow and thankfully staying on his faculty. For those of you who've had the pleasure of working with Faroq, you've seen over the last two years the extraordinary commitment he has to his patients, the extreme responsibility he carries for the faculty he represents. And then I think above all, especially speaking on behalf of Smollin, we couldn't have been luckier in terms of having a mentor like him over these last year. We started off our first case, all three of us in an FCT, and he was teaching from the minute we got here and I can say without a doubt that both of us are better fellows for it. So Faroq, it's an honored and introduced you. I'm so glad that we have at least another year of learning with you and being trained by you. And I think your patients are the most great ball. So we're excited to hear from you about your reflection over the last two years because as you said, every day is a school day. Good morning and thank you. The theme of thanks for the nice stuff. I'll see you here, what happened on Friday for the rest. I've been looking forward to this a lot actually. You know, on the way in this morning, Angela, my wife is here and we know she was asking, are you nervous or scared or anything? Actually a lot of times when you talk in public, you get nervous and a bunch of strangers and things, but this is actually, this is awesome. I mean, I get an hour to talk to people I've, you know, sweat and cried and just been in the trenches with for the past two years. And you know, this is this is a real privilege. So thank you all for being here. I call this every day the school day and some of you all hear me say that from time to time. And that's something I picked up from someone who kind of set me down this path a long time ago. Same as Anthony McDonald, he's a VA general surgeon in Gainesville, Florida. And now pretty much exactly 11 years ago, I was starting my 30 year medical school and my first clinical rotation was at the VA in Gainesville. And I had no idea what surgery was and I had no real thought that I could ever do it. And he sat me down partway through my rotation and and asked me to consider this career. And I never even honestly, I never thought I could I could ever do this. And and he really he sat me down and told me that I could and he used to say this all the time every day of school day and when the things get tough in this job, that's the reminder that we learn something every day. So this is where the most recent adventures I would talk about started to fears ago. We were just the Midwestern family, minding our own business in Michigan and started to apply for the pediatric surgery match and one day boom, you matched. Children's hospital Boston, holy crap, I matched at Boston. I could not believe it called Angela. We were thrilled and scared and all of the emotions. And a few years later, we moved to Boston. We did some very Boston things. Took zoom into a Red Sox game, took the boys to you see only one of us is really excited about being in the children's hospital. Had a month off, which is great. So I got to consume some knowledge. That's Xavier eating my first guidebook to how to survive as a fellow is my younger son. And then Ben and Barrett sent me these pictures, getting me all excited. Got my page and my coat, my ID. And I was ready and then it was official. I was the junior fellow. And first day came along. And I remember the first day of rounding and just sort of shadowing and getting over round and then there's a few first impressions from the first day. That's a lot of patients on that list flying through rounds in the morning and when do we examine the baby? And then as you're hearing about what the patients had done to him, what's a name it, Pexy? And then this Lee person seems to know what she's talking about. I think I'm going to listen to her. And then the or a list, holy crap, we get to do all these cases. This is going to be awesome. So as for tradition, here's my completion pretty much on numbers for fellowship. And I am very happy to say that. I feel very well trained and got a full breadth of experience and got to do a lot of some really fun cases. And I'll go over some of these in more detail, but some highlights. 68 EATF variations. I'll say variations. Well, 20 diaphragms, 12 low becdames, most of which with orcoscopic, 17 wombs or neuroblastomas, 6, 6, 5, 0, teratomas, 29 p-sarps, 5 cloacas, 3 extra fees, 2 atreesias, 3 colodocal cysts, 2 pancreatic resections. And then on the other side are some other procedures. I got 29 ECMO cannulations, 7 livers, 4 pancreatic edemies, 1 multivisceral, and some many ordered cases. Plus a lot of bread and butter, including 100 broncs and scopes. So I got to do a lot of cases. And I feel very, I feel very good about that. Here is also for tradition, a spread of the cases I did with each of the attendings over the last two years. And actually texted Jason about this few days ago when I made this slide, because it's amazing how he was actually gone for the past the last quarter of my fellowship and still ended up leading the pack with over 140 cases, which I'm sure doesn't surprise anyone in the audience. But I feel very privileged to have worked with everyone on the faculty and done a broad ride of cases with everyone. So I'm going to go over a few cases and this is mostly driven by the ones I have sweet pictures of. So there are other ones that were also extremely memorable, but these I feel I'm going to share and then a few that meant a lot to me personally. So as the first thing, this is something that I heard, I'm sure other general sort of your residents have heard this through their training. I don't do pediatrics surgery, all they do are lines and tubes and arneas. You don't want to do that. Yeah, right. That's where I learned my fellowship. We do a lot of everything and I feel very, very good about that. So starting off with a few cases. So this is my first weekend on taking trans transplant call. This is my first transplant as a fellow. And remember getting the email about the transplant. I'm