Good morning, good morning everyone. Good morning, everyone. How you doing? Good to see you all. A lot of bright, fresh, beautiful faces out there. So today's a special day for the fellowship and for Dr. Fallon. We're happy that he has arrived at the end of his fellowship. He are almost. And so today we'll be hearing from him about how that went. So Brian Hales from the great state of Michigan where he grew up with his parents and siblings before leaving the nest to attend college at the University of Notre Dame, where he received his bachelor's in economics with a minor in tech, business, and society. He then spent several years figuring out how he wanted his career in medicine to look during which time he worked for Huron Consulting, which is a group of experts that worked closely with academic medical centers, helping them to solve their various problems. When he finally heard the call to medicine, Brian completed a pre-med program at Michigan State University before earning his medical degree at Columbia University College of Physicians and Surgeons. Brian then went on to complete his general surgery residency at the University of Michigan, not to be confused with Michigan State University, where he did five years of clinical training and two years in the research lab. He was awarded numerous teaching awards for his commitment to the learning of medical students and his junior residents. He was also inducted into the Gold Humanism Society as a resident for his humanistic delivery of care to his patients. Dr. Fallon ultimately earned a position here at Boston Children's as a clinical fellow in pediatric surgery during which time we have been fortunate enough to witness his growth, clinical and technical excellence, and his unwavering poise and compassion when faced with challenging situations. Brian couldn't have done this without the support of his family, including his lovely wife, Pats, and his two sons Hans and Goose. So without further ado, please put your hands together and join me in welcoming Dr. Brian Fallon to deliver his talk entitled Fellowship in Review. All right, good morning, everyone. Thanks, Mark. It was a very kind of you. So today I figured it was a great time now that I'm ending fellowship for you guys to get to know a little bit about me. I tried to keep this all in the wraps for two years. So as Mark you mentioned, I grew up in Gran Rapids. I had Michigan, which is on the West Side of the State with two loving parents and five siblings. So it was one of six. Went off to the University of Notre Dame and I initially majored in, I went into pre-med, I had grand aspirations that weren't really particularly well thought out to be a pre-med. Then I figured out once I got to Notre Dame, exactly what that meant and all the stuff you had to do to get to be good into medical school, all the tests and all the studying and all that type of stuff. And I realized a second semester of freshman year after a 12% score on my bio exam, that economics was a better field for me. I wandered around a couple of different majors and settled on economics. It was really happy about it. It was a great degree for me. It allowed me to really enjoy college. I studied abroad in Chile. I played for the Notre Dame rugby team. I made a lot of great friends and really enjoyed my four years there. And at the end, I didn't really know what I wanted to do so I did what everybody who doesn't know what they want to do does and I went into consulting. As Mark, you mentioned here on consulting group and in their academic medical centers practice. So I worked with physicians as clients, a lot of medical schools. And I think that sort of kept the bug in my ear about medicine and it was one morning. I remember very clearly waking up in the Sheraton, Albuquerque, as I was getting ready to go off to work. And I called for some reason Dartmouth. I don't know entirely why I chose Dartmouth, but here on the East Coast and everybody was awake and their admissions office, so I called them and I said, does anybody actually go to medical school after business? And they said, oh, yeah, of course. And they kind of walked me through the process. It was really grateful for that conversation because it sparked my interest and said, yeah, I think I can do this. So after some pre-med coursework, going back to work, going back to school, which my loving wife, it was not even my wife at the time as you still stuck around for that change. I think I managed to get 15 out of 16 rejections to medical school, finally the 16th one. Columbia said, sure, we'll take you. You can come study with us. Went off to medical school, but that sort of uncertainty about my career persisted. I wasn't quite sure what I wanted to do. I played rugby, I played hockey growing up. I was six foot tall, 200 pound guy, and they said, obviously you're on orthopedic surgeon. So I said, okay, great, I'll go on orthopedic surgery. And that's kind of what you did. And the deck was stacked in the favor of the orthopedic surgeons, because they were actually the sponsors of our Columbia Rugby team, Columbia Orthopedics were on the chest of the jersey. So I felt like that was my fate. And then I realized I liked medicine, and I liked patient care and understanding physiology, which, you know, offense to orthopedic surgeons is not their forte. And so I started looking into pediatrics, very surgical specialties, cardiac surgery, I had an excellent time on a pete surgery rotation. And eventually I said that between after 