E12 Philip Dawe On Leadership And Military Surgery

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Ameer Farooq  00:00

Welcome to Cold Steel, the Canadian Journal of Surgery podcast with your hosts Ameer Farooq and Chad Ball. The goal of the CJS podcast is threefold. The first is to highlight the best research currently being completed by Canadian surgeons. Second is to offer educational topics for both surgeons and trainees alike. And most importantly, the third goal is to inspire discussion, thoughts, creativity and career development in all Canadian surgeons, we hope you enjoy it. Hi, everyone. Once again, on behalf of the Canadian Journal of Surgery, I hope that all of our listeners are staying healthy amidst this pandemic. We’re gonna keep on putting out content for you. In this episode, we interviewed Dr. Phil Dawes, Dr. Dawes is a trauma surgeon at the UCLA Regional Hospital and is also a military surgeon. We talked to him about what it’s like to be a military surgeon. And more broadly, we asked him to tell us what he’s learned about leadership from having a unique perspective being in the military, as well as being a trauma surgeon in the civilian setting. The discussion is extremely thought provoking. And I think you’ll enjoy it.

Chad Ball  00:59

I’ll start maybe with the same way I started with our colleague, Scott Gmora and saying that your training pathway, or path traveled anyway is a little bit different than most specifically, with your involvement with the military for quite a while, I was wondering if you could tell us about how that came to be and what your pathway was for folks that don’t know you?

Phil Dawes  01:46

Sure. Thanks, Chad. And I guess before I answer that, I’ll say thanks for inviting me on I’m not falsely being modest. When I feel really humbled and almost embarrassed to be on this podcast. I’m not sure I merit the attention, but I’ll do my best to make it an interesting chat here. I guess it is a little different than most people there are certainly other military surgeons in Canada, general surgeon specifically. And some of us have similar paths. But mine started in the military a long time before I kind of got into medicine. I come from a family that has a few people who’ve been in the military. And it wasn’t my dad wasn’t the Great Santini from the Pat Conroy novel. He wasn’t the overbearing military guy but he was in the military. And I guess we looked up to him a lot and we all ended up joining the military at different times and just because of different timing, different things we were doing, we ended up my older brother and I, in any case, joined within a few months of each other and I wanted to go to university. So, I did an undergrad degree at the Military College in engineering and then I was an infantry officer for eight years or so. And even way back in high school, I knew I was interested in medicine, but I don’t know, Military College seemed like kind of a neat thing to do. I like math and sciences and stuff, so engineering was interesting to me. My dad was a combat engineer, so I studied engineering never used it for a day after undergrad really, because in the infantry, you don’t use a lot of engineering, for sure. A lot more of just physical stuff. And I guess, a little more raw leadership and planning and tactics and stuff like that. But because I knew at some point I wanted to go back, it was always in the back of my mind. And over the years, I had to, on my own time, kind take correspondence courses to get all the prerequisites in line I had to study for an MCAT and I remember doing a finishing by organic chemistry degree. And this has been in the era of like faxes and stuff when I was faxing my homework from Afghanistan back to some guy in Athabasca  University in the year before I finally got into med school so I had to apply I think three or four years to med school before they finally let me in and University of Manitoba was the one school that was cool enough to let me come and I had to be a GP because when you go through medicine subsidized by the military, they want you to be a GP initially. And so I did family medicine residency, and then a couple of years of the GP and I knew I think pretty early that I didn’t want to stick in the military, as a GP with either get out of the army and the practitioner GP in the community or do something else, because I really wanted to be clinical, it’s spent all that time going back to school. And unfortunately, the GP they’re kind of really pushing all kinds of administrative duties, which we all have to do at some point. But I didn’t want to do exclusively, obviously. So I think 2010 I was back as a resident in my late 30s, which made me cry sometimes, but finally sucked it up through there and did a trauma fellowship here in Vancouver. And they hired me here.

