E73 Lawrence Gillman On Coping With Loss

Listen to this podcast on SoundCloud

Chad Ball  00:12

Welcome to the Cold Steel surgical podcast with your hosts Ameer Farooq and Chad Ball. We’ve had the absolute privilege of chatting with some amazing Canadian as well as international guests over the past year. While the topics have been broad in range, whether clinical, social or political, our aims for the podcast continue to remain the same. We hope to inspire discussion, creativity, scholarly research and career development in all Canadian surgeons. We hope you enjoy our second season as we continue to highlight some incredible guests, deliver detailed masterclass sessions on a myriad of clinical topics and introduce some fresh new features such as debate and companion formats. We hope you relish the podcast as much as we do. We’d like to welcome you to a very special edition of Cold Steel. Today we had the absolute privilege of discussing a number of topics with Dr. Lawrence Gillman. Lawrence is an associate professor at the Department of Surgery at the University of Manitoba in Winnipeg. And while Lawrence is well known for many, many things across the country, including founding STARTT trauma team dynamics course, he’s also known as a national thought leader with regard to ultrasound and simulation. What we enjoyed most about the conversation by far and away was a personal side of surgery and medicine. More specifically, we touched on raising kids, we chat about family loss, and about coping with both of those things both in the pre-COVID-19 context as well as since.

Ameer Farooq  01:52

Dr. Gillman needs to you’re the founder of the STARTT course, which is the Standardized Trauma and Resuscitation Team Training course, which is a very popular course and has been very critical to trauma training, particularly in Canada. Can you talk to us a little bit about how this came about?

Lawrence Gillman  02:08

Sure, certainly wasn’t our intention to start a course it was from kind of humble beginnings. Sandy Widder and I both trained in Calgary, both of us were kind of exposed to simulation as part of the critical care training program and the ACES course, and kind of realized at the time, nothing really existed in surgery, at least in our centers. So when we went back to our programs, we both kind of at the same time, sort of individually decided we wanted to start some sort of local simulation, CRM kind of crisis resource management training. Both of us happened to contact Peter Brindley at the same time, because he was one of the ones that trained us and taught us a lot about simulation, just to get some advice, and he actually suggested, hey, why don’t just start a course, training people across Canada? And we kind of said, well, that’s kind of silly, but oh, maybe we’ll give it a try. And so we kind of threw something together for CSF. We approached CSF, it was in Calgary in 2012. And we said, Hey, can we try running a course here. And that’s kind of where it started, we ended up sending out a needs analysis, just a survey across Canada, and no one else was really doing any simulation at the time. And there was a huge interest in doing it. And it sort of just grew from there. And we never really had any direction or purpose, we kind of just let it take us where it would go. And we sort of just followed the pathway. And it’s led us on some great experiences. And it’s kind of growing on its own. And it’s been a really neat way to get to know people across Canada and starting to be around the world. And it’s just been a great experience. And it just kind of grown and blossomed on its own.

Ameer Farooq  03:56

So for those of us who don’t know what STARTT is, or having participated in STARTT, can you just briefly talk about what STARTT entails and exactly what the simulations are like?