like, what kind of transplant are we doing? All of them. So the first transplant I do as a fellow was a multivisible transplant on an 18 year old. And that was one that I had never even seen the operation before. And stepping right in across Hale from Dr. Kim and he said, let's get going. And did the whole evisceration with him. And then Dr. Wikilew showed up and we all did it together. And that was one of those mind blowing operations I've ever done. And along the lines of transplant during the course of two years with Dr. Kim and Dr. Wikilew. I've gotten take out some very ugly livers. I've seen more colors of liver than I knew existed. And I've got to help sew in some very good looking livers. And this is the one that we put in right around the holidays last year. And there's no better gift than a brand new organ. And working with them has really been a privilege as far as graduated responsibility in the operating room. You know, it's been fun during the course of two years getting to do more and more during the cases. And then now from the last few getting to do the vascular work as well. And it's been been awesome. You know, you finish general surgery residency feeling, you know, I can operate. I can do this. And then you start fellow chemists and whoa, I got to let learn. But then it feels good at having learned a lot. And then it's extrapolating some of those skills to other cases that aren't necessarily transplant oriented. This is a very interesting one early this year. And this is in seven south as baby that's transported in and septic shock. And this is what the baby looked like. Maybe had a femoral line. And they, you know, the team up there is well close and say broke. Can you look at this? And the baby's legs didn't look right. Maybe I'm getting ultrasound of the abdomen and I showed it totally inclusive thrombus of the cave likely from a femoral stick done elsewhere. And called Dr. Kim and took the baby to the operating room for a laparotomy and illucable thrombectomy. And that's some of the clot we took out of the baby's cave and femoral veins. And the baby made full recovery and legs recovered and did really well. Got to do a lot of foreign bodies. So all the NSEs all the just in the room get to, you know, this is always the fun competition. So who gets to get it first of us in the mouth. It's it's y'all if it's deeper. It's us. And that's always fun. And we see we've seen a lot of this one of the more interesting ones was a was a hook that we had to change instruments a few times to get out. And I still remember my first ones with Dr. Modi and Dr. Hamilton sitting there and them talking me through exactly how you get scope and using different instruments. And I think the first one with Dr. Modi was a thumbtack that learned the lesson of that can get stuck in the vocal cords. And that's scary. But then he said just pull, so pulled. And it came out. It was a little bit. Other times the foreign body. This is one with Dr. Buck Miller. Sorry. She's like, I don't want everyone to see that picture again. This was a I think a 14 year old girl who liked to eat her hair. And this is a big ball of hair in her stomach. And and this was after, you know, a really long time of taking this thing out piece by piece. There was there were gastrodomy with a Sam on the other side of the room. But we did some we traded labor to get this thing out. And put them mentioned one of the first cases that I got to take. The small there was an SCC and they're lucky got to see a few of these during my fellowship and these were incredibly rewarding cases. I mean, you have this very subtle physical exam finding that then you get to fix it and make and make it better. And the parents are incredibly grateful. And most of these have been able to see an index clinic following up. And they've been so most grateful families that that would be back. And the bottom left corner Dr. Fishman and Dr. Kim's patented closure to make a normal looking butt. And and had seen these in all shapes and sizes during the two years. And then learning about how to make sense of things. And you know, for a first glance, what is this? You know, this Dr. Dickie has sent me down a few times. Okay, this is what this anatomy is. So these is a colloquial extra fee. And let's talk about M and M yesterday. I'm got to take care of a few of these patients and I look forward to and care more of them. And but just to be able to first time seeing one of these babies born and being in their delivery room and then the new new new technology team saying, okay, talk me through this and be saying, I'll get back to you on that. I just covered in something moist. We'll figure it out. But then now feeling feeling good about at least understanding it and and take care of it. And then with Dr. Shamberger, Dr. Weldon, Dr. Wilde, and Dr. Kim, a lot of complicated tumors. And one of the things that I've learned taking care of these children, a lot of whom are older, is these are, you know, good kids with bad problems. And and that's one of the things that's really tough about taking care of these kids. You know, one of them with, we had a child, I remember with him, Dr. Wilde, whose parents were Nitschietta's, Donald Walser, coma. And they were from, they were big Ohio state fans and we came from Michigan and Brent made sure to tell them that first day we met. And it was and they never, they never let me forget it that but they forgave me and she did, she did all right. We took her sarcoma out. Should have very large of Donald Walser coma. And I remember seeing them six months later after more therapy and they were doing the, the, the walks of the hospital down Beacon Street. And I was just out with, with my boys on the street and I saw them and they waved out to me and they'd say, hi, how are you doing? And and actually pulled me inside a stop walk in and met the boys. And and I was just so amazed that they remembered me and actually credited me somewhat with the care of their child. And and that just meant a lot to me. This, just some pictures of amazing