Chad Ball  05:48

It’s amazing how many people that you and I know. Certainly, I would consider stars and you’re on that list as well. I had to persevere at various stages with regard to applications to whatever it could be residency could be med school. Very interesting to hear you say that it’s such a common reality. I think something that for folks who would look at you and say, Oh, well, I can walk into medical school and maybe should have walked into medical school. It’s, it’s refreshing and honest to hear that you had to keep trying as well.

Phil Dawes  06:23

I think that’s probably a good lesson for a lot of people. I don’t know how many listeners would be at the stage where they’re still applying to things. But I think maybe it’s because what you’re articulating about hearing that a lot is probably more a testament to the fact that it’s not the quality of any applicant that doesn’t get in or does get in first try or anything. It’s more just, if you really want something that maybe shows some kind of determination, or that is the right fit for you or that somehow deep down, you know that’s the right job for you in the end. So yeah.

Ameer Farooq  06:59

Do you think that being in the military has kind of drawn you to being a trauma surgeon? Or do you think that would have evolved naturally.

Phil Dawes  07:08

It was certainly more prominent in my mind; I think there are a couple things that really cemented the decision to pursue that. Like the road to general surgeon, for instance, as I alluded to, I was pretty confident that family medicine wasn’t really for me, it was nothing, I don’t have anything against family medicine, but I just wasn’t really big on doing clinical day, it wasn’t really for me. And so, you run into a few people here and there, you think I really, really like to do what that guy or girl is doing. So as a family medicine resident, I had to do it in second year, I was on a general surgery service in Winnipeg and one of my oldest mentors is a guy named Hugh Taylor. He’s not trauma. He’s actually just a great MIS surgeon in Winnipeg, but just his approach to acute problems, his approach to life, his approach to his patients and the way he spoke to his patients and just the way he balanced, really busy clinical career with his outside interests and everything was really appealing to me. So that got me interested in surgery and that got me applying pretty early on in the process of my career. And then for trauma, I have some, unfortunately, a lot of family exposure due to trauma. That kind of, I guess, might have pushed it towards it. I think just having been in the infantry and having lost friends and family members overseas. If I’m not, at the point in fighting the fight, I think I always wanted to help the guys that were as much as possible. And in my mind, nothing would help more than being a trauma surgeon. So that was kind of where that came from, in large part.

Chad Ball  09:23

That makes total sense, I think whether you’re in the military upfront, or really have had no exposure to it at all the whole spectrum. Certainly when you start to pursue a trauma fellowship, you’re intimately engaged with lots of folks like you, whether they’re special forces medics that are training side by side with you or other fellows, like you, It’s a pleasure and honor. One of the things, Phil, that it’s very clear to all of us that know you and your partner’s quietly behind your back because you’re clearly known as a leader. And I think, I certainly heard that from the residents that you set up and that are around you as well. So really from all 360 sides, I think people describe you like that. So, my overriding comment, I guess would be that in medicine, we have a lot of managers. But that’s very different from, at least in my mind what a leader is. And probably the best talk I ever saw was given by Henri Bismuth, a famous liver surgeon in Europe one time, and he gave an entire hour long, essentially presidential address about the differences between those two concepts. But I was curious how you how you view that how you define them, and does the military side of leadership in any way impact your view of it and impact how you deliver that concept? on a day-to-day basis?