50 hours of pediatric's clinic, I said, I think I'm gonna go into surgery. So I went toward general surgery, thinking probably pediatric surgery, maybe cardiac surgery. So I went to the University of Michigan, and was sort of leaning toward pediatric surgery. But then I went in the ECMO lab, had a lot of exposure to cardiac pulmonary bypass, thought the physiology is really fascinating. The operations were cool, and there's a culture in surgery. It is at Michigan, I'm sure, it's at a lot of places where sort of big surgery is the big one at the table. You know, everybody looks up to the liver transplant surgeons and the people doing thoracal abdominal aerodic aneurysm repairs, like that's what you gotta do to be a real surgeon. I said, obviously cardiac surgery. G-tubes, appies, that's nonsense. I don't wanna do that. I'm gonna do cardiac surgery. So that, my, about a month before applications were due to fellowship, I didn't tell Dr. Modi this when I was interviewing. But about a month before application I was getting letters for cardiac surgery fellowship. And fortunately, I paused and kind of reflected is that really what I wanna do. And obviously I'm here, spoiler alert. So I went into pediatric surgery, and some of you guys are wondering why pediatric surgery for this guy. You've been wondering that for two years. So I figured I would talk a little bit about what it is about pediatric surgery that pulled me into the field. And if indeed, I was right at that time. So the first aspect of it, I had a sort of funny story as an overnight resident. There is a 15 year old girl who came into the breast abscess and of course, breast abscesses are not anyone's passion per se, but I was able to meet with her, took 15 minutes. She was very anxious. The young man comes in and no 15 year old girl wants to have that conversation with a male doctor that hour of the night, two in the morning. And I was able to reassure her. We did an ultrasound guided aspiration very quickly and in and out in 15, 20 minutes after the time that I met her. And it was sort of a trivial thing and the grand scheme of things when I thought back and I was like, that was really cool. That as a general surgeon, pediatric surgeon, you can walk into the ER and half of the people in there are something that you can help with. Sometimes it feels like more than half when you're the sod overnight. Sometimes it's all of them, but that was really a powerful motivator for me. And so when I got here on day one, that demonstrated that I was exactly right. So my first case was with Dr. Lilahai, first case of fellowship. They gave me the first day off to kind of walk around and watch cases. So this was August 2nd. It was a left Inglina Herne orrophy and a 21 year old man who lifts weights approximately six times per year. And I thought, that's weird. I thought I left the VA after I graduated residency. It was very much harkened back to adult mass. I was like, that's kind of odd. Why am I doing this surgery, Dr. Lilahai told me is like, this is probably not what she expected when you came to pediatric surgery fellowship. My second case immediately after that was a little bit more what I expected. This was with Dr. Buckmiller. It was a one day old 37 week, 3.1 kilos. We did in a fallacy of closure, stapled mechels that have particularctomations. Maybe remembers this case. And of course, it wouldn't be a complete case without a circuit at the end. So we did the circuit for the baby. And that was sort of whiplash for me because I went from this to a patient 124th the size, all in one from pre-opted a pack you. And of course, it's nine o'clock somewhere. And that first day it was nine o'clock PM in the NICU for CDH rounds. And so I was with my two senior fellows. They showed me exactly what we do in which there was no surgery. There were what we weren't talking about operations. We were talking about physiology of this baby. We were talking about the cardiopulmonary physiology that intensive care, which didn't really fully have a full appreciation for that. The non-surgery, how much of our day was going to be talking about non-surgical stuff. And as it turns out, day one of second year was the same as this must be the old, oh, that's right. Okay. That's the right picture. So this day one of second year was spent teaching my two new junior fellows how to do a gastroskisis, place a gastroskisis silo at the bedside. And I think gastroskisis also typifies that holistic aspect of our field that so much of these babies, in fact, it's for some of them all of their care is non-surgical. And yet we spend so much of our time with these babies talking, looking at their bowel, looking at their fill in their belly, watching them and working on advancing feeds. And so that was, again, a great example from day one of both of my two years, exactly what pediatric surgery meant. Other examples of this kind of holistic nature, the duoderm house and fallacy of management, we spend so much time as fellows. This is also a great experience for us as fellows. You can see my two senior fellows last year. We spend a lot of time together managing these babies, again, non-surgically, or it's sort of like a slow-motion surgery. You could say over the course of days to weeks in which we get them reduced. This year, I had the good fortune of learning from Dr. Dickie, kind of duoderm house 2.0, which is the way I asked baby or a cloac electrophy that we manage with duoderm house applied in a much more complicated way. We're trying