cases they got to do. This is a right having to type it back to me with Dr. Kim. This is the very large chest wall reception with Dr. Chamberger and Dr. Wile. And sorry, this is a picture of that child that just talked about. And this is her abdominal wall sarcoma that we took off. And then there's some fun cases where you just had to make it up. This is why I got to do a Dr. Fishman where we had an adolescent come in with a palpable thrill in the right groin and beginning of some limb like the discrepancy. And and she said, yeah, it's always been there. It's like my legs things. And got an old and she had an ultrasound and she had this a bee fistula from her femoral ardent femoral vein. Luckily from a stick when she was a baby. She was in the NICU years ago when she was a baby. And so we took the operating room, did a femoral cut down and then found the trimat the fistula. A traumatic fistula from her line that she's had her whole life. And so we found it, ligated it and then felt and there's still a thrill. Oh crap. So then we made this maze of just like getting around every single branch of the femoral ardent vein. There's a much more complicated fish that are multiple connections throughout. And it's a way to find each one and ligate them. And this is one that I remember in particular because this is the first time I felt like I totally thrown Pratimu under the bus because she was the first time they were attending M&M and M&M was that afternoon. And I'm with Dr. Fishman and it's like M&M is about a star. He's like, you can't go. I'm like, I know I can't go because between the two of us we can only remember what happened, how many loops these were. So Pratimu was like, can you present? And so she presented so we could finish this case. And she did very well. I came back to see her since I was a clinic and she's like, you know, I want to miss my friend who was singing down on my groin. But she did all right. I got to do a lot of EA cases and a lot of newborn ones as well. And actually one of my favorite cases in fellowship was the thoracoscopic soft yield treasure. And I got to seven of them in the last two years and with a range of attendings. And I think this was one that again got to see these patients in follow up and very appreciative parents. And then a few lapidlynealatrejas. These are ones that like the lap EAs. It's been fun working with the anesthesia team trying to try to get through it together because this is a real job for the anesthesia team as well for these newborns. Some big colon cases. This is the case on the on the left. I got to a few days ago with Dr. Rangel when that we had seen as a newborn and an uptake care of and seeing the next clinic who had the left full left colon was involved with the ganglionosis. And we just pulled through a few days ago and went home a couple days ago. And it's been very well. And then got to see some big colon. So I'm this one with Dr. Dickey. This colon wasn't going to work and so we got some good pictures of that one. Here's a patient that Dr. Mooney, Dr. Smithers and Dr. Chen were all involved in who was an example of a very nervous parents, but very appreciative in the end. And they had tried for a real long time to have a baby and they had gone through some disappointments. And then when they finally had their first born prenatally, they had been told that oh, there's this ecogenic bowel and they're very nervous about it and actually didn't and out of that nervousness, didn't see further care until the child was born and then was found to have a double bubble. And so we all went over there because they were really worried and I remember sitting there with Dr. Mooney, Dr. Chen in the room and telling them, I remember Dr. Mooney saying this, I used this line since he said, long happy life. That's what you got to remember, long happy life to these parents. And that sort of backed them off from the ledge, you know, a little bit because we're going to take their baby to the operating room. And so Dr. Chen and I and Dr. and Pratima took him to the operating room in an annular bankress, we fixed it and he did great and they were very appreciative. This was one with Dr. Pewter that he is good to send me updates on because this is one that was really rewarding. This is a three year old who came who had had a Treesha done, a general Treesha repaired and had chronic malnutrition and it come to see him and he basically had, you can see his ribs here, essentially a quashior for when he saw him. He got tanked up with some TPN, a little bit of and then a properly optimized. We took him to the operating room and found that he had a strict charred as an assamose and a very dilated segment of jajunum. So we did a longitudinal tapering and revision of that an assamose. And we actually took his GC Fiscialist as a YouTube site down about a month or so ago and he is completely unrecognizable, thriving kid. He is like a beef cake and his parents sent him emails and he sent to me and that feels really good. And this is another case with Dr. Wile. I never thought I would do another Whipple up here if I finished my general surgery training to be honest. I remember doing my last one and we were like, all right, we are going to do this again. And then Brent had this patient who had a pancreatic head mass and needed a Whipple. And it is a lot different doing it in a healthy 9-year-old with a soft pancreas than in an older patient who has a hard pancreas with a big duct. And this was a real technical challenge but so much fun and the patient did really, really well. And that was a great one. I got through a lot of diaphragms and these were technically very fun cases. Some open ones, some forcoscopic ones with some others in Dr. Zendaihas. And these have been, as we all know, this is the easy part, the fix in the hole. It is the rest of it, the heartache of it that I see some people from 7 South here that have been the real learning experience and take care. There are really complicated patients. This is my most proud technical achievement of fellowship. There