Lawrence Gillman  04:07

For sure. So it’s changed a lot over the years, we’ve learned a lot about simulation, we’ve learned a lot about teaching multidisciplinary groups. So our intention initially when we started the course was just to teach our residents so that was how we started it. But very quickly, we realized teaching residents to work in teams in isolation doesn’t really make sense. And really, unless you teach the whole team, you don’t really accomplish anything. So very quickly, we opened it up to nurses and respiratory therapists as well. What made it a little bit unique from other courses is that a lot of courses use nurses even the ACES course uses nurses ACES is the critical care sort of equivalent, but the nurses are there to sort of Confederates. They’re there to supplement the learning of the physicians, but they’re not necessarily participants in the course. What we changed is we made everyone full Participants so everyone comes in to the simulations blind, no one knows they work as teams, they work together as a group. And the idea is that everyone trains together. So it’s changed like I said a lot over the years. The current model is, everyone gets mailed out an electronic version of the textbook, they’re asked to do some pre-reading before the course. They come in, it’s a one day course. The morning starts with some very basic didactic stuff, just an hour sort of review on CRM principles, hoping a lot of people have done the reading and know a lot of it, it already talks a little bit about trauma team design and how you might structure your trauma teams. And then we get into some basic, low-fidelity teamwork team-based simulations where we do what’s called a paper chain activity where people work together on a very simple project, but it teaches some very important teamwork principles. From there, we move into our simulations. Basically, they rotate through four high fidelity simulations in the day. So high fidelity, meaning sort of real lifelike trauma simulations, they’re very hard. They’re designed to make people not fail, but they’re designed to bring out problems in the team communication, the focus is not on the medicine, there’s obviously a lot of medicine and a lot of discussion around sort of resuscitation principles. But the focus is more on interactions between the team members, how they work together their leadership principles and problem solving principles, and trying to give them a toolbox of tools that they can use later in other resuscitations. Basically, there are stumbling blocks that are built in, again, sort of in the simulations to help bring out those principles. And to help help the teams learn together, they’re told they’re going to make mistakes, they’re expected to make mistakes. And that’s the beauty of simulation is you make mistakes in the simulated environment, no one gets hurt, and you learn from those mistakes. So they spend about 15 to 20 minutes in the simulation, and then we spend about an hour debriefing and talking about it. And the debriefing is really the nuts and bolts of simulation, it’s really the time to discuss everything talk about feelings and emotions and how everyone felt during the simulation. We have trained debriefers that spend the day with each team. So we call them team leaders, or team navigators. And they just spend the day with their team. The team consists usually have four physicians, three nurses, and one or two respiratory therapists. They work together for the day they learn from each other. And the debriefer leads them through the day basically, and lead them through those simulations. Coupled with that, we have some skill stations as well, they spend some time doing some phone-based simulations, simulating distance resuscitation like telementoring, basically, similar to if you were taking calls from up north or from a rural station. And then they do some skills as well, ultrasound skills like IV access, and crichs (cricothyrodotomy). And we tried to do things that were relevant to all the groups basically, and within each simulation, we tried to bring out objectives for each of the groups. So that’s been the main type of course that we’ve run. We’ve also run an alternate course, where we include pre-hospital personnel as well, we kind of call it STARTT plus. We’ve only run it a few times in Winnipeg. But in that course, we actually bring in pre-hospital personnel as well, we’ve had aeromedical personnel as well as paramedics. And we do some pre-hospital work as well part of the scenarios and some handover between pre-hospital and hospital teams. And then we actually do a mass casualty at the end as well. So that’s the second version of the course that we’ve run. That’s been great. It takes obviously a lot more work a lot more setup, it’s a lot harder to do sort of flying into a center. But it’s been a great addition as well.

Ameer Farooq  09:10

Sounds like an amazing course. You obviously wrote a textbook as well, that goes along with the STARTT course. Well, first of all, why did why did you write a textbook for a course that, you know, is mostly about simulation and about team building? I’m curious about that. And the second thing is, how have you kept the course fresh and kept evolving things as things go forward? Because I think one of the hard things about a course like this is you kind of have to make the scenarios new and fresh, because otherwise word gets out among the participants and perhaps you lose some of the fidelity of people know what the the scenarios are going into the course.