to get all the bladder and the bladder plate and the sequel plate and the emphalus, you'll all reduce using the great power of duoderm. So that's a really powerful experience with this child and this family, again, this baby did obviously go on knee surgeries, but so much of our time with the baby was non-surgical. And then I have so many pictures of baby's butts in my phone and they all are different in some way. And we learn through this, this especially the power of the physical exam and diagnosis. You know, you learn in general surgery, the abdominal exam, of course, but you don't examine every adult patient's perineum or their butt and look at their anus in fact a lot of times you try not to. And I spend so many times explaining to Dr. Dickie and Dr. Nevada how many holes does the baby have? That's the big question. And the physical exam is the only way that you can do that. And I have so many good memories of day one, let's lift up the legs and look and see what's under there. And it's a really good tool that you don't get I think in a lot of other specialties. Pedesters, we also is unique in that we deal with patients before they're born. So you're looking at images with families and their child is sort of this concept, you know, they haven't even arrived yet. So this is an example we met with Dr. Bucknell of this family who had presumed at Treeso some kind on prenatal MRI, he shows it here. And then you get to meet the family postnatally when you get the x-ray that we've all received from the B.I. Says the baby's here and here's some abnormality in their x-ray and you have the benefit of knowing them prenatally, having counseled them and then you could meet with them postnatally. And then talk about the findings and the operating room of the perforated Treeso. The multidisciplinary care also, very much holistic starting prenatally in this instance of fetal neck mass, you're planning with ORL, with anesthesia, with the NICU. And then the operation, frankly, for having done it a couple of times now to twice, it's really not that much of an operation. But all of this baby's care is so intense in its life-threatening condition, where you have to, you're planning for basically an exit procedure of some sort and then the operation and then you fortunately get to take care of the baby in the long term. We do the same type of thing for the severe CDH as I unfortunately don't have any pictures of the acute CDH babies after the effects of the effect of the baby on the right. I think I chose this picture instead of those, but that's a great experience where we do all the time in the operating room again. We end up fixing the diaphragm, but the portion of the day that is committed to non-operative care, understanding the baby's physiology, sort of watching it transition before our eyes is a huge part of our learning. So the second reason why Chose P. Dr. Surgery is I think typified by another 2am story during my research years. I was a fourth year resident, I guess, and overnight and it was Dr. Marcus Jarbo at University of Michigan. Said, hey, we have this ACIP 500 gram baby perforated. He said, all right, get stuff for a drain and he talked me through this stuff to get and that's kind of hard, anxious and nervously getting all this stuff ready. And diligently, it's all laid out, it's ready to go and he walks in, he has a hold on, one sec. And I was like, well, did I do something wrong? We're missing something, he was, I got to send a real quick email. Send me a email for it. They're all there's thunderstorms. I said, I got to email my baseball team and let them know there's no practice today. And I was like, huh, that was, all of a sudden, I'm so focused on this baby, which of course he was too, I know, but sort of the humanity and the normalcy of caring about your kids' baseball teams or to show them through in that moment. And I think that mindset and sort of the focus on family, focus on priorities, not only priorities for our kids, but priorities for our families, I think was a huge part of a culture of pediatric surgery that in cardiac surgery, at least the University of Michigan, I just didn't see it was such a different vibe, a different culture among the surgeons and among the people who work in that field that really meshed with me. I tried to do that to emulate Dr. Jabo, maybe a little too early during fellowship. This is a picture of me as my son, soccer coach, assistant coach. This is a rare picture, so take a picture now of me actually attending a game and going on the sideline. So I'd maybe, maybe I'll wait to do that a little more that next year. I tried to do it this year unsuccessfully, but had a lot of fun and it really is a big part of the culture, I think of pediatric surgery that focused on family. You also, another aspect of that sort of focus, not only on our own families, but on understanding that our patients are kids, and a big part of your day is when you meet a patient and pre-op your watch, anesthesiologist do that all the time as they talk through what mask you're gonna choose and you're trying the child life, the whole entire child life team is focused on the fact that our patients are kids and babies and you can't just wake them up when you wanna wake them up for the standard 4AM labs because that's when it's convenient for me. You have to really treat them as the kids that they are. One of my favorite stories about this is on CDH rounds occasion where you'll, I see you will talk about how the baby needs to be, needs