Phil Dawes  10:44

Wow. Great question. I think leadership is just a wonderful topic. I think it’s interesting, because it’s certainly been spoken about and written about a lot more lately. I think, the last 20 years, 10/20 years, people have started to study it and take courses on and things like that. And then the stuff that I don’t think was as mainstream outside of the military was to take leadership courses for corporate leaders and industry leaders and things like that. Because I think, as you pointed out, I think there was a lot of emphasis on managerial skills and not making that distinction between leaders and managers. So I think it’s a critical distinction to make, I mean, managers, I like to dumb it down and sort of think of managers as people who control specific resources and can facilitate things happening. But the leaders are not tied to any one position, or any authority or any resources, necessarily. They can be people who have all those things at their fingertips, but they don’t have to be, you can have a resident, a junior resident can be a really good leader. A nurse who’s not in a leadership role can be a really big leader. It’s not tied to position, it’s just I guess, a set of attributes that allow you to make changes. And I think the other reason it’s interesting is that I think a lot of leadership can be a form of emotional intelligence. And there’s some stuff that’s difficult to teach and things that come naturally to some people. But I think because of all this interest in it, there’s certainly some things that can be learned and repeated and taught. So yes, I don’t know, in the military, we do talk about it a lot. But we also get to just see it in very raw forms. And I think kind of seeing is seeing and following is sometimes some of the best ways to to learn things. And I’m flattered that you say that’s your impression that other people’s impression of me, but it’s not something that I’m acutely aware of, I think I try to practice certain principles, but I don’t walk around telling people I’m a leader or thinking that on a daily basis, but if that’s the effect, then I’m flattered.

Chad Ball  13:29

What are what are some of the techniques or the, or the tricks that you might use to, you know, as a leader to engage folks that maybe are less engaged, whether that’s maybe a trainee, or whether that’s a nurse manager on a given on the traveling word or those sorts of things?

Phil Dawes  13:45

Well, I mean, at the end of the day, you know, you can tell somebody to do something. And that’s kind of, you know, there’s all kinds of you Google leadership, and you go into Google Images, and you’ll get all kinds of these posters that have all these sayings, and a lot of them are actually pretty true. But you can have the authority to tell somebody to do something, but if you really want them to buy in, you got to, it’s about relationship building, right? So and I think the way to get people on board, and it’s not at all about being the most popular person, but you do. There are certain elements, foundational elements of relationship that you need to have with somebody if they’re going to buy in and follow. And I think the basic ones are, that they need, there’s this sort of element of vulnerability, they need to believe that you’re going to admit when you’re wrong, and that you know, when you make mistakes, and that you’re not going to be this guy who’s going to go around and say, call everybody on their ship, but the minute somebody calls you on something that you deny that it’s your fault and deflect blame and similarly kind of this leading from the front as my dad would always say. You got to share in some of the hardship. That doesn’t mean as a staff that you’re going to write all the orders and dictate every OR note. But you got to do it sometimes. And you got to do some of the heavy lifting sometimes. And you got to share the blame if something goes wrong. Nobody hates working with the guy more than the one who says, Oh, you know, that common bile duct injury was because the resident wasn’t holding the camera, right? I mean, everybody knows that’s BS and even the guy saying it, I’m sure knows it’s BS but that goes a long way to showing everybody in your team that you’re not there for anyone but yourself. Right. So those are probably two of the big ones is just having this, developing this mutual trust and kind of leading from the front as I like to say, and because it’s surgery, I think there are a couple other things that you need. You kind of can’t get away from competency in medicine, and certainly in surgery. See, it’s hard to be a clinical leader if you’re not very technically apt. You got to be good at your job I think to maintain some sort of credibility amongst your learners and the people who are following you and stuff like that. And probably the last thing, and it’s kind of a motherhood thing, but I think it’s really important, is to treat people respectfully. Again, it’s not popularity, it’s not being the funniest guy or the funnest guy. But if you bad mouth, people behind their back, or you knock that other service that isn’t providing a great service around your learners, they’re going to kind of wonder what you’re saying when they are not around. So I think basic things like that go a long way, in my opinion, and kind of developing that trust so that people are willing to follow you when you do want to make changes and things like that.

Chad Ball  17:03

I couldn’t agree more. I mean the vulnerability is certainly a huge issue and that it’s interesting to cultures of fitness, in this case, not businesses, but how hospitals really vary from place to place in that regard.  Some places really struggle with that. And other places do it remarkably well.

Phil Dawes  17:23

I can’t speak for the whole hospital, because I’ve only been working here for three years or so. But I certainly find our group here is pretty good about that. Whenever I I’ve presented my underbelly several times, and people have been pretty darn good about it. They’ve been very supportive and that just shows their leadership and how much I trust them to expose all my weaknesses and stuff.