Lawrence Gillman  09:46

For sure. So so the textbooks funny, like I said, Everything has just sort of followed its own path and fallen into place. Again, we didn’t set out to write a textbook. Our goal was to say supplement it with some sort of pre-reading material one day is a really short course for this type of activity. Asking people to commit two days is a huge commitment, and really hard to do. And we didn’t, especially physicians not so much ironically, it’s nurses and other allied health that don’t get the funding that physicians do and don’t have the monetary support for education. That’s been a real learning curve and trying to keep it costly, we can talk about after you. But learning about how other groups learn has really been neat. But we needed a way to impart the information. So everyone came in sort of on an equal footing. We started by writing a very short kind of 13 chapter book that we would photocopy and send out to participants. And then from there, we kind of said, well, there’s nothing like this in the literature, nothing, no textbook that really deals with CRM, and trauma. Wouldn’t it be neat if this was published? We tried some publishers didn’t have much luck. I happened to be writing a textbook chapter for a friend, Dr. Karakitsos who’s overseas. And so I emailed him and said, hey, you know, how do you get something published. And he said, well, you got to make it relevant to you got to make it appealing to publishers. And so he and I added a whole bunch of authors, a whole bunch of chapters, that maybe aren’t completely relevant to the text, but to the course, but are really neat, and really interesting and unique on a lot of military stuff, a lot of a lot of disaster stuff. And then we approached Springer, and they were super interested in it and excited. And that sort of led to our first edition of the textbook. My favorite chapter is the most useless chapter is a chapter on trauma in space. It’s fascinating. It’s written by one of the NASA flight surgeons. It’s amazing, completely irrelevant to everyone other than someone who would go into space, but an absolutely fascinating chapter. And so we tried to bring out chapters like that that are very unique and not seen in other textbooks. We don’t want to recreate other texts, we wanted this to be different. Also, you’ll see in the text, there’s this common thread of teamwork. So even though not all the chapters are completely relevant to the course, they still highlight how teams function and how trauma can be improved by teamwork and working together as a group. So even though the the topics may overlap with other textbooks, like the TLS manual, we tried our best not to recreate it, but really highlight the relevance to the course. So that was the first edition, Springer, it’s been an extremely well-selling book, in their top sellers in medicine. And so they came back to us this year and asked us if we do another edition. So we’re working on a new edition. This time, we’ve learned a lot about sort of content and what we want to see in the textbook. And so we’ve added actually, the old textbook was about 35-40 chapters, this one’s gonna be over 60. We’ve really added a lot of very interesting chapters, it’s gonna be really unique. and way more team based focused. I think it’ll be a great text, some chapters have started to come in already. Chad’s writing some chapters for us. And so I think I can’t wait to see the finished product this time around.

Chad Ball  13:24

Yeah, I mean, there’s no doubt Lawrence. And I would say, Sandy, as well, you know, the whole country is so proud of you guys. And proud of the product, both the textbook and the course that that you continue to put out year after year. It’s, it’s amazing. I was curious. You know, I certainly know behind the scenes and talking to you guys that you’ve had the opportunity and the interest from large surgical societies, including if I can say at the American College of Surgeons about essentially consuming or taking over your course. And of course, there’s pros and cons with that. And we’re without doubt so happy you guys keep control of it. But I was just wondering if you could talk about some of those pros and cons of aligning a course like STARTT with a with a major society, and certainly your relationship with TAC has been good to date as well.

