Finding Meaning in Medicine and Overcoming Adversity: a Surgeon's Journey So Far

Speaker 1: 0:01

Welcome back to another edition of the Red Leaf Fitness podcast, A show dedicated to bringing you stories, interviews and conversations about living a healthy, resilient and productive life. I'm your host, Sean Blinch, and I want to thank you for making time to listen to this episode today And, if you like what we're putting down, we would love it if you would follow, rate and share this podcast. All right, now let's get down to business. Welcome back to the Red Leaf Fitness podcast on Friday, June 16. I am sitting here with Dr Andrew Pfeiffer, MD Urologic Oncology. How are you today? I'm doing great. How are you? I'm doing well. Now, Andrew just dropped into the office where we record these podcasts and sort of blew my mind. Can you tell me what you just told me, like literally three minutes ago?

Speaker 2: 1:00

Oh well, you know it's, for me it's a standard thing. I, you know, plan, was you know, to be at the class at 6am today and then, roll into this great opportunity with you.

Speaker 2: 1:15

But plans change And what happened to me last night is that what happens all you know let's say one in, let's say one in two times when I'm on call, is that I get called in to help another person at, you know, a very, very early hour in the morning And so I spent many hours overnight operating on a lovely individual who is now doing going to do great and, you know, very fulfilling to help that person and so on, but kind of screws up my sleep schedule, kind of sleeps up my plan for the day. Wasn't rested enough to come in and really kill that workout this morning, So kind of bummed a little bit. But you know, as is life, you know she's got to fight. You know fight another time. That's kind of what it is. So, yeah, but very pleased to be here today and, you know, and looking forward to, you know, great things moving forward.

Speaker 1: 2:15

And I kind of want to let that frame what an incredible person that I think you are and how much respect that I have for you, not just like myself or the community here and the and the greater community around you people like yourself. I don't know how often you give yourself, let alone like credit or even a trace of credit, for the incredible work that you do every single day saving lives. And for those of you that don't know, i am Andrew's trainer And one of the things that we work with slash against at times is the demand of Andrew's job, and I kind of want to let that frame up what we're going to get into and just talk about the kind of medicine that Andrew does. But before we get into that, can we go back to the very beginning And can you talk a little bit about where it all started by, like right from the beginning, where you're born? start from there.

Speaker 2: 3:13

Sure, no problem. So I, i'm a new Torontonian, you know. So I've been here in Toronto for about 12 years now with my wife and kids, and. But I was born and raised in Montreal And I, you know, lived my life in Montreal for many, many years and probably would still be there if it wasn't not for meeting Michelle, and you know her looking looking forward to a life in Toronto which I'm now, thankfully, part of.

Speaker 2: 3:45

So I, born and raised in Montreal, a great, you know great childhood. My parents were, you know, hardworking individuals and provided a lot for my brother and I and the and really, you know, grew up in a family where I was very fortunate and privileged to be supported from an education standpoint and always encouraged to do my best in school and worked really hard and, you know, did all the things normal kids do and and was very, was very, obviously very appreciative of the fact that I had a great support of parents who, you know, pushed me in that way And I can tell you that from, you know, from a professional standpoint, i always, always, always, always, from a kid, wanted to be a doctor, always, That's interesting.

Speaker 2: 4:37

I never in my life thought about anything else And I think my late mother took credit for that, which is probably the case because you know she, she lived vicariously through me for many years And you know, being a woman in the 60s in Montreal, she wanted to be a doctor too. But actually, you know, you know she, actually she, we talked about this a lot and she went. When she got her rejection letter from McGill, there were two reasons that were stated on the letter why she couldn't be a doctor that year. And she was physiotherapy, which was fantastic. She had a wonderful career for many years and then onto other things and helping my dad. But the two reasons on the letter was one, she was a woman And two, there was a quota on Jews at McGill, so she was not allowed the sheet She. There were too many Jewish applicants and they were. They basically capped the Jewish admission to McGill medicine And yeah, so it.

Speaker 2: 5:42

So for me, like you know, for her, it really drove her to, you know, to push my brother and I to succeed and to do a lot of things like that. And when I got into medicine at McGill, she, you know, was probably one of the best days of her life, you know, and she, she. I remember that day very clearly And so I. So I went on to, you know, be a medical student at McGill and worked really hard there. And then what was interesting about you know, what happened to me is that after my first year in medicine, like nobody really understands urology, like who goes into urology? And interesting, it's like the second most popular, most sought after specialty, like in North America, but nobody thinks about it And nobody experiences it until you actually experience it.

Speaker 2: 6:30

And what and what happened to me was that I had a good family who was also a urologic oncologist here in Toronto. I did some great research was published in 2002, in the research that I did with him and I haven't looked back. And it was really for me a drive to be a cancer surgeon, somebody who has the impact to help people, which is something I really honestly always wanted to do, but at the same time have a reasonable quality of life. And you know we talk about quality of life, you and I a lot, and you know how busy I am and you know how a wrench gets thrown into my weekly schedule and sometimes it's unpredictable, like this morning, but it's far more predictable than many of my colleagues who work much, much more overnight and have unpredictable schedules every day. So for me it's funny. I have to deal with the unpredictability sometimes and just kind of chalk it down to that's my life and that's it and move forward.

Speaker 1: 7:38

Andrew, a couple questions for you actually.

Speaker 2: 7:40

Can you define urology Sure? So urology is a surgical specialty, so it's a five-year surgical residency dedicated to the management of what is genitourinary disease, so everything from problems with male anatomy to female anatomy also, so 50% of my patients are women. You know everything from cancer of that's what I do, so I'll talk to you about that in a second but it's cancer of the urinary tract. So prostate cancer is number one. Kidney cancer, bladder cancer everything from kidney stones to bladder problems and problems with urination and incontinence, to infertility and male infertility being a very big part of our specialty to pediatric genitourinary stuff. like a lot of kids are, a lot of people are born with malformations of their urinary tract that require surgical management, things of that sort, and those are the main ones. And within that, so what I did was I did after medical school in McGill.