Chad Ball  17:58

it’s such a privileged place to be, what you describe when you can be vulnerable, when you can be enthusiastic. And at the end of the day, when you have the right mix of folks around you day to day. It makes work unbelievably fun.

Phil Dawes  18:17

I feel pretty lucky. I told you, when I last saw you, here in Vancouver, just so lucky I feel to be here. Our group is a pretty extraordinary in so many ways. Again, everybody’s great to work with, but there are differing opinions, which is only healthy and you don’t want you know, six people who think exactly the same, because then you can just group things your way into trouble. Sometimes we have dissenters who are healthy critical thinkers or dissenters for sure, who will commonly question what we’re doing and why we’re doing something and more often than not, they’re right in questioning the majority of us. So I think there’s just this great, healthy balance, we actually like each other. On rare instances where we can get out and have some sort of excuse work like a research center or something like that. We actually enjoy each other’s company quite a bit. So I feel unbelievably lucky to be working here at VGH. For sure.

Ameer Farooq  19:29

For those of us who have never seen what it’s like to be deployed, and be on a military mission as a surgeon or as a physician, can you tell us what it’s like to actually be working in the field? Is it anything like movies, or is that totally misrepresentative?

Phil Dawes  19:51

I guess depends which movie. It’s not like M.A.S.H. I wish I had enough resources to make a still. Or that I was as cool as Alan Alda? Hawkeye, but I’m not? Well, I guess it depends on the mission. I wish I had better stories to tell and some of my colleagues here for sure, in Vancouver. Particularly, like Naison Garraway, for example, would have much better stories to tell than I would, but I have been on a couple shorter missions that haven’t been super busy, just because of the timing of things. I was in Afghanistan as an infantry officer but I was never deployed there as a medical person. But I mean, the deployments I’m sure they vary widely, certainly the two that I was on were quite different. But it all depends on the size of your deployment. How many resources you’re deploying with. As a surgeon, obviously, you’re deploying with a minimum capability. And there’s all kinds of nomenclature, but simply put, the smallest surgical, you know, within kind of Western nation forces would be at very least kind of a surgeon and some kind of anesthetist usually, two surgeons. Certainly, in Canada our construct is normally to have a general surgeon and an orthopedic surgeon, work together. So, if it’s a primarily ortho case, then I would assist him or her and if it’s a primarily trauma or general surgery case, then they would assist me. So, the bare bones would be that plus anesthesia and then you’d have I guess in a war tech, which is equivalent to a scrub nurse, and anesthesia, as I said, and maybe a critical care nurse. And you can just scale up from there. So, some deployments when they’re at the height of Afghanistan, roll three, it was called, it’s a pretty big hospital that had a CT scanner, and it had several GP’s, who were kind of trained up to be the emerg docs, and the trauma bays and you had a full complement of surgical suite. They had destinations, providing other surgical teams. Obviously, we have ultrasound, everywhere we go, we had blood and usually in the form of at least PRBC and plasma. And a walking blood bank is a big thing to provide whole blood. And so, it can vary. But for us, for all intents and purposes, I mean, as a minimum, like I said, it would be a surgical team with anesthe and a couple of supporting people. And that can be pretty light sometimes, which is potentially more interesting. But obviously, the resources are going to limit a little bit what you’re able to do. So, I’m not sure that answered your question. What’s it really like it the tours that I was on, were a little bit on the lower volume side. So, I usually describe it kind of like a minimum-security prison. You can’t really go anywhere. You work out a lot and you eat three square meals a day and you kind of wait for something to happen.