more PRNs and they're inconsolable and Dr. Zolatska, sir, Dr. Dikyudivari will say, has anyone tried to pick up the baby and hold the baby? And then the next morning you show up, how's the night? They didn't need any PRNs. They just needed the bedside nurse to hold them for a couple of hours and they were totally fine when they're held and as it turns out, they're actually just babies and then when it all comes down to it. And I think another big part of the people here is the flipping that air around to us as fellows and us as surgeons were seen as people, most of the time. We're seen as people, I think this, the picture on the left here is a screenshot from video that I got from our coroner, says the day I was taking the boards and I don't, you know, they were thinking of me taking my boards. It's a big day for me, but I wouldn't expect that the OR staff would be worrying about that they got other things to think about. And similarly, I was rounding on my 40th birthday, which as a certain point, you stopped caring about your birthday, but the Floran P's coordinated with my wife and kids and they came in through me a birthday party, which was a nice little way to break up the complete Sunday rounds. And there's just that sort of normalcy of family and normal relationships and normal support that you would feel that I think is a big part of our group here. So another big part of pediatric surgery that I also didn't see quite as much in cardiac surgery was humility. The sort of story that kind of counter, but the counter example of this was when I was a research, or a clinical resident on cardiac surgery, I called the cardiac surgeon about a patient phone call I received and it sounded an awful lot like this guy had a aerotic regurged paravalier of a leak or something used a little way as after his aerobic valve repair. So I called the cardiac surgeon, I said, boy, this sounds like this guy has this leak and he sounds like it needs to come in and he goes, no, he doesn't. Well, that can explain to me why is that? Like what are you hearing that I'm not hearing? And he's expecting some profound learning. He said, I fixed it. As I thought, okay, but it could have become unfixed or it could be leaking, no, I fixed it. He doesn't have it. So okay, great, sounds good, good conversation. And I think that is so opposite our mindset here in pediatric surgery when you're dealing with kids, you get served humble pie all the time. In fact, my wife, she loved me greatly, but she did one of the titles she recommended for my talk was my failure resume. Because there's so many times that you think about M&M, I mean, her M&M list is a mile long and you think about all the ways that you screwed up or that you miss something. And I think that it's a humbling culture and sometimes it can be tough, but it's hugely important to weigh the think about patience or to think about our complications. This, for example, newborn baby sent to us after a couple months growing at another hospital, long gap, they had done static internal traction and Dr. Mary and I spent, it was very difficult and estimate, this is way up in the thoracic inlet and we, everything looked beautiful at the end. We were kind of impressed with how healthy the tissue was and we were sort of patting ourselves in the back. We said, great work, this looks perfect. And then we got the esophage, a few days later after the baby woke up and started to act a little funny and sure enough had a leak and you can see right, there's only supposed to be one hole in the esophagus but you can see two there, with off to the right. And that is really humbling in that, no matter how technically perfect you feel like you are, sometimes either you, we don't know, was this a us problem, was it a tissue problem, what it was but ultimately you need to stop and think about it and figure out how to move on to the next thing and accept that this is something we have to overcome and get the kid through. Another humbling moment was this baby that doctors in the house and I did a really great early asthmetake down, again, perfectly healthy tissue, really happy with an asthmosis. The baby was just really not progressing but didn't really show any other signs, no white count, nothing, I had this extra, I had this little air pocket in the bottom right, or at lower quadrant and I know that I said, oh, it's probably in a loop of a hole, that tissue is healthy, doesn't have a white count, baby, it's not doing perfect but there's no way that's a normal parent-name and of course the radiologists are calling. Could be new a parent-name, could be other things. And so we said that's fine, we'll just to rule it out, take it off the table, we'll get a CT scan and as it turns out, we found exactly what the radiologists that we might find which is new a parent-name, a lot of free fluid and sure enough, we took the baby back and the asthmosis is falling apart and it's again a reminder that approaching things humbly and expecting that maybe this is something that even though we felt that one great there, kids have their own, you can't always interpret everything the same and you have to have an open mind about what might be going on. The last example of this was an asthmic prolapse that Dr. Nandavata and I had done and we did this perfectly, technically beautiful laparoscopic dissection and it reduced and we tacked it and we said, oh man, this is gonna be perfect. The skin breakdown she's been suffering from is gonna be gone and it was, you left