Speaker 2: 8:52

you go on to a five-year surgical residency. So you spend five years learning how to operate on the urinary tract, which is a very complex thing to do because it's not that easy to get to in the body. It's not like you're a plastic surgeon operating on skin. You got to really, you know. so you spend two years doing general surgery and then three years doing urologic surgery And then, if you really want to get a job and do something interesting, you got to go further. So I spent many years. after that I moved to New York City where I was a fellow in urologic oncology at Memorial Sloan Kettering Cancer Center, which is like for those people who don't know, it's like going to, you know, interneeding at Goldman Sachs. or like working, you know, getting your level two CrossFit, you know, crossfit certification at like the CrossFit headquarters, you know, or something like you can't get more intense, you know.

Speaker 1: 9:54

then ground zero. Ground zero of what?

Speaker 2: 9:56

I do right. So and I was so, so honored and privileged to learn, like my craft, from some of the leaders and who developed these procedures, So it's really the Mecca. And so I had a great time in New York and you know, there's all these personal things that go with that and living in New York and Did Michelle come?

Speaker 2: 10:15

Yeah absolutely Yeah, we moved, we moved everybody We had. My younger son was born in New York, So yeah, so we lived in like I mean we look, i look back and smile right now And I was a slave for many years there, like a complete slave. But I look back at it with fondness now And I don't know if I do it all again, you know, knowing what I know, but certainly not at this point in my life, but it's, it's. It was just a. It was a great experience, but one that was like, you know, the perseverance to get through. That is what taught me a lot in life.

Speaker 1: 10:48

Yeah.

Speaker 2: 10:50

And actually I think about and I think helps me in my training here to get through work coats and keep on going and keep moving. And you know pushing through and all the things that the great themes that we, that we talk about in terms of you know getting yourself in your mind and your body in you know in the right state to improve yourself. You know I think a lot of that came from you know just toiling and just getting through and developing that grit.

Speaker 1: 11:16

You know was it? was it Jack Who was born in?

Speaker 2: 11:20

No, it was the youngest guy, Ryan. Oh yeah, ryan was born in New York. He's our token American.

Speaker 1: 11:26

That's a lit. Do you guys pay him, like you know, for chores and stuff in American currency?

Speaker 2: 11:31

Yeah, Well, he actually asked that, It's true. He asks, he says this is an American dad, i want American dollars here. I said listen, kid you know, you know, not in my house. You know.

Speaker 1: 11:41

fine, You sort them out, send them through the IRS.

Speaker 2: 11:43

Exactly, exactly.

Speaker 1: 11:46

So, speaking of kids, i actually have a question from something you were talking about from the beginning. So first of all, i just want to you know, highlight and platform just for a second how truly incredible I think that your mother is to to to go through something as bullshit as dealing with not only anti-Semitism but massive sexism in the sixties, and it's it's, it's unfa Like I actually shouldn't say it's unthinkable now, because both of those things are alive and well today. But to hear about it at the level of, like McGill University, i was shocked to hear that. Oh yeah.

Speaker 2: 12:27

It's, it's, it's, it's, it's, it's just unbelievable the amount of women who were excluded from racism, misconduct, that they were abdomen Down to a 95 percent 죽us, and that's very good, that they have the power to be the absolute witness, to free themselves from all the LGBT, um positions of influence or, uh, opportunity because of their sex.

Speaker 2: 12:41

And it's, it's, it's, it's analogous to just, i think about it all the time uh, how, you know, when I, when I have so many amazing female colleagues at work who do amazing things, i mean I have so much respect for female surgeons particularly cause a lot of them, you know, have families and raise kids and and and do what I do, at the same time, i just it's mind boggling, you know. I mean, uh, you know, in this day and age when everything, everything goes and everybody's accepted and and I think it's, you know it's quite awesome, um, it's still. You know, those people who choose to bear children, you know, and and and go through the surgical, you know, lifestyle, it's just insane, it's absolutely insane. And, uh, you know, much respect to, to, to, to my uh, wonderful female colleagues, you know absolutely, and and it makes me just think about just how systemic all that was.

Speaker 1: 13:31

If this is happening in the sixties and seventies and stuff, think about the generations of professionals that we have missed out on up until you know recently.

Speaker 2: 13:39

So so, so many people. It's unbelievable. But I'm proud to say I'll tell you that this year, like you know, to get into your to to you know, sort of a surgical sub specialty, there's what's called a match. So you, you interviewed all these programs and then you're matched to a program And if they like you and you like them, they kind of you kind of match on the grid And um it happens once a year and it's a very nerve wracking experience for all applicants and um 53% of all new urology residents this past year are women.

Speaker 1: 14:09

Excellent. You know which is awesome Oh?

Speaker 2: 14:11

yeah, it's great, and uh, and there's still some um, uh, i would say uh, problems with, uh, all specialties right now, and you know different types of quotas, different types of things that are going on, uh, supposedly, but um, but I think there's a lot of progress, you know for sure. So I mean um, that's a good thing, so I mean I. So I, you know this, this loan counter, anything in New York was great. But the funny thing is, sean, it wasn't enough. Right, i want to come back to Toronto.

Speaker 2: 14:41

I knew that's where I headed when I was headed with my wife and kids. Um, to get a job here, it's not enough. So I actually had to do more than go to go to that Mecca, you know. So I had to, um, because I do a lot of research and I'm, you know, um, this, uh, you know, i, i'm a assistant professor at U of T, so I do a lot of teaching, also in surgery and medical students, residents and all that. So I had to beef up my my, my, my, um, uh, academic portfolio by seeking out a master's degree. So I went and did a master's degree after that And then I um, you know, then I, then I was able to move back with uh, with those credentials.

Speaker 1: 15:18

Yeah, you know your colleague Dr Evan Lewis in neurology. he he once sort of blew my mind and he said he had a number which I forget now. but um, how many years of school have you done So?

Speaker 2: 15:33

uh, after high school, before I got my first job, my first paying job, uh, it was 19.

Speaker 1: 15:40

And then, and then, and then. After that, like so many.