Chad Ball  23:14

It’s so interesting that you bring up the movie, the accuracy of the movie comments because I was just recently watching on YouTube, Jocko Willink, going through a bunch of these classic movies, whether it was Black Hawk Down, or Charlie Sheen, as he was critiquing all of the accuracy of the Special Forces. It would be interesting to have you do that for medicine, it’d be great. Well, one of the things I was commenting to you that I recently reviewed in terms of submitted peer reviewed publication was a paper I think that’ll be outin the Journal of Trauma shortly. I was really enamored with. It looked at all of the US Special Forces, special operators death since September 11, 01. And I was struck by two things. One is if you had asked me, and again, in my fellowship, certainly and intermittently thereafter, we kind of worked side by side with a lot of those special force’s medic, I would have guessed the case fatality numbers would have been much, much higher than what they were part one. And part two, it was really a paper about closing the loop in a true morbidity and mortality way, really across the world, whether that was, in the Middle East and then Germany, as you know, and then all the way back to rehab in the US.  And how powerful and quickly you could make changes and it was clear that they had done that and their performance was something out of a movie, quite honestly. It seemed to be a level of performance and success and outcome. Good outcomes, that would be hard to even get close to in the civilian world. Does that surprise you? And what’s your sense of why that can happen so well in that environment?

Phil Dawes  25:02

Great question. I can’t wait to see this paper. But I think there are a couple of things. So, number one, with the right attitude, there’s a great environment to do the feedback loop and critique your performance and make changes. If the organization is dynamic and flexible enough, then that can happen. That’s not something I would normally say of the military, but I don’t think it’s exclusive to the special forces. The medical branch was incredibly responsive. Overall, the study was largely driven by the US forces, but all the reemergence of whole blood and one to one to one, and use of turnkeys, and all those things, those are all kind of out of this last conflict, right. And it happened extremely quickly as you mentioned, so we may be even more flexible, and the soft environment. As a rule, the Special Forces tend to really espouse kind of modern thinking and flexibility and the ability to make changes, as long as there’s kind of good reasoning and evidence behind it. They’re not going to wait for approval from some guy in queue in a cubicle in Washington, they’re just going to make decisions that make sense and make changes and they push leadership decisions down to the lowest level so that these things can happen. So that’s number one. I think there are probably a lot of other factors that would make the the outcomes better. One would be just off the top of my head, the protoplasm, like, these guys, would have incredible physiologic reserve, for the most part, not all Special Forces are the same, or made the same. But the top tier guys are machines, they’re the literally pro athletes and better sometimes. So, they’re going to be able to take burdens of trauma probably more readily than other people. As a general rule, and again, I haven’t seen the stats to back this up. But typically, the injuries would, even though the point of injury can be in some pretty hostile environments, there would be somebody with them, it would be rare that it would be like an unwitnessed trauma where somebody comes upon them. So, it’d be a very quick response to any kind of trauma. And even if that’s, quote unquote, only TCCC, something is happening initially. So, resuscitation is beginning right at the point of injury, as opposed to waiting 15 minutes for EMS to show up, as we’re accustomed to here. So, I think those would all contribute and then you naturally having reasonably far forward surgical suites, probably not a lot shorter time than you would have in big urban centers. But certainly for rural trauma, when you got long transport times and things like that. It would be much, much better when you’ve got those forward surgical suites, as austere as they are at least you have somebody waiting with a knife ready to get going on things.

Chad Ball  28:29

It makes so much sense. The other thing that really struck me in terms of their description of that environment that you would know, so well as, again, their ability to close that loop with honesty and speed. And what’s really the singular goal, it seemed like, to help more people survive.

Phil Dawes  28:48

To do better, yes, keep doing better. Right?

Chad Ball  28:51

Exactly. I mean, we all like to think that happens in healthcare that way. But there’s a lot more people involved, and it’s a lot more complicated. It seems like that sort of system that you’ve described, is really impressive.

Phil Dawes  29:05

It kind of comes back to what we were saying earlier about the vulnerability and everything. I mean, if you’re going to really try to make your performance better, it starts you know, with our m&m, not being a firing squad and just being, this is what happened. I might have obviously done this wrong but is there anything I’m missing something else I should have done or whatever, and when you lay yourself out like that, it’s a bit awkward at first, but if you are in the right group of people who are gonna just listen to you and give you the honest goods. It makes it a lot easier. And if it’s not in the context of an m&m, I think those groups, the special forces are pretty well known for just calling each other in an honest way, it’s not always easy, but you just kind of tell people if they’re doing something that maybe they should be rethinking?