Lawrence Gillman  14:15

It’s been a learning process for sure, Chad. I’ve gone through actually multiple societies and groups and we can talk about the pros and cons of each. To be honest, we are still looking for a home for it. Running a course I would have literally I would say the trunk of my car is not ideal. It has lots of problems. It has. It also doesn’t carry the weight it does when it’s associated with some form of society. And that certainly has been started to be an issue when we look at going overseas. Especially we’ve had a few courses that we’ve before the pandemic had set up in the Middle East and it’s always better if it carries the weight of society behind it. And just the administrative stuff, I do so much behind the scenes administrative stuff for this course that it’s crazy to the point where I’m doing budgeting, I’m paying for food and then getting reimbursed from and collecting court fees myself. Things like that AI is not sustainable and is not growing like you can’t grow a course that way. And STARTT has sort of reached the point, the tipping point where it’s getting too big for it to be out of the trunk of my car. So it’s not that we’re not looking for a home for it, the challenge has been finding the right home for it. And what makes it really unique, also makes it difficult to find a home. So the multidisciplinary aspect to STARTT I sort of alluded to before is amazing, and is actually my favorite part of it. I love teaching physicians, but physicians get a lot of education, nurses, RTs, paramedics, there’s very few courses for them to do especially like this. And I actually more enjoy teaching them because they don’t get this. They aren’t exposed to this kind of education as often. They don’t get the support for this type of education. And, frankly, they don’t have the finances to go seek out this education that physicians do. And so teaching them has been wonderful experience for me. And they are a big focus of why I still do this. However, they also make it complicated when it comes to finding a society willing to take us on. So we actually started exploring things with the Royal College because ACES is linked to the Royal College or used to be. The Royal College was very interested, we got to the point where we were in discussions and then they decided they weren’t going to do courses as much anymore. And so that sort of fell apart. We moved on to TAC we’ve had some discussion with TAC has supported us in the background, but they don’t really have the infrastructure to support the course sort of long term. We’ve CAGs has also we’ve been in discussions with but again, they weren’t that keen on supporting the course, in terms of administrating the course and taking on that sort of burden. It is a big deal. We worked with the emergency society for a few years actually. And they were very close to taking on the course. Where we got into difficulty is they fund a lot of their a lot of their society based on fees from courses, which is fair for physicians. I mean, I don’t think physicians have problems paying $2,000 for this type, of course. But nurses and RTs can’t afford that they don’t get the funding for that. So our goal has always been to keep the price competitive. But to do that, you need a society willing to understand that. And so charging two or $300 for a course, that probably costs more than that to put on for the nurses and RTs  wasn’t palatable to a lot of groups. So you’re actually losing money, you’re you’re counting on the physicians to fund the other education, which most physicians don’t care about. But core groups don’t don’t see that value. So we are or we were in in discussion with American College actually, before this happened before the pandemic happened. So we’ll see where that goes. But we are still looking for a home if you know anyone.

Chad Ball  18:31

Wants it. It’s amazing. You know, obviously we all know this with any any continuous and longitudinal project, it takes an immense amount of behind the scenes work as you pointed out, and passion and commitment to make these goals. So again, kudos to to you. It’s unbelievably impressive. Now we’d like to switch gears a little bit here and talk to you about your interest in your, again, really a national leader in terms of surgeon-performed ultrasonography and in trauma but also the you know, the critical care suite and general surgery as well. And recently, you published a really great manuscript in the Canadian Journal of Surgery on improving communication and telementoring. So I was wondering if you could walk us through your pathway of involvement with ultrasonography from from the beginning maybe and then lead us up to what you guys talked about in that great paper.