is the Junal atreja with Barath and Dr. Moody. And we fixed the atreja but more importantly, Zemlethor is trapped in intact cast of the entire colon at the end of the case. And that was actually one of the last cases of first year. And at the end of the year, Ben and Barath were amazing senior fellows. They stepped away and then I was left alone for a little while and I was tired. But then Zemlethor and Pratima showed up. And I was very excited to have some help and to have two amazing junior fellows. So here are some lessons from the years. So how to look good in the OR. We all know Dr. Weldon's trademark hat style. Dr. Moody's picked it up and I think recently people have caught me wearing it the same way. This is Pratima. She showed me how to put it fully in and to not it on the inside of the bladder while you put it in. Which is really hard to take out. How to deal with challenging anatomy. This was a lap nissen, booked with Dr. Jackson. And this is the one that walked in and said, all right, we're going to see the regular lap nissen. Walk in the room and I see this patient. It's a, oh my gosh. How are we going to do that? And we did it. But it was really, it was really challenging and I actually done a couple of these with them. And he's very, very scoliotic patients, usually with SMA. And just taking the time, going nice and slow and getting it done. And from Dr., Dr. Shamberger, learn how to sneak in through a thoracrybdominal incision to take out some pretty big tumors. And this is for a Williams patient. And those who know me, I love minimally invasive operations. And this is just a fun couple of pictures I got taken in the next few weeks ago with Dr. Kim. We, the two of our colloidal patients, they came in fall at the same time. To be fair, the one on the left also had required a left hemie-hypotectomy. So at a bigger incision. But it shows it shows a more, more, more extravagantly. But we got to do this one here on the right, which is a 17-year-old girl who came in with an asyptomatic colodoval cyst. And she's an aspiring singer. So one day if she's like on a poverty or something like that, she doesn't have any scars. And we can take credit for that. We're doing a laposcopic colodoval cyst with a complete asyptomatic pleporial room. And I think Dr. Kim for being very patient with me as I put in probably a million stitches during that case. He sat there and washed and helped and didn't complain about how long I'm sure it took me. But I'll say the upshot is he was inspired at the end of it. He said, you know what? I'm just going to make a device that makes a lot faster. So since then, I've been enjoying working with him and the innovation fellows. And actually making a device that makes incroportal suturing easier, especially in tight quarters. And here is introducing it to Dr. McKeeley, who demonstrated how easy to see us. A few other lessons from fellow ship. We've all heard this one from Dr. Jennings. You can do a lot with a live baby. And if you use this one, it comes up a lot, you know, especially when we're dealing with emergencies. And this case in particular was my first really sick baby as a fellow with Dr. Dickie. And the first weekend on and where this baby transferred in with a presumed neck had bad pneumatosis, was just totally falling apart. So we took the baby to the operating room and unfortunately found midget volubulus with near total loss of the intestines. And that's a picture of the dead intestine from that first case. And I've done some research on intestinal failure and things in residency. And one of the things that I sort of thought about on the other side of it, after you already have a kid with short gotten. And I never knew what it felt like to be on the front end of it and seeing it happen. And that was, I just remember that moment when all our hearts sort of hit the floor. And I sat there with the whole team in the room as Dr. Dickie went outside to talk to his parents and there were 16 and 17 years old. The parents were. And you know, this is one of those where we talk about M&M sometimes what do you tell them? What do you offer them? And she went out there and talked to them about, you know, the options and they, you know, understand we said we wanted to do everything. And so we did everything. We put the child in a silo came back and indeed all that intestine was dead. And I've given the child a lateral to water and ostomy, a change in ostomy. And eventually child was put back together but with very little intestine. But you can do a lot with a live baby. And this is a baby over a year old. And now the baby is two years old or just about with his mom and we all know Bernie. And with the help of the care team and being at this wonderful place, all of us helping take care of him. He's still alive and kicking and pretty happy kid. Another one that comes to mind a lot is a saying of Dr. Lilheyes. The absence of options clears the mind. And this page says codecmo. And we've had a few of these during the two years. And these are those sort of mentally clarifying moments, you know, where everything else falls apart. There's really nothing more emergent than this. Everything stops. You go and you can relate that baby. And you don't think. And afterwards, these are those moments when I sort of take a step back and say, what do I thought of this back when I was a medical student? Because now it's sort of, you know, yeah, we do this. We can re-incanulate, some all this can later baby this morning. And it's just for, in a way, it's kind of routine. But when he's taken a step back, it's crazy that we can do this. So you can take a baby who's dead, getting chest infrections and put cannulas in and have an amazing team of eckmotex and, and intensiveness and nurses who bring a baby back to life. If you're lucky and a lot of times it'll make it, but occasionally they do. And if we've had a couple, does that been here who have made it? And it's just every time I see those babies afterwards, it's amazing. And this was, I think my last eckmote cannulation is a fellow. And