Speaker 2: 15:45

So I did 19 years of schooling, um, that includes, so it's a four, it's a multiple years of Sloan Kettering. I was in Boston for for for a while doing the master's degree And and then I moved here and then it's been, you know, about just over a decade now that I've been in surgical practice, which is interesting because, you know, uh, becoming a new surgeon that first two years as a new surgeon, when your name is on the dotted line and you're responsible for somebody else's wellbeing, is harrowing. It's an experienced man And, um, you know you have the skills, but I learned very quickly that you can have, you know, um, all the greatest training from all the greatest people in the world, um, which I was fortunate to have. You can have the degrees from the best schools, but when you're in the operating room and you got somebody else's life in your hand, um, there's nothing else that's more important than experience And you rely on on, on your senior colleagues to to give you that extra little bit and like, yeah, you know you're you're doing the right thing there And you know it's, it's just you know.

Speaker 2: 16:51

So I was very fortunate actually. So shout out to my, my great colleagues at my hospital. I mean we have a great group and and, um, you know it's, it's it's been great to kind of mentor younger surgeons now and getting getting getting through that and so on. So it's been it's been a great thing And I'm just very thankful for the environment that I'm in right now and that I'm able to deliver the type of care that I can to uh to my patients.

Speaker 1: 17:15

Way, way back when you said when you were a really young and you wanted to be a doctor, we are you like. Can you kind of go back to that and sort of get your go back into that young Andrew? Where do you think that came from?

Speaker 2: 17:35

So that's a great question. Um, it had to do with I was very I was medicalized at a very young age, very young age. Um, i was a real trendsetter, you know, when I was a kid, for numerous reasons. Number one, i was the only kid around now it's very common, but the only kid around with a severe, life threatening allergy. So I like, when, when you know I I'm severely allergic to, you know, everything from the sea, fish and seafood and everything I can't, i can't do any of that. So, um, so I love sushi, in theory, you know, although I've never, you, never, you know, never taken, i never had that. But the um, what's interesting about it is that I was, i was always carrying around an EpiPen as, as a young kid, going to camp, going to school, always vigilant, making sure that I was okay. And, um, also, from the ages of three and between three and five, i spent like 50% of my time in the hospital, admitted to the hospital, when I was a girl, it was, i was a small kid.

Speaker 1: 18:34

What age?

Speaker 2: 18:35

So when I was between three and five years old, i had, i had ridiculous asthma. So I, you know, i was like I was a. You know, i was at the Montreal Children's all the time And um.

Speaker 1: 18:47

Is that a good hospital? That was great.

Speaker 2: 18:49

Yeah, it's like six kids in Montreal, okay, you know. So it's like. So I, you know, i was, and I it was really bad asthma and they didn't have the great things that we have today. So I was hospitalized a lot for that, so I couldn't breathe and my you know, my parents went through a lot with that And, um, you know, thankfully I'm perfect now. I'm zero, zero, zero issues, and but um the uh.

Speaker 1: 19:11

Do you have a puffer or anything Like I mean?

Speaker 2: 19:12

I have, but I don't use it, Okay. You know, I'm more worried about my kids because my I've given that gene to my boys, you know right. So uh, so they, uh, they. You know they struggle a little bit, but they're okay With the air quality.

Speaker 1: 19:23

I remember Jack was saying that he was like So you know, we watched them exactly.

Speaker 2: 19:27

Yeah, so it was. It's been a little tough with them but it's okay, you know, and we were thankfully have great stuff and great physicians here and great um medicine. We're very fortunate in Canada to have all of that, you know. So, um, so, yeah, so there was that. And then there was my mom's influence. I remember, like I used to a funny story that I've told others in the past it's just now. I'll be on the podcast is that?

Speaker 2: 19:49

uh, you know, when I was a kid, um, you know often, uh, you know, you, you get a story read to you before you go to sleep, kind of thing. I mean, i did that for my kids for many years and you read bedtime stories and stuff. So, um, my stories were that, um, you know about, uh, about anatomy. You know, i used to. I used to go to school and I, my mom, i used to laugh. My brother laughs at me, he goes you used to go to school and tell kids that the right side of the body was controlled by the left side of the brain and vice versa, and people would look at you like what the hell are you talking about? You know, it was like eight years old, you know, and um, so, like it's just, you know it, i was medicalized very early from a personal experience and then, with my mom's influence, and, um and uh, I've always been a guy who, um, you know I think I've taken that from my late father as well Who, um, i've always been a guy who wants to help, you know, always been that that guy. So, uh, the guy who delivers to, to, to, you know, for other people it's friends or family, um, putting everybody first, um, my life has been about putting everybody first, including my, my patients, you know, uh, i mean, look, i put my patient last night ahead of my own health last night. I mean, you know, just just acutely, that's what's going on.

Speaker 2: 21:02

I put my kids and like, like we should, you know, my wife and all the important people and my friends, like when my friends, when I have friends, i put them first. You know, like I really I care, um and uh, i care in a deep way. But, and what's interesting about it is that, um, you know, part of our journey here together and how you're helping me through and how I'm helping myself a little bit mature, is, um, putting myself, um, at the front of the line sometimes, you know, and part of my journey here at Red Leaf and uh in life has been to um, to put myself first, um, because you can't put everybody first all the time because you can. You know that that, that's that's, i would say that's been a really big um, uh, a really big problem for me, Um, and my health, uh, has suffered both, you know, physical health and mental health and all those things You got to, you got to.

Speaker 2: 22:05

I have to learn. You know it's very tough for me, but I have to learn how to put myself first. I'm, i'm, i'm finally making inroads a little bit, you know, to improve myself.

Speaker 1: 22:15

Yeah, and that's one of the most amazing things about when you, you know you talk to someone like yourself who, quite literally on a daily basis, goes in there and actually saves people's lives, and that's it's not every day I get an opportunity to like get in and speak with somebody, not just in the conversation level between you and I between sets and stuff on the floor, but actually be able to ask questions that the general public probably never get the opportunity to ask a doctor, you know. And so along with those questions is also the opportunity to share what it actually is that you're dealing with. It's there's there's a bit of a there's a bit of a duality to this thing, where one who saves lives also burns their own in the, in the, in the process.

Speaker 2: 23:08

I'm learning how not to do that. I'm learning how, you know, it's all. I've always been a guy who really goes dives deeply in what they do. Yeah, you know, and part of that's a good thing, you know. I mean I'm I'm, you know I'm of a very fortunate new community member here newer, you know you're a chalk guy.