Chad Ball  30:08

That’s true. You know, we wrote an editorial on the Canadian Journal of Surgery recently about morbidity and mortality (m&m) and that was really driven by concern across a lot of hospitals in Canada, and certainly discussion and feedback about the, the risk in that in the current sort of state of 2020. And being accused as a bully or being accused as being over intense and in those venues. And in to some extent, you only know what you know, unless you’ve been around to a lot of places, to put your m&m rounds into perspective, say across 10 hospitals, the hard thing to do unless you’ve been in 10 Hospital, And that perspective and that honesty, and that vulnerability as you’re saying, can really be interpreted sideways, depending on who’s in the room. So the point of that discussion was really, to try and encourage everyone to revisit that and then recognize the importance as you’re outlining in  m&m process and realize it is really central to improving patient outcomes and patient focused care.

Phil Dawes  31:21

I think at the end of the day, if we remind ourselves of that, and people are a bit more willing to be honest about their own performance, and I find a funny thing. I mean, I’ve had two m&m I can think of in my short career, including in residency where it was a serious. This probably shouldn’t have happened, or it’s the dreaded complication or whatever, but I kind of just laid it out is exactly what it was. It was no sugarcoating or blaming on anybody else or whatever. And the funniest thing happened, like all these guys, it’s sometimes can be pretty difficult. Suddenly, they send you case reports of the exact same vaccine complication. Or they say, this happened to me before or whatever, all of a sudden, I think, when people are inclined to pick at your story, because when you’re bullshitting or when you’re not telling the whole truth.

Ameer Farooq  32:16

Not to belabor this point. But I do also find one other aspect of this discussion really interesting in that it seems like in the military, contradictory to what you might think about the military has really given agency back to the person who’s on the front line, rather than, as you say, someone who’s way up in the in the hierarchy. And I feel like in medicine, it’s the exact opposite, like the medical student, or the junior resident is totally kind of disempowered from saying what they observe and giving their feedback. Can you talk about that contradiction? Is that is that a real perception?

Phil Dawes  32:59

That’s a really good question, Ameer, first of all, I’m sorry, you feel that way. If you feel totally disempowered, I hope that improves over time. But I guess I would make the minor distinction. I think it’s becoming true for the whole military that people are empowered at all levels and stuff. But I think historically, it’s always been the case for Special Forces. So, there’s a history of Special Forces being just that we’re, you know, leadership is down at the lowest level and initiative and encouraged. And certainly, our, Canadian special forces who I have worked with, but I’ve never been a part of or that to a tee. I mean, you’ve got fairly junior noncommissioned guys that are making big time decisions on their own and speaking their minds to whoever’s in charge. And obviously, I mean, they’re doing in a respectful way, but every everybody’s value counts. Whereas the green the big green army, as I like to call it, so the more conventional army is probably a little bit more old school and hierarchical still so and part of that is just a function of a lot of things but one is the numbers. So, they’re much bigger kind of formations and organization. So, if everybody down to the lowest level had a voice, it kind of gets to be a little bit noisy and B, you know your special forces guys have been selected as pretty smart, and athletic, and switched on people, so their opinions, not to undervalue the green guy but the Special Forces guys would probably have more intelligent things to say. So, in medicine, I think, there’s a bit of a shift happening, I think here at Vancouver where we become a beggar General, we’ve become pretty aware of perceived problems with that. And we’re working on that as well to make them feel more empowered and stuff. But I think everybody should have a voice. And I also think the one other difference, Ameer, that comes to mind is that in medicine, so much of it is experiential. And in the military, you can have an officer who outranks a junior, noncommissioned guy, but who has fewer years, and certainly way fewer in deployments or something like that. And he’s technically in charge here, should he technically be in charge, but doesn’t have as much experience. I think, that lends itself a lot better to getting feedback from the guy who maybe outrank but who has way more experienced than you. So the analogy might be if the scrub nurse said, Are you sure you don’t want to use this instrument, you’re not going to say, Well, I’m the boss, here, I’m the surgeon screw you. Might say, hey, it’s a really good idea. Whereas the med student and the first-year resident, they might occasionally see things that make total sense, but oftentimes, they just haven’t seen those experiences. So it’s a lot harder for them to make those observations and comments. That makes sense.