with Dr. Chen, Dr. Price Townsend. And here's a picture of another baby on this orchid. But it's fun to be here, right? I mean, you got to say, but baby, it's great. You know, baby comes in, you fix them. It's awesome. But it's also tough to be a doctor. And this was a lesson that, you know, you're reminded of over and over. And I think it's one of the things that, you know, with at least dwells with me is there's, the fun case, they're fun and they're in there. There are a lot of pictures, but the ones that dwell with us are the tough ones. It wasn't, maybe don't go as well. And this was one that, with, we were on call one weekend and the some familiar faces here that weekend, where we had a baby coming in for a possible cannulation on arrival. And so we got everything there, circuit team, ready to cannulate. And there were Dr. Zalaskis and Dr. Modi and Dr. McManus. And there's L, I think, here in the audience. And we're waiting and then the baby arrives, transferred from the hospital. And then when they get there, they're getting chest compressions. And, and we're ready to go. Let's get this baby on. And then we get more of a story that the baby's been getting chest compressions for well over half an hour. And that story's already been told. And there was nothing that we could do to change that course. And, and having the team step back and say, this isn't right. We should not do this was a real learning point for me. That, that was the right thing to do. And that was a tough decision. And sometimes the right thing is to not play the hero, but to be a doctor. And a few really important patients for me. This was a patient that some of us remember from last year who was on ECMO for a really long time. And she was two years old and had arrested elsewhere and come here for an ARDS evaluation. Eventually was cannulated. And then to VV ECMO and then eventually got compartment syndrome. And so Dr. Jennings and I, just a bit of a laparotomy and revealed it and released her compartment syndrome. She ended up staying on ECMO for a while and eventually was not successfully weaned off. And eventually her parents decided to withdraw care. And this was one that really was an example of how amazing it is to work on with seven self. And this is a letter that her mother sent us. And this picture actually is, I believe it's still up in the ECMO room for her saying, do your job. As a reminder, why, why we do what we do? So she sent us this letter a few months after she passed. And she said the day we took her up from life support was the most magical day of our lives. Even more magical than the very day she was born. I held her in my arms with my two fingers over her little heart as it slowly came to a stop. And that moment will never leave my heart. They allowed me to perform her post-mortem care and I combed her hair. On that note, to put a bit of a smile on your face, when VV was awake at one point I asked her if she was scared and she replied with the shake of her head. No, I asked her if she was in pain and she replied again with the shake of her head. No. I then just to be sure she was hearing me correctly asked her if she was a princess and she replied with a big nod. Yes. So again, I thank everyone who cared for Riley and knew her for their amazing care. And the most amazing goodbye mother could ask for. And so, you know, as certain as we like the ones that we save. But they we have a lot to learn from the ones that we don't. And it gets tough during this when we do have losses. And one of the things I really appreciated during this time was how supportive this place is. And this is a text from Dr. Weldon when we had a bad loss. And said these days are hard, probably the hardest. Thank you. Hug your kids. Life is fleeting. And these little words of support have meant a lot from everyone and the staff. And you know, it's it's a weight that everyone here carries when we take care of babies and sick patients. But it is helpful to know that no matter how gray one's hair is and how many times it's been down this road before that it still hurts and the weight is heavy to carry. But that is possible to carry it. But there are babies that we save, of course. And this was one. It's a picture actually mom took. But Dr. Papa docus. This is Bethany. Right. See you fellows in me with a baby being transferred in with free air on seven North. And this is a letter that that mom actually posted and sent. Now, I know this is kind of fun actually. So in touching. She said this is a letter she put post on a blog that she shared with us. Once a story she talks about how her experience was really difficult coming alone driving in the baby arriving before she did. She's getting here and she knew that the baby was going for an operation for she got here. And then when she got here, once the surgery was completed to serve as approaching me, they seemed taller than they were very imposing and shook my hand asking, do you have questions, ma'am? I trembled with fear and my heart was overwhelmed with gratitude for these two men. I noticed a foreign name, Zindy and Grick maybe. That's pretty good guess. I felt not so far away from them being an immigrant myself first generation. I felt gratitude for America for welcoming me and immigrants in general in its past, present, and hopefully future. I felt gratitude for living in a country that allows different cultures to coexist, team up and do great things together as brothers and sisters. Words couldn't leave my mouth even though I tried so hard. I wanted to tell them I was grateful that I wanted to do something for them because they took not only the time to perform certain things. They took only the time to perform surgery on my son, but they took the entire lifetime to dedicate to giving me any type of hope. They studied, they sacrificed all that for that exact moment I was living and for that handshake after. I wanted to prostrate before them and ask them what they wanted in exchange for cutting up my son's belly with precision and knowledge. I couldn't do any of this that I