Speaker 1: 23:27

You're a chalk guy.

Speaker 2: 23:29

That's a great personal, interesting joke that we have, yeah, so I'll tell real quick Yeah.

Speaker 1: 23:36

I mean one day, one day, andrew sees people using a bunch of chalk and stuff in a workout and he's like. He's like Hey, you know, should I be using chalk? or I was like Yeah, so you're like no, no, no, no, i can't be using chalk. I gotta earn that. I'm not chalk guy. Yet The moment you walked in here, you were a chalk guy.

Speaker 2: 23:53

I just you know it was. It was more of the intimidation factor of walking in here as a, as someone who's never done CrossFit And I always talk about, you know, losing so many decades of my life to not, to not doing really the right thing. You know, and I feel like I found the right tone here. You know, and you know, you know, using chalk at work, as simple as it may sound, was always assigned for me as somebody who's really just in their game. You know on on, you know doing whatever they're doing on the, on the on the bar, and it's always just like, yeah, okay, i'm not that, i'm not a CrossFit athlete, i can't work, i can't use chalk, come on, you know, anyway, it's, it was funny, but one day, you know, but anyway, um, i'm not sure. What was I, what were we talking about? Um lost my train of thought.

Speaker 1: 24:36

We were just talking about, uh, how you're really at this fork in the road and just really starting to prioritize your health. Yeah, Yeah.

Speaker 2: 24:43

So I mean, it's like just getting back to that.

Speaker 2: 24:45

It's just um, you know, um, learning how to put myself forward in in this regard and take time for myself, um has been an important um thing for me And um, i think it's actually improved everything, like when I um, you know, when I get to work, when I, when I'm home, when I'm it's just it allows me to kind of stay focused, because I don't feel I feel like I have my time in the day for myself And, um, as a result of that, i can put more of myself and other things. So I'm not kind of I don't feel like I'm stealing um time from, like, my kids or my wife or my work, because I have my defined time that's for me, which is, um, my time at the gym, um, you know, my time with you, um, which is, uh, has been a blessing, uh, in many respects And um and uh, you know I can really kind of you know, even you know level up what I do other places in my life, because I'm I feel like I'm taking care of a little bit.

Speaker 1: 25:47

I love that man. That's so good. You've been working so hard for so long elsewhere And this is finally your opportunity, and you, uh beyond, deserve it.

Speaker 2: 25:57

And I'm just so glad that you're, you're, you're you're there and we're doing this together.

Speaker 1: 26:01

You know, one of the things that I have always found so interesting about, uh, you know, our chats in between sets and stuff is just getting a better understanding of what's actually happening at the surgical level, like the stories that you'll tell me. you know, it's not like you tell me every single detail, but you'll, you'll, can you, can you share with uh us about what happens in a surgery, like, can you walk through and you know?

Speaker 2: 26:30

I mean standard stuff, i mean the um. So surgery is a very high, highly intense point um in the uh in the life of a patient. But, um, you know, for me, surgery is the calmest point of my day. The calmest point because, just like you know, i see you, or you know Michelle or Tiago or some of our unbelievable athletes here, just going through these, these workouts, like it's like, like you know, you're the boss, you know, and you just killing it, um, that sort of familiarity and comfort, um in that space is what you know, as a surgeon, i experienced in the operating room. So, um, it's exciting um to be in command of the ship at that point, um to have uh people listen to you and listen to your every word and every syllable, to to direct this surgery in the best possible way to get the best possible outcome. So, um, surgery is also a team sport. So I'm relying on whether it's an assistant, um my nurses, who are tremendously skilled and uh, to shout out to all those nurses out there who are just phenomenal and, um, you know, partners in, in, in in healthcare, which is amazing. We need double the amount of nurses we have, you know, in the world, in, in in in Ontario. Um, we just need more people, um and uh, we need amazing people like that we have. But you know the surgeries, um, you know it's just it's interesting because, um, you know, no matter how dire the situation, how, um, aggressive the cancer, how, um, you know, dangerous the operation is, uh for that person, um, i think the most important thing, that surgery really starts in the conversation before uh, and you know you have to be very realistic with the patient in terms of explaining what the potential pitfalls are and the risks. We've all had those conversations the risks and what the benefits would be. And you know, and what's going to happen if you hit that, that, that obstacle, you know, and you have to make that really important decision, um and um, but the most important thing is giving hope to your, to your, you know, giving confidence. You, your patient wants to know that you're in charge and you know exactly what, what to do. And, um, that's the most important thing that I can give to my patients. You know that, that feeling like I know what I'm doing and because I do and I'm going to help that person, the most important thing in my life, at that one moment, is that outcome, and that's what I, that's, that's what you know, that's what I try to give my patients to understand that they get my best at that point in life. And you know that that's it.

Speaker 2: 29:22

And, um, you know, the actual act of surgery itself, depending on what it is, is, um, following a template. You know, um, but what's interesting about the template is that it never actually works out. You know like surgery is getting from A to B, to C, to D to E, to, you know, down to Z, and doing all those steps in order, and that's your outcome, that's your best outcome. But, um, because of you know different situations, whether it's the cancer, whether it's bleeding, whether it's um, you know where things are in different situations. you know the surgery tries to pull you from A to B, to C prime, to D prime, and you're on this alternate pathway, and that alternate pathway doesn't lead to the best outcome.

Speaker 2: 30:03

So so a good surgeon has to get D prime back to E, back to the original thing, not E prime, but you know what I mean Back on that original line. It's almost like you're driving down the highway in the middle of the desert and you're just getting pulled from both sides for different things that can happen And your job is to hold on to that wheel and just keep driving straight and you know, and just pushing, you know, with with your, with your knowledge, with your surgical skill, towards that final outcome. And, um, you know that that's what you have to do. Your job is to deal with those situations and just focus on the patient outcome. And that is the best, the most important thing. Your North Star is getting that patient off the table with the best possible outcome that can, that can be there, given the situation.

Speaker 1: 30:48

So it's intense. I love the piece about hope and then how it also connects to just how how you respect the patient in their life and your, your laser focus. That's amazing And it just makes me think about how you know. you know, in someone's life, a cancer doctor is literally one of the last people they want to see, but in their darkest moment you're the exact person that they want to see.