the hospital a few days later, only to find out a few days after that, this picture she sent us and the skin irritation leaking was back and it was like we'd pulled that stoma in a little bit too far and we could point to very clearly it was like no matter how perfect it was, it's, you have to have an open mind and be ready to be humbled by what might come. And so then the last reason that I went in to pediatric surgery, I think a lot of people probably can relate to this. As a friend of mine said that he just wants to be a baby doctor and I think, I think ultimately when I was contemplating cardiac surgery versus pediatric surgery, the main, the sort of the straw that broke the camel's back and favorite pediatric surgery was I couldn't stomach the notion that somebody was gonna be operating on NICU babies and it wasn't gonna be me, I would be operating on heart disease, which is great, it was very technically satisfying but knowing that the NICU babies were gonna get care from someone that wasn't me, I just couldn't stomach it because there's something that brings so much joy about the NICU babies and the care that we give them. During fellowship, these NICU babies come in your life in a lot of different ways. A lot of times it's the text from the B.I. Fellow or the Brigham Fellow, new transport request, X27 week or six days, a domal extension, perf free areas, I agree we got a plan. Sometimes it's a little more straight to the point. Sometimes apparently this new baby Broughton has, with NIC, has free area on the KUB and sometimes in the middle of the night after it's your second or third one of the night, ODEAR free area of the IDMC and that's, they come to you in all different ways, we've all been in those situations and you're having, it always interrupts your day, you're never expecting it, that's what's kind of great and fun about it and they come with each one a little bit of a surprise, which always makes it a good challenge to figure out. On the left is a baby that I was able to do with Dr. Doe, previous SIP, had a drain as you can see about a stereo strip and a little quadrant and reprperforated and we did a stoma, I think the baby was about a kilo and that were on the right, sometimes it's obvious, big inflamed left-wing one of hernia, sharing up Dr. Angon I found a perforated sigmoid colon and a strangulated hernia. And then this middle one with Dr. Langer was a little bit of a surprise, giant amount of free air and we found this baby had an across significant portion of the greater curve of the stomach. So you truly have no idea what you're getting into, you know, it brings the certain degree of sort of camaraderie, we're gonna work through this together with the anesthesia team and the OR team, oftentimes they seem to come in the middle of the night. And then of course there's an non-emergencies which have their own degree of discovery to it because you never, again, getting back to that concept of humility, you get an x-ray and we don't know or even you get a contrast that you don't totally know what you're gonna find until you get in the belly and it's this middle case in particular, I still when we finish this now rotation with fabulous, fortunately, not scheme without ischemia, we finished the night, this talk with Dr. D'Amari and I think Dr. Lee and Dr. Bucknell, everybody's in the room, I think I stopped there, I said, what did we do exactly? I'm not entirely sure because it's just such a challenge and that's one of the fun things about it is, I feel like I learned something new about neonatal anatomy and anomalies each time I go into a baby belly for a billiacemasis or whatever, a funny x-ray. And this work with these babies comes with a lot of hardship certainly that we come across as talking with Mark Earson that people I think don't always, that's hard to relate sometimes if a baby dies, if you open a baby's belly, it's anectotalus and you don't have any other choice, but to close the belly and that's something that really people, unless they're in this field can't really appreciate and it's not something I can go home and talk to my wife about and have her understand and have a really relate or any of my friends or family. And so that can be really hard and such why the support of your colleague is really important but it is also important to maintain that perspective and I always, I say this around a lot, somebody who's around with me, when you go in and you examine a baby's belly and instead of what you're used to in general, search your residency, which is climbing over and trying to lift the sheet and you find out they don't have any pants on and so you're covering their waist and you're trying to examine the drain that's tucked under them and a big adult and then you go in and examine a baby's belly, you unwrap their little burrito and you examine their belly like this and then you wrap them all back up and walk out and I regularly say this to people, I say it's hard to have a bad day when you're examined a little baby. So I think that whenever you are having a bad day, I'll go do rounds in the evening and just chat with families and examine a baby's belly and that's I think that that part for me has been a huge joy of this these two years. So those are the reasons why I chose pediatric surgery and I think these last two years has proven that that made the right decision. I hope so at this point. And it's been a really awesome two years in that regard and some of it was predicted that as I just talked to her, I