wanted to do. I was just nodding, indicating I did not have any questions and watched them move away as a long infinitely to cast away my fear and show my gratitude. It's rare that we have families that are so eloquent and to be honest, you know, just showing how sometimes these amazing things we do become routine. This is one that this mother never would have guessed that she was so eloquent and so glad that she shared this with seven. Along this theme, I want to talk about how, yes, we operate, we get to cure kids, but really we take care of children. This is something I learned from Dr. Tidal Lomb, who is my residency mentor, who passed away for years ago. But the lessons he taught, some of the most important lessons he taught me weren't the ones he said to me. But he demonstrated that it's really the little things and remember that these are little kids and that we take care of them like our own kids. And this is the picture from last conference we went through together before we got sick. And this is him buckling in my son, Susan, in his car seat. He just went back there and buckled him in like this is his own grandson. And that picture on the Y, but it's one that it's very special to me. And so that's what's been so amazing working here is that we see that everyone here takes care of children. It's not just the medicine. And everyone here knows that here's some pictures of Dr. Dickie treats every child. She takes care of like her own. And this picture doesn't fit in the hospital so appropriate. It's holding up baby that we that child of we know well, like her own. And Dr. Shamberger of course treating every child like his child, his grandchild. And remember when I took a zoo been first tour of the hospital and been rolling through the offices and and ran to Dr. Shamberger's office to say hi and introduce him. And zoom in of course the massive like four years old he's like covered in these guy like a candy wrapper in his hand. And like oh we're going to meet the boss. And then Dr. Shamberger walks in and he just takes a candy wrapper from zoom and say I got that for you. And throws it away. You know, something that seemed very, very minor. But he like he cleaned up after my four year old. I'm like oh my god mortified. And it was no big deal. Because we take care of children. So a special case I want to share with you. This is one that you all know well and you know that meant a lot to me. Was beginning the second year and sort of a year down. But much cases of the philosophy. And I got a call from my uncle in California. And leaves a message and broken English slash Persian and I don't really speak far see. So called back and talked to my cousin. And. And she tells me that. My second cousin's had a baby and that baby has now had two operations. And to remember that I was a doctor and so they just had a question for me. And turns out that baby was a 32 week. So premature male 1.5 kilos was born in L.A. But a type C EATF was in a baited repair at birth. 5 days later leaked was taken back to the operating room and was given a spit dish. And she called because the she she asked them. They told me to come back when he's two. So we can replace it with a stomach. And what do you think? And at this point I've done. I'm team of operations with Dr Jennings and Dr Hamilton and Dr. Smithers and the EAT. And my first response was come to Boston. And there was no hesitation there. And that was sort of a congealing of experiencing. I have 100% confidence that this is a place you need to be because this is the best place for my family. And so this is shearing and her son, Arash, who many of us know. And I'm going to take a little detour here. And this is sort of for my mama, if you will. And since you're all friends and we're going to work more with each other. I've always wanted to share where I come from with people who are close to me. Because they come from a very small ethnic group. And basically if I ever told my mom I was going to sit in front of a group of smart people that I would share with them, who we are. Because not many people know who we are. So this actually is how we're related, by the way. So this is my grandfather in the middle. His name was Fulod. And I was actually named after him. He died before I was born. But the F Fulod for Oak. And he was a father of his father. And so there were brothers and law. And this is them in Iran. And he's a bit about my people. So this is my grandfather. And then one of these two is my grandfather. And one of these two is Gus's grandfather. You get to guess who's. This is my dad's side. And this is Gus's grandfather. For father's day last year he had given us some bottles of wine. And he had this and he makes wine. And this picture was on the front of it. And this is his grandfather or great grandfather. Great father. And I saw this. Like holy crap. He looks just like my grandfather. So maybe Gus and I are related back when I don't know. But my family immigrated from Iran to India. And my grandfather and my mom's side who live. He actually walked from Iran to Bombay in the 50s. To seek better opportunities and because of persecution and things like that. And things that are very common in the world. And so he left when he was a kid with his brother or his family and friends. And they just walked. And of some time to Bombay. And that's where he ended up raising my mom's side of the family. And that's actually a not uncommon story for our ethnic group. And so this is a little aside of who we are. So I'm Zerastrian. And what we are is a small religion nowadays. But all the surviving one of these religion in the world. Originating from what's modern day Iran. And this picture up here is an image of Zarathouh Shra. Who was sort of the originator of the religion about 3000 years ago. In that region. And it influenced the development of a lot of religions. People study older religions. You learn about us. But first religion to really talk about duality of. Of human nature. Free will. Heaven hell. Good and evil. Three commandments. Good thoughts. Good