Speaker 2: 31:13

Well, listen, i, you know people. People say, like what, you know, what? what do you do well in life, right, and professionally speaking, hopefully, i do a bunch of things well, but professionally speaking, um, you know, i really, really focus on um, you know, that moment where you, where somebody is just you know they're, the pit of their stomach is just dropped, you know, and they're just giving them a diagnosis, and you're, you have to be honest, you have to tell them the details but at the same time, there's a way to do it. There's a way, an honest way, um, that gives them the hope that they need to move forward. You know that they don't, that. You know their life is not over and life after surgery, life after treatment, will be different, but it'll be livable and it'll be enjoyable. They're still going to be that same person.

Speaker 2: 32:00

You know I always my favorite line that I say to my patients, very often those who, um, who get a diagnosis, is don't live in the shadow of this diagnosis, live in spite of the diagnosis. You know So, cause you know you, you know diagnosis doesn't, doesn't define you, you're just. You're the same person. You're just. You got to deal with that, you got to move forward and, um, you know, we've got a partner to to give you the best possible outcome we can have. And, granted, there's a whole variety of, there's a spectrum. There's the easy ones that you can cure people, and there's the tough ones where you can manage the disease. And, um, you know, one of the one of my research interests, um, one that I spent a lot of um time developing, um, you know, as a student and as as a researcher, is what's called survivorship. You know, and there's a lot of analogies to you know, to, um, you know, physical fitness and this and the fitness world, to survivorship. Survivorship is, you know, when do, when do you, when do you consider a survivor of cancer?

Speaker 2: 33:01

Well, people say, well you know you, you know your surgery, you have, you have radiation, chemotherapy, whatever you need, and then you're fine, and then you're, then you're surviving. Actually, that's not it. Survivorship starts on day one of your diagnosis, right, and it starts when you, when you get that diagnosis, you are surviving that diagnosis and you move forward with, you know, with, with the tools you need to survive that moving forward. So I really focus on that with my patients and really cool.

Speaker 1: 33:28

Yeah.

Speaker 2: 33:29

So that's that's kind of you know where where my mind is about that. It's really cool.

Speaker 1: 33:33

I love that so much I'm just framing it right from day one as something of momentum or you're already winning And they're just. we just got to keep the momentum going. Exactly, really cool.

Speaker 2: 33:44

Exactly, That's just how it works and how people need to keep, you know, focused and keep their keep, their, keep the like. there's nothing like hope. you know, to pull somebody through, There's nothing like hope.

Speaker 2: 33:57

I mean, for God's sake, you know I'm dying on some of the on the 20th burpee that you put me through And you, all you have to do is say, andrew, you got one more man, just do it, you know, and that hope pulls me through. You know that kind of thing. The same thing exists in in other things in life where you got to pull, pull, pull people through. I mean, you know I learned a lot. I learned a lot as a as a student. I learned a lot as a as a resident.

Speaker 2: 34:25

You develop your style as a surgeon, but I'll tell you I learned I learned the most amount about survivorship, about hope, when I dealt with both my parents and their cancer and their eventual deaths and how, how they, how their physicians, you know help them through that and how I was able to help them through that, even though their outcomes weren't ideal. You know that I learned a lot from that. That was a tremendous experience. So there's a lot of that you get with me. You know, as a, as a physician, you know a lot of life experience that you know. That compliments what you learn in the daily base. I mean you know I talk about what, the pauses and negative attributes of, of of medical education are all the time.

Speaker 1: 35:11

What's missing, you know you got you know I talk about that a lot, but then that's one of the things that's also really cool, man, because there's there's, there's a silver lining to pain and, having lost your parents, you can look at, you can look somebody in the eye and and you can say, with a certain level of authenticity and truth, that you know what they're feeling.

Speaker 2: 35:32

So that's exactly what happens. I, i, you know, i often so I get, i get a lot of referrals for for, you know, for a lot of people and wonderful families come and see me and they sit down and they, you know, and I and a common thing that I'll say, which is really true, right, i see the nervousness of the daughter or the son looking after their, their, their mother or father, and they just don't know what, what to do.

Speaker 2: 35:56

And I look at them. I say you know, i know what you're feeling, i know exactly And I, i open up sometimes and I say well, look, you know, i looked after my parents as well And I know what it's like. So, trust me, i'm going to look after and I do every single patient. Look after them the way I would expect my mother or father to be looked after And say don't worry. And I got you, you know, and you know that it's a powerful moment And it's one that I, i, I focus on And it's, i know, it's not just lip speak with me, it's really. I got you, you know, and I'm going to, i'm going to do everything I can to make sure that that, that your loved one, is going to come out of it, you know so Yeah, i can.

Speaker 1: 36:40

I can just only imagine that's tremendously calming to have that conversation, like, as the person speaking to the doctor, to have the doctor say that to you.

Speaker 2: 36:49

It's. You know you try the best, your best, you know, to do that And I just I hope my patients respond to them and they have. You know I have wonderful patients who've, you know, come back to talk to me about their experiences and so on, and you know, i just I'm just one guy trying to make a difference, you know, in in life and and for people, and it's a great, great, great honor and privilege to look after my patients, for sure.

Speaker 1: 37:14

What does the room look like in the sense? what do you do before you get in there and what? how many people are in there with you?

Speaker 2: 37:24

So it depends on what it is like. You know, usually there's. I have an assistant, so, like my trainee, so I train a fellow every year who's like an apprentice. There's some residents, so these are, these are, you know, doctors who are learning how to be urologists. And then I have a medical student, so somebody who's really junior and green and you know have to train them up and so on, is a resident, a student, so a resident is a student, but it's like a post grad student, Okay, so I did a residency for five years in urology.

Speaker 2: 37:54

Once you graduate medical school, you know nothing. I mean, you know stuff, you're a doctor, but you have no skills in the real world. So residency is like real world training, is it?

Speaker 1: 38:04

tied to a school.

Speaker 2: 38:06

It's tied to a school and tied to a subspecialty, okay. So, like there's, you know, neurology residents like Evan Lewis you're talking about. Evan did a neurology, you know. Shout out to Evan who's who, without whom? I would not be here at Redleaf, by the way you know, yeah, yeah So.