Ameer Farooq  36:19

It makes a lot of sense. And yes, you definitely see the difference. I guess now as an R5 when you say what about this, then people do definitely take a step back or at least pretend to. For the trainees listening to this, if someone wanted to, get involved in the military, whether they’re in surgical training or in some other specialty, what are the options out there in Canada?

Phil Dawes  36:53

There’s a lot. I think, if we’re talking surgery, specifically, I think if you have zero exposure to the military, probably a reasonable place to start just to get some sense for the new year would just be to go to the local reserve unit and see if you can sign up and do some reserve things. Unfortunately, we don’t have a ton of deployments right now, which is what is always most interesting to most people, I think. Because hanging out in a garrison somewhere in an urban center is not going to be really that exciting to most people. Certainly, that’s not to me. I think, to me, the cool stuff about the militaries, is deployments but  in any case, that will get you some idea for the community. And then if it’s something that you’ve really got an interest for, I think just talking to people who are in or we’re in, whether they’re in the reserves, or the regular force, or deployed or something, then just trying to attract one down and ask us some questions. And if you’re really keen on making the leap after doing some background investigations, I, again, speaking to one of us, we can put you in contact with the people who recruit specialists currently. We’re not, to my knowledge, I don’t think we’re recruiting trainees right now. Partly because we have the luxury of having a pretty good compliment right now. But once you’re done your training and you have a job, then you’d be eligible to be hired on as a general surgeon in the military and the Canadian military.

Chad Ball  38:43

That’s awesome. So we can’t thank you enough for spending time with us today. Again, we know how busy you are, and we really appreciate your insight and your thoughts. I know you have a heart out. So particularly if you have maybe one more question The class get, you know, all the guests this and sort of the shout out time. Is there any particular folks that you along the way, whether it’s in the military side of the family side of the medicine side or your path? And that you said it?

Phil Dawes  39:14

Yes that’s a big question. I’ll try not to cry here. If I were like Brad Pitt, I would have prepared this. No, I’m just joking. A lot of people so I mean, a very supportive family, obviously. For surgery specifically, I mentioned Hugh Taylor in Winnipeg. He was kind of this guy that quite frankly, I had and still have a man crush on. I was just like, this dude is awesome. I want to do what he does. Here in Vancouver, Nate’s and Morad. Just wonderful guys to work with when I was a fellow, and they just totally took me under their wing and hired me. So that was great. The rest of the colleagues are wonderful as well. But those two in particular kind of stand out. In the military side of things, my brother. Trauma became pretty important when my youngest brother died, he was killed in Afghanistan, so it was probably the most inspiring thing. Wanting to, if I could, save one soldier’s life, I think it would make all the kind of training and everything else all the work worthwhile. So, if I had to distill it to one shout out to him. That’s it. And my wife, she’s been pretty amazing, too. So, there you go.

Chad Ball  41:18

No, thank you for that Phil. That’s a beautiful ending. Maybe the last word I would or last comment I would make would be very simply, you and I and folks that do what we do on the trauma side, we often quote that, you know, injuries are the number one cause of death from really after one years old, up to about 45 years old. And, and it’s such a neat skill set to have, and I think guys like you who are going to continue to push the envelope and drive trauma care for the next couple of decades, are really doing everybody a service beyond the military folks, for sure. And we thank you for it.

Ameer Farooq  42:05

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