words. Good deeds. Also, if you ever encounter. Us. We have fire temples. Is there called our temples because there's a fire in the middle. There's a few of them in the world. Mostly based in India and Iran. This is our holy book called the Abesta. And if you ever heard of Navros, no ruse, Persian New Year. It's actually originally Zerastrian holiday. The three wise men, three Maggi, where is the restrian. And this guy, if you saw the heaving raps, it is here. He was born to Zerastrian family. And his name was broke, actually. Pretty mercury. But probably think I'm most, you know, I think one sort of, you know, trivia, if you will. But important is, is actually the oldest code of human rights. I'll, all people of Iran, in descent are sort of proud of this. I'm Cyrus, a great, you know, freed the Jewish people from Babylon. And this is a Cyrus cylinder. I'm the first code of human rights. And he was the restrian. So there's very few of us left in the world today, 200,000. Now mostly in India, Iran and North America. So anyway, sorry for my, my aside, but I figured I'd share that because I very little teach this audience about pediatric surgery. But maybe I can talk about something I know, which is me. So back to the story. Now, the story is, this is my family. And this is Sharon's father. This is my grandfather. And that's how we're related. I really know very well, but family's family. And so she flew to Boston, not knowing anyone here except for me, alone with a baby with a spitfish in a plane. And nothing but hope. And it's actually not uncommon, you know, that this, these are the, these are the families we take care of. You know, they fly in and we have these parents that come in just totally, you know, alone in a plane. Alone in a plane with a baby with a bad problem. And it's a help, help us. And so she did that on faith. And so he got here and had a problem. You know, so this is proximal bitbischola in his neck. And this is just a little suffocates. And so there's nothing between here and here. And we took him through a lot of operations. But we were able to fix it. And so this is a few pictures from his case. So this is, we started with the left floor cost could be in thank you to doctor. Some others and doctors in Dejas. For this part of it and the amazing thing about it was seeing how everyone could attribute it from a circle standpoint. Dr. Henneth and doctors in Dejas. Everyone and and our smith everyone did another aspect of a surgical care. And here's some pictures from his thoracoscopic lower pouch. Toker process. And here we see his clips as he went from further to overlapping after we converted into an open. And here's after we converted to external traction. We did is we took down a spit fish. And put him on traction from both hands. And as I mentioned eventually we didn't ask the most is. And we got this off a grand and he healed. And he grew up on seven north. And we were going to talk him in about seven north. And how amazing that place is. And how those nurses in particular are such fierce, fierce advocates for those babies. And it's almost intimidating as a fellow when you're starting off because it feel like, you know, I'm stepping in on their. I was like, you know, the nurses between me and the baby. And then when with him I got to experience from the other side a little bit. And appreciate it so much about their really there protecting those babies. And being there with the ICU team and how they would just keep me up there all the time. And I know this is tough for a lot of people. And but he did well. And here he is on one of his month birthdays with the balloon that he loved. I mean, a few, you know, failed excavations and some tough running there, but eventually he was able to be excavated. And after five months total after Dr. Hamilton, I did a nissen. And we were able to send it back to California. And he's eating solids. And this is him with his big brother. And I was going to show just like next like 20 minutes of his videos of him eating. Because it's so it's so hard fought. By everyone here. I remember going to when he got sick on the floor a few times and having Linda and the rest in other members of the four teams. And they were there at his bedside saying what do we do? And I could go on and on and on. But you know, I am personally so appreciative to everyone in the EAT. Everyone in this hospital and every unit in this hospital in the ORs with every anesthesiologist to care of his tricky airway. And making him a happy baby. And there is at home. But some special moments. So now for some other fun stuff for the little time I have left. So this year got to go to China. That was fun. So with Linda and and well done and Ben and Paula and Caitlin and Aaron and everyone. And we got to go. It was awesome. And we got to some really cool cases. And lo and behold, who do we meet and who we find in China? Dr. Fishman. He actually is a picture up in the ICU there in Guangzhou, China. And I think it's a celebrity. This one is a picture of Elvis. I think on that same wall. It got to be part of some cool cases. So this was Ben's first case as an attending. My senior fellow. I have to do this with him. You know, routine first attending case. A revision's journal in a position. You know, bread and butter. And it got to be part of Dr. Shamburg's last case also with Ben. And that was very special. Take the deep part of. And you know, we take our victories when we get them. Oh my god, Dr. Willah. I was letting me close the skin. It's official. And actually my last call last Friday with Dr. Wellen was was a special one because it's one that he was like, all right, it's time to fly. You're done. We had a teenager coming with a larger variant mass. That was going to be tricky. Now, he was pretty big. And he said, all right, you just do this. You do this with Aaron. I've seen your resident, council resident. And he just heckled us for the case. And let us do it and trusted us. And we were struggling for a little bit, you know, to get it out and be careful with it. And thought, well, what