Speaker 2: 38:20

I love Evan And you know there's. you know urology residency and general surgery residency and dermatology residency, and you spend years learning your craft and what you want to do. So I have these residents. they come, they're they're not full urologists, but they have a graduated responsibility as their experience grows And before they take their Royal College exams to be an official subspecialist, like certified in Canada or the US, you know. So that's, that's what happens. So, and then there's there's nurses. there are really three, probably three or four nurses per room who manage, help me.

Speaker 2: 38:51

You know, scrub in with me who. You know the classic thing that everybody sees that you're looking down your scalpel. You know tractor, that kind of thing. So that actually happens Oh yeah, oh, no, no, it's, it's the real deal. So I have a scrub nurse, or? a scrub tech, who works with me, who. it's amazing. It's about the only point in my life where I actually ask for something and get exactly what I want. It's fantastic.

Speaker 1: 39:13

I love it, You know like I joke with my wife all the time.

Speaker 2: 39:16

She's like, i'm like, you know, like why can't you know? why can't I get stuff? You know, like, like. Why are you asking me? Why are you telling me that I can't have what I want here? You know, like, like. You know I get it at work. Why can't I get?

Speaker 1: 39:29

it Anyway, so be a little bit more like my scrub, Exactly.

Speaker 2: 39:34

So, anyway it was, you know, and these are just these. Nurses are tremendously skilled and they they're really partners of the team. It's a team sport, as I mentioned before. So, depending on the surgery that we do, which is a whole variety of things, like I, i do big open surgery, so big, maximally invasive stuff, and I do robotic surgery, the most minimally invasive oncology.

Speaker 2: 39:57

So so I did a lot of the training in robotics, like yesterday I took out a prostate gland using Da Vinci surgical robot, which the hospital bought for me, and another surgeon, some other surgeons who use it, and other specialties, like $10 million robot to do minimally invasive surgery, which you know I always say that robot doesn't make a bad surgeon a good surgeon, it makes a good surgeon that much better, gives you those tools to really, you know, blow the roof off your outcomes in and preserve tissue and preserve function in your patients after surgery and so on. So it really depends on the surgery. You know what it is. Some don't require any, you know, intervention by you know, some it's just me and there's no scrub nurse, because it's just very quick, you know you can be in there by yourself You can be there.

Speaker 2: 40:42

Well, I mean, it's not. You're always, you know, you're never by yourself, but like, and of course there's the anesthesiologist who's looking after you, puts the patient to sleep and who will do a spinal if they need, or things like that.

Speaker 1: 40:54

And they don't hang out right. They come and then they go. No, no they're watching.

Speaker 2: 40:57

They're there They're there, Like if a person is on a ventilator you know to you know as unranesthetic. they have a tube in their throat, that that that breathes for them, instead of a machine that breathes for them. So that requires one to one management and moment, and second to second vigilance by the anesthesiologist to make sure that that all the drugs are working perfectly, that the patient is asleep, that they're comfortable, that they don't experience any pain, that they are, you know, their, their, their oxygen is normal, their blood pressure is normal all those things.

Speaker 1: 41:29

What's the metric feedback that an anesthesiologist is looking at? How do they know?

Speaker 2: 41:35

There's a whole variety of things. There's like temperature controls. There's, you know, their, their oxygen saturation, blood pressure, heart rate. There's muscle stimuli, so they, they have to paralyze the patient with paralytics. They, you know, they monitor muscle tension with their paralytics. They can titrate things up very easily. There's this, something called MAC, which is an anesthesiology thing that measures how much inhalation gas is required to keep that patient deep under anesthetic or lightener. And it's really, you know I'm not an anesthesiologist, but you know it's a tremendous craft, a very, very cool, very cool thing. So you know, my anesthesiologist and my hospital are just some amazing individuals and they just do amazing work.

Speaker 1: 42:22

So by my count, you're up to around seven or eight people, is it like?

Speaker 2: 42:28

that's the way that yeah so it can be a lot in the operating room who are required to be in that in that surgery. So the you know I'm captain of the ship there, right, I'm? you know I'm. This is all done for me. It's very humbling. Everybody's doing this for the patient. I'm, they're doing all for me.

Speaker 2: 42:43

You know it's like a privilege, right. Yeah, that's why there's so few spots for surgeons and doing what you do it's like it's a coveted thing to have. That. It's powerful, you know, and, but you can't let the power go to your head. You're just one Person in that room and you know there's no egos in the OR. There's no bravado, there's no, there's no pounding your chest kind of thing. You know it's all that stops at the door. You know you can joke and you know Like I remember one of my trainee, one of my, one of my mentors, way, way back. He has, you know, big personality kind of, kind of guys to open the door to the OR and say, okay, everybody surgeons in the room, let's move. You know, like, like that kind of thing. But it's, it's not like that. You know there's nothing you know that's kind of made fun of and shied away from. So it's, it's not like that, it's. It's. It's much more wholesome, you know it's much more inclusive and it's much more. You know, a really good environment, you know.

Speaker 1: 43:40

So, being one of the, the people in the forefront of this fight, right, you, you, you see every day what's actually happening there, out there on the battlefield. Um, is there often things that you wish the general public knew about cancers and things that it's just it's hard to communicate That because of your proximity and the volume of the war you're in Yeah, I mean, you know I it's a great question.

Speaker 2: 44:07

You know, you and I have been exploring this Unofficially for a while now, just in our discussions, and you know the. I think that what people need to understand is how. First of all, there's really two things. First of all, how hard people work. It's not easy to pull off surgeries. You know we talked about the amount of people are involved. Yeah, you know, we're people too. We're exhausted. You know we're. Uh, you know all of the kids have other stresses in life And everybody leaves their baggage at the door. When patients come in the door, it's really, it's quite breathtaking. Yeah, all of a sudden, that like you know, you know that, that Um, you know that fights you had with your significant other, or that kid who's giving you a hard time, or that financial constraint that you're worried about, it's, it's gone, it's just evaporates and and the focus, the lightning, sharp focus, is on the patient and the patient outcome. So people need to understand that, you know, and if it's one thing I wish people would get, is that It's how hard people work for their benefit and to not take it for granted, because many people, most people, do Um.