knew all this stuff ahead of time but I kind of really got a cemented now for these two years but I also learned a couple of unexpected lessons these last two years. Not really, you know, you don't really know what you're getting into when you graduate, general surgery residency and start your fellowship. And I think one of the first ones is that you have to constantly check yourself. This was a text that received from one of my co-chiefs who was a colorectal surgeon at BMC and it was interesting because I've had two senior fellows last year and my two junior fellows this year and I always thought I was the approachable guy, you know, that I would be welcome them into the fold of children's and be open and accessible and as it turns out, sometimes I need to look in the mirror and check what my resting face exactly is. And similarly, I kind of hung my hat on education and during residency, and I was fortunate to receive a couple of awards for teaching education and those sorts of things. And recently I'd got my pulse 360, which thank you for everyone who filled it out. I learned a lot from it. And one of the leading things that I got, people said, wake up, you need to start teaching. I said, oh boy, all right. And it's an interesting thing. You can get so mired in what you're doing and we as fellows were busy and it's easy to get lost and how busy we are and say, oh, I'm so busy. Too busy for this, I don't have time for that. But the thing that sort of came naturally to me or so, I thought as when you lose sight of who you're supposed to be with what you're supposed to be doing and the people around you, I think, you gotta check yourself sometimes. The other important thing I've learned, we get a lot of referrals. This is where the world comes for answers. And a lot of times it's easy to morning, quarter back and sometimes it's appropriate and sometimes there are things that happen in other hospitals that you can kind of scratch your head and say, boy, I wouldn't have done that that way. But there's a lot of things I learned in these last two years people doing really amazing things. We're fortunate that we know, you're not gonna transfer an adult with pancreatic cancer here. We know who's coming here because of what we do. They're probably gonna be a baby. They're probably gonna have EA or Colorectal anomaly. We kind of know what's coming, so to speak. And this, a couple of these cases were really remarkable this year. I read the notes from this is an example of a baby with tracheal atreza. I know we've talked about another forum before, but I was reading the notes that this was at a hospital in Hackensack, New Jersey, that I looked through and they say, we have pediatric specialties, but it's like a clinic with like six pediatric specialists across all specialties. So there's maybe one pediatrician somewhere and one maybe pediatric neurologist who comes once a month. And I was reading the notes that many, many people tried to innovate this baby and it wasn't until they said, we called the anesthesia team and the NICU team and so on. And it was a pediatric, there one pediatric ER doc came up and helped with intubation. And as it turns out, this baby had this very rare condition that even we hear rarely see in a place that gets these babies from everywhere. And so these people did an awesome job saving this baby's life and it's easy to forget that these things are happening elsewhere. There's another example of a baby. We heard about this at the Super Bowl Grand Rounds, the trauma of a baby who got, was hit by a car and completely split their foreface, their manvolum, their maxilla, and was quite literally bleeding to death from their facial fractures in the trauma bay. And somehow an EMT in the field managed to get an airway and we could barely keep the airway and let alone trying to get it into novo. So again, people are doing amazing things. The Columbia's motto was amazing things were happening here. I think it's time to look out and say, man, appreciate what amazing things are happening elsewhere. The next thing, I think this is probably the most important thing I learned and I kind of knew it. My mother hammered this into me. One of the many good lessons she taught me was always be thankful and always be practicing gratitude. We, as I've alluded to already, we fellows, we are tired and people say we're overworked and people know we show up to rounds in the morning and people say, oh man, I'm so sorry, you're up all night. And you know, be good to the nicky and drop the baby off at midnight and I go, oh man, I have to be alone. Baby, you must be tired, but don't feel bad for us. We chose to be here and we have an awesome job. This is this little Pew Research Survey. You can find these job satisfaction surveys all over the internet. And you look at the things that are the most important factors for job satisfaction and I can promise you, we have every single one of them in spades. The respect that your job earns, I mean, try going out into the hockey rank and tell people you're a pediatric surgeon and not get this look of sort of awe and appreciation and admiration. Then similarly, we've talked a lot about the meaning in our job. Taking care of little babies bring so much meaning salary. There's plenty of debate about residence salaries, but certain earning potential for physicians is great. Autonomy, similarly, in residency, maybe less so, fellowship a little more and then when you're an independent practicing surgeon, you have great autonomy