will Dr. Wellen do? I know. Make a bigger incision. So we did. And even though it was time to fly, I remember every day of school day again. And so lesson learned there is to make a bigger incision. So some things I'll miss. Tweets from Betty. From the OR. So there won't be a fellow anymore. I'll just maybe sneak a few. And then now we're out with Dr. Peter. This is fun. So this is actually all from one Saturday early this year. He's very credible as you know Dr. Peter. So this is just, I took notes. I'm like, it's a mon of a demon guy to hear this. So Sarah on the floor says, you know, I don't like odd numbers on feeds like a Peter. You know, the intestine can't count. The intern. I like to be optimistic that Peter don't. And then really teaching us about the art of circumcision. I'm paranoid about bleeding with circumcision. That's why bobe everything that might bleed everything. Even the scrotum. Things that look forward to coming back with a new role. This is going to be me when I come back as a Denver. The horrifying moment when you were looking around for an attending, but then realize you are the attending. So look for smarter attending. So in successfully attending the attendee or attending. Luckily, there are a lot of attendee or attendings around as well. A new office. Good to hang out with Alex and Ben. We have a bit of a man cave, but that's the. So what I get is being the official last male fellow of Boston, Joldus Hospital. And that's fine with me. Working more with these folks in the colorectal center. And I was a book that actually Angela got from my, my boys. And I was like, I want to take that. Operating more with these folks. Smaller with them. And all the great cases we've gotten to do and get to more hopefully. More sleeping. More hanging out with these guys. And a few special thank yous and more thank yous for real on Friday. But thank you to every one in our awesome department. Thank you to Terry in particular for. For not retiring. Thank you to the OR family and everyone in the operating group who looks after us. To every MP who carried me through fellowship, especially. Learning how to take care of these patients on the floor. And I see fellows and residents who have. Who've done the legwork and been a joy to work with and teach. Ben and Barath amazing senior fellows who taught me so much. And I continue to go back to lessons they taught me when I was there. Junior fellow. And Somala and for them. Always prepared. Always ready to run the list. Somala. Multitasking and for them. You know just different shoes every day. And this is my pre roast because I know it's getting it's coming back to me on Friday. But really it's been a joy working with y'all. And I'm so glad that we got to be together. And and Vee there is as Dr. Shambar is a final fellows. And the real reason it did all of this. My wonderful wife Angela. She's here and my boys. Zubin and Zievi. And. She's carried so much weight. So that I could do this. And basically been single mom to these boys for the past nine years. And. I owe you so much. And. I look forward to our next chapter together. That's it. See you all Friday. Let's have fun. And look forward to y'all roasting me. So thank you. So. So. Thank you. Just a very brief comment that was a wonderful presentation and certainly highlights your year. I can speak for all of the surgical faculty. And I think the anesthesia faculty we've all enjoyed working with you over the last two years. It's always challenging to. There's still two years of experience into an hour. And I think you did a superb job. And certainly your. Humanity has shown through so greatly. We're all very excited. I know Dr. Dickey is particularly excited that you're going to be staying on faculty. So we on Friday. We won't say be saying goodbye. It's welcome. So. I know there will be lots more comments. And I know Prithemin's model already have the real truth behind the man that we're going to hear about on Friday. And so we all look forward to that celebration. Anybody else have any brief comments? I would like to make this morning or shall we save them all for Friday. Dr. Fisherman. Well, for Oak, you have a special spot. Dr. Shimmer, there's last fellow. And I know he cherishes that. These end of the year talks is something that. You know, you go through medical school. And you say you can't imagine being the situation. You go through all your training, your residency, your fellowship, your research time. And all of a sudden, like you're done. Right. It's the new beginning. And it's a great time for reflection. And it's a different style. Your presentation here was really very special. I think not a small number of tears and understanding the humanity of this. The most important thing for me was watching Angela with her tears because that's what it's all about. We were I will not forget the day when you matched. I've told you the story of that. And we were quite excited. I've been in the tent to get you to go back to the Midwest and we're thrilled that you have resisted those in treaties and are going to stay with us. All of the faculty and our colleagues and other just ones who are here with us are thrilled that you're going to be joining us and. And you are quickly going to be in attending your attending. But we're thrilled that you've thought that our environment is the place for you to. Our launch your career. And I don't think anybody could do it with, with more class. So thanks for everything you've given us. And, and thanks for your bring us. And, uh, I'm sorry if I didn't see I'll just you don't get to see Friday because this is sort of the formal stuff. And it's a lot more fun. I'll probably hit better be more fun. The biggest job of the first year fellowship is the change party. And I'm sure these guys been working on it, uh, old year. So other, comments, questions. Others? Nothing. Okay, everybody notice Dr. Jennings refused the microphone. Anybody else? We will certainly look forward to Friday and this is a memorable event and thank you Angela for being here with us.