Speaker 2: 45:11

The second thing is that, um, health is precious And you know I sit here, i sit here with you, um, you know I'm I'm here at the gym often and, um, you know I'm in, i'm in, i'm in evolution. I would say. You know my own physical Um being and you know where I want to be and I have that goal. Um, you know I'm getting there, slowly, hopefully moving forward. That's why I'm, you know, relying on uh, you know uh, professor Blinch, here for uh to To help me out on my path.

Speaker 2: 45:41

You know, um, but what people don't need to understand, what people really need to understand, is that health is, is is fleeting. Health can disappear in Heartbeat. That's what I see very often. It's like, doc, i don't know how this happened, how did? how did I get cancer? Like it's like, it's like, like, like that, like Snap of a finger. Life has changed. So I look at myself and I walk in here every day, I take a deep breath and I look at this and I say, wow, how lucky am I to you know to be to have a functioning body. You know like, it's not not super duper, i'm not 21 years old anymore, but I have a functioning body that's working well and and, uh, i can come in here and do these things and I'm going to improve it and I'm going to work with it and, um, you just have to think about it. You have to have that mindfulness moment to appreciate life and appreciate your own health, because, god knows, we don't know. None of us have a crystal ball, that's right.

Speaker 1: 46:35

You know, that's right.

Speaker 2: 46:36

That's the truth.

Speaker 1: 46:41

That was really great, that was really cool.

Speaker 2: 46:44

It's, uh, it's the truth. You know it's the truth. We're all fortunate, you know, to be here to do this together. You know it's a big deal.

Speaker 1: 46:55

What's the hardest part about your job?

Speaker 2: 46:59

I would say um, you know, i love what I do, sean, I love, i love it. It is like you know that moment when you walk out and you know, you speak to family members and you tell them that their family members cancer-free And that they're and they survive the operation and they're great, and it happens thankfully, you know, thankfully, often right. But that feeling of like you know, the elation, the, the release of anxiety, the hugs and the high fives and all that, that's the best part.

Speaker 1: 47:33

Are they hugging you? Oh yeah, they're hugging.

Speaker 2: 47:35

They're hugging, they're doing everything like you.

Speaker 2: 47:37

Doc, you know, you know we love you, you know that kind of thing. So so there's a great. You know I love that and I love connecting with people in that way. Um, and the hardest part of my job is not getting that, not getting to do that often enough. Um, that's the hardest part. Um, many of us and I'm not putting myself on any pedestal Every surgeon, every doctor out there right is just clamoring for an opportunity to do what they're trained to do in a in more efficiently, for more people. Not for self aggrandizement, not for wealth, you know, uh, god knows if I was doing it for wealth. I do.

Speaker 2: 48:17

I do something else, you know, because this is you know you know, but but, but It's, it's really for to do what we were said in life to do and that's to help people. And there are too many Obstacles to that at the hospital level. Too many Um a lot of people who are well meaning in administration and who are not frontline people Who don't understand still what it is and who, if they were, you know, in a situation you experience the care or lack of care or weight or Um logistics of what we go through, what would get it and would say you know what I get it's. It's almost like um feel the dreams You never see, the movie feel the dreams, so one of my favorite ones of all time, you know.

Speaker 2: 49:02

And at the end where the brother-in-law, when the guy walks off the ball field and the ghost kind of apparition guy You know comes up, he's actually a real doctor and he saves the little kid right. And the brother-in-law, who couldn't see any of the ball players you know, finally says where all these ball players come from.

Speaker 2: 49:16

Yeah you know, and it's like finally somebody will walk into it and say I where all these ball players come from. I totally understand now, you know. So the hardest part Is is do, is is is Waking up and going forward despite the obstacles. The logistics of what I do are difficult, like there's no reason for me to have operated one in the morning last night, there's no reason I waited hours for the operation to go. But in our, you know, but there's only one emergency room, funded after six o'clock at night, or for three, even earlier than that. So we have to wait and patients have to wait their turn. More nurses, more resources for operating rooms, you know more, more, you know, would. It would save so much Time and aggravation and improve my quality of life. You know, speaking selfishly, i would be. I would be in the 6 am Class today, you know. So it's, it's just it. That's what it is.

Speaker 1: 50:12

So it's just frustrating and just for a timing perspective I don't because I don't know if I said it at the beginning. So it was 6, 50 in the morning or around there when Andrew walked in and his plan originally when we were planning This was he was gonna hit the 6 am Class, boom roll in and we were gonna have this chat right after feeling good. But no, you know, he was uncalled and Duty called and that's what duty called and I just I couldn't.

Speaker 2: 50:39

You know I and you know we folk, you know you and I talk about sleep a lot and To walk in without any sleep to, you know, didn't do that. It probably wouldn't been advantageous for me. You know, all that effort that I put into a class would probably not as be as beneficial as was If I was that's rested and you know I have a full day today. after this I have tons of two clinics and all this stuff, So I needed to just, you know, rest for an hour you know and take a, you know, a serious shower, just a to kind of calm

Speaker 2: 51:09

down and come in here level, level-headed and clear-minded, you know, in terms of our discussion, which was my number one focus to morning this morning, that's such a, by the way, it's such an honor, privilege. There's so many Amazing people who I've listened to on this podcast. Never did I think that I would be, you know, chalk guy, or on this podcast, i mean, like you know, like it's a, it's a real privilege on, i mean, you do such an amazing job, you know I appreciate that.

Speaker 1: 51:34

What the pleasure is mine if you can imagine being able to sit with all these cool people and hear their stories.

Speaker 1: 51:40

So, you know you can't see the. You know we don't have a video of this yet, although, spoiler alert, there's going to be video versions of this podcast and not too long from now. But Andrew's actually sitting here in his scrubs right now heading off. Well, he'll go do a full day at the hospital. You know it's interesting. You know I bet there's a whole other podcast on its own. Just to be able to listen to someone make yourself go off on how they can improve the medical system.