Lawrence Gillman  19:24

Sure, again, I guess like anything in careers, everything is a journey and finding your home and finding your niche has been sort of my journey over the years and I think I finally found sort of carving out a little bit of a niche and combination of education and trauma. So I started I as you know, I trained with Andy Kirkpatrick. He’s still a huge mentor of mine. We talk frequently and work together on projects. He’s been amazing and obviously his passion is ultrasound. So I picked up a lot of that from him. We spent a lot of time during my fellowship writing papers together on ultrasound and studies on ultrasound. And I kind of carried that over when I started my career back here in Winnipeg. There’s a lot of work in ultrasound, a lot of it’s on the emerge side and critical care side, as you alluded to. And keeping up with that just techniques in ultrasound, wasn’t really I started doing that I spent some time working in optic nerve sheath ultrasound, but quickly realized that that’s sort of an area that’s maybe beyond me a little bit, and there’s better people doing it out there. But then realized that the area of education and ultrasound and simulation and ultrasound is a newer area and an area where I could contribute some of my education stuff and how to tie it in nicely with the other simulation work I was doing in terms of picking a focus for my career. I think for new researchers, you start broad, but eventually you have to focus and it’s okay to have a few passions. But it’s nice if you have one clear direction that your career can head. And mine certainly seems to have taken the path of education and simulation, which is wonderful. So we started doing more education and simulation stuff with ultrasound. So we made some models that we use for teaching optic nerve sheath. We worked a bit on simulators and ultrasound, we did some work on evaluating sort of the quality of ultrasound imaging and how you give feedback when you’re teaching people ultrasound in hopes to improve credentialing and ultrasound. We’ve used some stuff with hand motion and ultrasound hand motion analysis. And we’re sort of one of the early groups to do that. And so that was sort of the direction we took. And then again, sort of tying together the work we’ve done with the STARTT course and telementoring, and teleresuscitation just with the natural next step. And that paper isn’t necessarily unique to ultrasound, it sort of applies to everything. What we wanted to look at was how there’s a lot of work done both by Andy Kirkpatrick and a lot of his colleagues on the technology of telementoring and teleresuscitation. But we wanted to focus more on the human factors and how you actually improve that interaction. And is there ways we can teach people to telementor better, basically. So our first step, was this paper looking at just a review of what’s out there? The short answer is there’s very little out there. But there was really neat stuff from the EMF dispatch literature, which initially seems completely separate. But if you define telementoring, or teleresuscitation as walking a novice through a procedure, over distance, resuscitation or dispatch, guided CPR makes sense. It’s a simple skill, you’re walking them through it over the phone, and you clearly have a novice on the other end, doesn’t matter that they don’t have any medical training. And so that was kind of the easiest corollary that we could find to learn a little bit from, and it was really interesting. What they found was using people in crisis, obviously are very overwhelmed. So using very simple language seemed to be better than making it more complex. Having a script for the person, mentoring them over the phone, even though these people take these phone calls every day, this is what they do. But they still get caught up in the moment and miss things. And if you have a very formal script that they read from, it improves resuscitation and outcomes and improves the quality of CPR being performed by the bystander, and taking a few minutes to get to know the situation of the person their what are their limitations. What does it look like around them? Is there a car on fire beside them is that their loved one that they’re clearly connected to? Or is this a complete stranger, which may make the resuscitation easier for them? Taking the time to do those sorts of things helped with the resuscitation as well. So I think these are lessons we can learn and take into our own resuscitations when we’re guiding someone over the phone through a procedure. They may not be complete novice but if they’ve only done a chest tube once in their ATLs course, 10 years ago, it’s very similar to a bystander doing CPR. So can we develop scripts that someone could read to help guide both the mentor the person resuscitating helping with the resuscitation over the phone and help the outcomes of the resuscitation? Can we take a moment and get a sense of what their surroundings are, what their tools they have available, who they have to help them? What’s the what their emerge is like? Are they in a small nursing station or are they in a formal emergency department? Do they have a nurse with them? Or is it just a literally a janitor or someone who’s happens to be there that’s untrained. So I think there’s lessons we can learn from this. I think there’s a lot of work to be done in the human factors at telementoring. And some work that we’ve started with Andy, and with others looking at scripts for simple procedures. And I think this is just a starting point. And then we have to work from here.

Chad Ball  25:21

Yeah, it’s, I mean, it’s so well stated and it’s, it’s it’s such an interesting area, right? If we go back to sort of the the grandfather of it, although probably he would probably be mad at us for mad at me for using that term, Scott Dulchavsky, and the work that he initially did in Detroit, with everybody from the, you know, the Red Wings to, of course, the ISS astronauts. And he’s really, you know, I think probably who is most impactful on Andy’s career who would be impactful on on yours and mine, for sure. But it’s, it’s a fascinating area, you know, it makes me think that the last time I was in Australia, giving talks, I was in Brisbane, in terms of the, the extension beyond, you know, telementoring for ultrasound. But they had a direct link to sort of a small room off in the emerge and they had video and they had audio. And they were actually concurrently or synchronously assisting in trauma resuscitations in Darwin, which, you know, most of us know is way in the north of Australia, almost near Indonesia. And it was remarkable, like they had multiple camera angles, and they were walking these guys through intubation, chest tube insertion, as you point out, even ventilatory settings, like the whole deal. And, you know, I just kept looking at it and, and thinking what, why aren’t we doing this and in this country to a much greater extent, given given our distance and, you know, geography and timing. It’s, it’s a little bit beyond me. And, you know, Andy and I have talked about that on the podcast before. Probably we both are a lot of us feel a little bit guilty that that that hasn’t been achieved. But, you know, I don’t know what you think the sort of hurdles and the struggles have been in getting us there. You know, obviously, infrastructure historically has been one, but I don’t know, I just feel like we’re under utilizing this whole line across this country.