over your patient's care and you have opportunities that are never ending, particularly here at Children's where we have so many resources. And then similar to the first one, the respect, the recognition. I mean, you don't see your, you don't leave a grateful client gift for the person serving you dinner at McDonald's or the person who picks up your garbage, but how many grateful patient gifts, I mean, we as fellows get them and as attending surgeons, we get them. So certainly that recognition is there. And we're, if we're not, it's important that we are grateful for the opportunity just to do this job overall. Despite the hard times, and there are hard times as we've talked about with the, every now and again, if I forget that, it's important to again, walk around and look at the positive things that there are and the fact that I chose to be here ultimately. And similarly, speaking of gratitude, some of you may recognize these causes of work, workplace stress as predominant features in your day-to-day life, particularly those of you who work in the OR, keep our general surgery team afloat in the OR, keep our floor patients afloat, just heard a little bit about how the hospital is currently on fire, not literally, but of course, figuratively, it won't sound any alarms. But the people and our admins who keep us all as surgery fellows afloat, they're regularly working on call, getting called in the weekends, because nobody knows where the meniscus knife is for pala or myautomies or getting yelled at by families for whatever other issue might be the issue, to your, what we're enjoying ourselves, operating on little babies and doing these great cases. The gratitude for the people around us who support us and yet who don't get the recognition, I Googled my name and my face came up and I Googled the name of a couple of our OR staff and sorry guys, I was Googling you, the OR staff and our MPs and nothing comes up, their faces don't come up and I think that recognition sometimes can be lost, I think it's important for us to not forget that. Another important component to pediatric surgery that we say is we're saving lifetimes you all, heard this phrase, this was the 50th anniversary of Apsa, saving lifetimes and it really gives us meaning, it sort of drives us and says we're not saving an 80 year old man dying from pancreatic cancer, which is of course important, but their life expectancy as it is is short, we're saving a newborn baby that we hope to give them a lifetime of 80 years, 100 years out of, because we're able to save their life or intervene early. And I think it gives us a little bit of an inflated sense of self-importance quite frankly, because it depends on what you look at, are you doing the saving, are you focusing on the lifetime? And if you focus on the saving, then you have course, that's what surgeons were doing, all the saving, but I think if you focus on the lifetime component, like we're not a part of these baby's lives, we are sometimes for a long time, but so many other people are. And I got to learn a little bit about that, see it firsthand when I got to see some patients at the end of their sort of time with us, their care cycle with us. This is a baby with a long APA, of course, we've had many of them come through this one, it was with us a long time, I had some misadventures, including attractions and disruption, the urgent take back OAR long, the long feeding issues have often come with this, got to know the family fairly well. And in this picture from 1962, based on the hue, they, this is the night before they left, and they flew off to California, and I got to spend some time with the sun, and I haven't seen them since, and that's awesome, because they're growing and thriving in California, I hope, if not, I assume they would be back here. Similarly, I had the opportunity to see what Dr. DiMari, one of our patients, in fact, the first patient that I had mentioned from this year, gastroschysis, this was day one, put the silo in, casual at the bedside, let the junior fellows do it, Eliza seems to be sleeping through it, as you can see from this panel. And then what appears to be NACU, sort of an unusual course, many, many operations, much less bowel than he had to begin with, and then we got to see him on the other side, I got to see him when he came back in clinic, many months later, and he's a totally different kid, and they were just coming in to get their G2, sort of a trivial little thing, and they sort of had done a bunch of stuff since I'd last seen them, when I thought boy, I'm the centerpiece of their life, I see him all the time, and then they go out, come back, quick G2 pull, see you later, and now I don't know where they are, which is awesome, and hopefully they're doing well. And so it's important to maintain that perspective that yeah, we're important in the first parts of their life, but so is their family, so are their classmates in second grade, so are their teachers, piano instructors, baseball coaches, their pets, those people are all important, and if not more important than we are, it's important to keep your, sort of keep that perspective, I think as you're the goal is to get people to not know us, need us anymore, and that was really fun to be able to see that on the back end, when these patients come back to clinic, and they're like a totally new person, and then they go off, and they forget about you, which is considered a success. So the last component, this was a quote from one of my chiefs