Speaker 2: 52:07

I mean we yeah, we talked about this also. I mean, i'm an expert of managing My field and problems that problems that occur, right, no question about it. But one of the biggest divides that I found is that I have no idea how to live. Well, you know, and I mean that I, i mean I a little bit more now, but my own sort of migration, my own understanding of how to optimize a Normal functioning individual is not, you know, it's not what it should be. There's a huge divide between what allopathic medicine knows what's alipath?

Speaker 2: 52:42

So I'll. It's a meaning like I'll, like What. I'm, an allopathic doctor like I, i, you know what I'll. I'll, i'll put the is is just regular, being regular, like a regular medicine, so so sort of conventional, conventional medicine.

Speaker 1: 52:57

Okay so there's.

Speaker 2: 52:57

So there's a big divide between conventional medicine and And we don't spend enough focus on What you guys do in here in the gym, which is optimizing outcome, living well, you know, maximizing your, whether it's strength or weight loss or whatever the goal is. Though those of them, those are amazing things and I don't spend, i didn't spend enough time in my in my life focusing on that for my well patients, and It has to be part of it. You know all the great research going on right now has to go with prehabilitation before surgery. You know rehabilitation, and not just pre but post-rehab, post rehabilitation after surgery, but not even after surgery.

Speaker 2: 53:38

Healthy people, how do you maximize your health for the longest period of time? I am so tired of people Coming in with preventable disease. You know, whether they smoke, whether they're overweight, whether have no idea what to eat, no idea how to do it, and they haven't hit the gym or done anything physical in 20, 30 years. You know it drives me crazy.

Speaker 2: 54:03

There is a huge opportunity for exercise science and institutions like Redleaf, for instance, right people who are in the know to to collaborate with, with you know Certainly, you know with doctors, and to really focus on that wellness. I mean, there are things that that exist in society right now that but haven't caught on like wildfire and a part of it is also the physicians, because we don't focus on it and we should. And It takes something like an eye-opening experience, like joining a community like Redleaf, for me to understand How important, how vital it is for For people who are not necessarily sick, you know, physically, to optimize their, their, their wellness and their life by, you know, as they say, eating well and lifting something heavy. You know things like that. So it's a huge, huge deal huge deal.

Speaker 1: 54:59

It is a huge deal and you know, i have a couple of things that are coming in my mind and the first one is just basically that, like there's a, there's a. I'm quite critical of this. You know, in the fitness industry And maybe in the general public can sometimes be really critical of the medical education system and just highlighting How much nutrition and stuff that they get taught. Okay, fine, there might be bead of truth there, but I I'm not really looking at it that way. You, we have to understand the bigger picture that these individuals are going to school for 19 years To be able to operate a ten million dollar piece of equipment to save your life. Okay, like so. It's not a question of something's not working or broken. Perhaps now you have people like Andrew and other doctors saying, okay, this is how we're gonna optimize this, this is the learning We're like. This society is still learning this whole thing.

Speaker 2: 55:55

That's it 100%. Sean. You hit the nail on the head. There has to be broader collaboration with people who develop expertise in exercise science, you know, and and nutrition To, to bring those things into in default. I do that now for my patients focus on a lot about you know, cancer, nutrition, doing that, getting people off to to, you know, to train to, to lift heavy things, to improve their bones, especially if they have spread of cancer to bones, things like that. Those are really really crucial things. So I'm all for that and I'm something that I'm certainly gonna bring to my practice moving forward and we'll spread the gospel Around to anybody who's listening for sure and, like Andrew saying, the collaboration is starting but it's just not enough.

Speaker 1: 56:41

We're in the really, really we're almost in like the pre stages of it. You are starting to see it grow and and There is a wonderful book out there called Outlive by Dr Peter Peter Atia. It is similar medicine as Andrew in New York City. He has a great podcast and and there there is a line There's a quote in his book that is absolutely chilling and I can't stop thinking about it And I'll sort of paraphrase it because I don't have it exactly, but it's something to this effect that you are going to prioritize. Prioritize your health. One day it's either going to be under your admission or you're gonna have an event.

Speaker 1: 57:19

Yep and I can't stop thinking about that.

Speaker 2: 57:21

Yep, it's so true, because we, you know, as something will happen to you at some point in life It always does you hope that it happens really late, you hope it's not something severe and you hope it's something manageable. And you hope that you know, at the time where life ends for you as it does for everybody, and your kids are great, your family is great and you've you've succeeded in life at creating Meaning. You know, and that's the most important thing, what do we all crave for? We just we need to, we need to, we need to live a meaningful life, and it's not about things, it's not. It's about experience, it's about community.

Speaker 2: 57:54

That's why I love this place, because I mean, you know, i look at that board you have outside all the time. You know about what it means to for people. You know everybody's a little different, has a different flavor on it why they're here, what, what, what they're doing this for. And You know people need to focus on that and people need to have that again, that mindfulness moment, to get out of themselves, to understand that they're just. You know, you know They're there. Their time on this place is very, very, very quick and need to, you know, optimize and don't waste a minute. There's nothing, nothing, nothing more Significant than time wasted. I find that's what I tell you. It's two decades, you know.

Speaker 1: 58:32

Yeah, it's, it's fantastic and you know for For, for someone like yourself who sees, quite literally, life and death on a daily basis, it's no surprise to me while why, how you have the perspective you do. For example, every single morning, the first thing Andrew says to me is how am I, how are my kids? and That always has struck me as like wow, this is a guy who, like really thinks about the top three priorities in his life and he's always asking you about somebody else other than himself. Now, with that, i want to respect your time.

Speaker 1: 59:05

I know you got to get to the hospital, so I just want to thank you on behalf of the community here and for joining it's not me, it's not me, it's not you that thanks me, it's me that thanks you.

Speaker 2: 59:14

You've, you've. You know this community is great. You and Michelle have, and you know, and the other coaches and expanding group and the community and everybody Has offered me a great you know, welcoming Thing in life and I'm just very thankful to have been part of this community and to continue to be part of it, and You know you'll look after each other. That's how it works. So I appreciate everything and it's been a great, a great thrill for me to sit here and talk to you, sean, about this. That's awesome.

Speaker 1: 59:44

Joe, i appreciate that and we'll see at heartfest tomorrow for sure either