Lawrence Gillman  27:12

Yeah, it’s a it’s a great question. Certainly, we are in an environment where we do things over distance. I mean, Manitoba, is probably the best example of that. We literally have people that come in 11 hours post resuscitation, post trauma, basically, and arrive in our emergency department just because of transport times and going through like they’ve been on a boat, and they’ve been on a plane, and they’ve been in the back of a snowmobile and a pickup truck, you know, by the time they get to us. And is there steps on the way that you could be guiding resuscitation while they’re waiting? That’s a great question. Like you said, though, how do you set up the infrastructure? Who’s manning that infrastructure? You really need almost like a call center, I guess, where someone’s sitting there by the computer. It’s a tough, tough question. But it certainly is one worth asking.

Chad Ball  28:02

Well, you’re you’re exactly right. And I, you know, I, I I get the sense. And this may sound overly harsh to them. And I might be totally wrong, and in full disclosure, but I get the sense that the technology now is clearly there, you know, having witnessed it across some of these extreme environments that you and I both been involved in. So that technology seems to be there. I think it’s more as you’re saying the organization piece, and also the financial piece. I mean, we’d have a pilot program in Calgary at one point we were trying to do that, I don’t know, just over 10 years ago in Banff, in terms of helping run the resuscitations and being helpful to them. And when the funding went away, the project went away. And you know, not everything’s about money, but certainly, maybe government commitments to funding these programs would would be helpful for sure.

Lawrence Gillman  28:51

Yeah. I mean, there’s so much there’s so much going on. That’s the problem, I guess, and how you prioritize funding, especially now. I mean, with the pandemic. That’s right. Expected, right. You know, like every now Yeah, yeah, exactly. But how, yeah, how you prioritize that? What comes first? It’s a great question. I mean, we’re still working on a trauma system in Manitoba. So we’re way behind that. But it’s, it’s a tough one. There’s limited funding, our our systems are at the breaking point already. So how you prioritize those things for potentially a small number, right. Like, I think there’s no question that if you live in a rural setting, you’re at a disadvantage from a trauma perspective, right? There’s no way there’s no way you can’t be rather than being 10 minutes from a trauma center. Right. But

Chad Ball  29:43

I know exactly. And we all know that the data clearly supports that, you know, injury for injury, you’re going to have a much higher risk of complication and death across the board, no matter what mechanism you’re talking about, or what injury pattern. I’m just not sure that you know, as a society, we’ve had that conversation. And that mean, maybe, you know, more rural folks that live in those environments know that intuitively, I would expect they would. But it’s certainly not a conversation we’ve had. And when you look at a few countries, again, Australia being a good example, they do it so much better than us. And it’s, it’s something maybe to strive for.

Lawrence Gillman  30:21

Yeah, there’s I mean, are people aware of it? I don’t know. There’s a fascinating study. I don’t know if you remember where they asked people, how much worse outcome would you be willing to accept, to have your surgery locally in your own center versus having to travel to a big center, and a lot of people were willing to accept huge morbidity just to have their surgery locally. So certainly, I think some people realize it. But they’re, they’re so attached to their local community, which is completely appropriate. I mean, they’re wonderful communities, that they’re willing to accept that risk, but how much? How much can you invest to level that playing field? And can you level that playing field? I don’t know.

Chad Ball  31:02

That’s a great question for the future. You know, we Ameer, and I wanted to switch gears one more time here and talk to you about family and the intersection with with a busy surgical career and raising kids. You had a challenging event near your family’s lives that really changed your your family unit sort of forever? And I have no no doubt it, it’s changed the way that you and your family interact. From there forward forever, as well. I was wondering if you could tell us what your view of the intersection again, between family and being a great dad, and then being a, you know, a high volume clinical, as well, as clearly, as we’ve talked about today, very, very busy academic, acute care surgeon as well.