when I was entering my chief here, so you're ahead of me. He had said surgical training is selfish, and I sort of didn't quite get it, and now I get it for sure. So the, we, as I've talked about, we all choose to be here, but our family's in spouses didn't, there's no fellowship for single parenthood or fellowship for having to take your kids to the eye doctor and do all the hockey practice drop-offs and so on. Sometimes, mowing the lawn with multiple kids in tow, doing all the bed times, I think that part, it's important to be aware of that, because again, we drop a kid off at 11 p.m., and you're like, oh man, tough day, woo, boy, it works, sure worked hard, and there's somebody else working hard at home, I think it's important to remember that. And it comes back to, again, themes of gratitude, themes of just kind of self-awareness of the big picture. So a couple of expected lessons, a couple of unexpected lessons, and it's been, it really has been a powerful two years, it's been a lot of fun working with all you guys. So thank you very much, I'm looking forward to next year. I'll be sticking around here as some of the most of you guys may know, I'll be working with the EA team, hopefully working a little bit in the Fetal Center, of course, General Surgery Clinic, and looking forward to a couple months off, where hopefully we'll get to go to some Bruins games, maybe go on some road trips and some date nights, maybe a few more than I did these last two years. But it's been, despite all that, it's been a lot of fun. So thank you all for listening to me, and for being here with me the last two years. Thank you. Well, I think everybody, which I think congratulating you for your accomplishments, not just of these past two years, but of your life to this point. And what's coming, and I think that the themes that you highlighted you demonstrate humility. And that is something I think attracts a lot of us to the pediatric world. Some of us aren't as good at maintaining it, but I think that was a masterclass in humility, because I've been this room. Those are hard to have worked and how much. You have made a difference, those families, and if you be work with them, for you recognizing them, if you aren't here, but without taking much care of yourself, is the epitome of humility. And I think you made the right choice. I'm sorry for the world of cardiac surgery. I'm not too sorry for here on consulting. Hope you're not listening. They're very powerful. They're a powerful group. And the theme that we don't matter as much as we think we do, is important. But many of those families will you find out down the road that you've forgotten them. They actually haven't forgotten you. And that is one of the incredible qualifications that comes as we get a little bit more, a little more senior is actually see that some of these families you did make to the curb of different state lives. So I'm sure where's Dr. Modi? I'm sure that last time I spent tour of tourism, Dr. Modi, boss for a few more days. I haven't been his boss for a while. He's fully cooked. It's funny Brian, he didn't tell me about cardiac surgery, but I actually thought about cardiac surgery as well. Those are the two things I was choosing between. I'll save a lot of what I have to say for Friday, but I'll just say that I don't think anybody in this room is surprised by the maturity of your presentation. You've always been a very mature, thoughtful, poised, calm, unflappable fellow, which is what we all appreciated during your two years here, in addition obviously to your technical excellence and your great care of our patients. So thank you, well done. We're all very proud of you. We're all very excited to have you join us on staff. And we look forward to celebrating you on Friday. And does it should make me a comment? Or maybe you even have a question. Brian, I want to thank you for, again, the humility, but just the perspective that you bring. It's a slog some days, not every day's Instagram worthy. And that's part and parcel of us having a job. But some days you can sit back and really appreciate how truly awesome this machine of medicine is. And you can either be down in the dumps, sometimes feeling like a simple cog in the machine and you know, unappreciated or whatnot on those days. Or you can feel incredibly grateful and humbled to get to be even a small part of what we do collectively in medicine and having gratitude for the people you get to spend time with. I mean, you can't beat the company you keep in a place like this. I think it is inspiring that after so many years of training at this moment, you have that perspective. And I'm beyond grateful that you will be joining us to stay. So I just want to thank you for bringing that today. Thank you. Thank you. That would be tough to follow. I think we can all agree that the field of medicine with large pediatric surgery, this institution, the people you work with, this department are incredibly grateful for your decisions that you've made up to this point. And some of us are incredibly grateful for the decision you've made to join and remember, remain a part of our team for many years to come, hopefully. So thank you and congratulations. And we are looking forward to Friday, which might get a little bit spicier. I think Dr. Lee and Dr. Foyne may have something more planned for us to learn about your life. And we'll see how humble you can be. So congratulations. Thank you. I'm looking forward.
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