Lawrence Gillman  31:52

Yeah, so I mean, I know no secrets. I think most people, at least that know me, well know my history. So I’m certainly not against sharing it. My wife passed away of breast cancer five years ago, tomorrow, ironically. So it’s, it’s always a tough time for us around this time of year. It, it was a very short, sort of, she was only sick for about a year. So it was very quick and very unexpected obviously. We were young at the time, we have a very young family. So we have four kids. They are currently I have to even stop and think Sophie is the oldest and she’s 11. Michael is 10. Jack is 8 and Claire is 6, she was only one and a half when her mum passed away. It’s nothing that anyone ever expects in their life. It was obviously a huge blow to our family. I think the only reason I kept going was because of the kids. Kids are unbelievable and amazingly resilient. And despite being very affected by this, they’re also very normal kids and have a normal life. And it’s amazing what they can grow through and what they’ve become. Because of this, maybe in spite of this, I don’t know what the right term is. It’s obviously taught me a lot about priorities and about balance in life. I will not begin to pretend that I understand balance and that I have any balance. So I can tell you what I’ve learned. But I certainly am not the I’m not the best example. I we still struggle all the time. I think it’s taught me about prioritizing things. It’s taught me that you can’t do everything well. And you have to accept that there are going to be limitations to what you can do. I certainly made some changes to my career after this happened. I contemplated giving up either surgery or critical care actually, just to kind of streamline life. And certainly my life would be simpler had I done that. I wasn’t ready to do that I was still really early in my career only about five years in and wasn’t really ready to make that sort of decision. And I’m glad I did it in retrospect, I’ve carried on with both. But keeping both both of those is even challenging, because they’re very unique careers and very separate skill sets. And there’s not a lot of overlap. So you have to do enough of each to keep relevant and to keep confident really surgery is a bit of a head game. And if if you’re not confident, even if you have good skills that can certainly impact you. So balancing that and family life has been really challenging. We have a great nanny, she doesn’t live with us though. So when I come home, I go from one job to another and I take over from her and she goes home and so even though I’m tired and exhausted after a long call night I’m still up with the kids all day. And so like I said, I don’t really have balance. I’ve kind of that’s become our life and we all sort of work around it. But finding some way to achieve that balance is what I would recommend to people. Sometimes you have to give things up, I gave up endoscopy, which I used to really enjoy, but something needed to give. And so that was something that was sort of a package that could easily be passed on to someone else, which was okay. But it’s really hard. And we still struggle every day trying to figure things out and how life works. One of the, on the personal side, one of the realizations where you realize you can’t do everything. I really struggled. Carrie was an amazing mom, she was that was her life passion. That was her goal. I mean, she was a nurse by training, but her whole goal in life was to have a family and to raise a family and to have a big family. And she did it so well. And she ran such an amazing household. And after she was gone, I really felt like I couldn’t live up to that standard. And I really tried for a while I tried for probably a good year to maintain a lot of the things, how she would do it and try and do things her way. And realize very quickly, that wasn’t sustainable, because I couldn’t, she was doing that full time. I couldn’t do that and work at the same time. But I had these expectations for myself that I wasn’t living up to. And I was feeling like a really terrible parent. And then sort of a light bulb went off. Kind of I don’t know, well, maybe a year or two in, where I realized, you know what, I’m a really good Dad, I’m a really crummy mum. And that’s okay, like, I can’t be both. And you know what, just because I, like I said, I can’t meet all the standards, I got to let some go. And you got to find the priorities in life and focus on those and you can’t do everything. And so once I once that clicked, I felt a little bit better. I felt you know, what, I’m going to focus on being a really good dad not to, you know, that being gender roles. And obviously, I’m, I’m more mum than dad most days. But that helped me cope, that realization really helped a lot.

Chad Ball  37:09

Well, I think you’re, you’re, you’re probably too hard on yourself, at least from the outside. I mean, there’s no doubt the reason your kids are well adjusted, beautiful, amazing kids is is because of you. You know, in addition to just kids being resilient, and, and you’re always a quite honestly a beacon for a lot of us across the country when we struggle with, you know, personal issues outside of medicine, in our jobs, in the hospital that that that causes us to struggle. You know, I was wondering what you think about, you know, colleagues or or folks that you work with, who maybe do have some large life event, whether it’s an illness or a death in the family or a child, you know, getting into some sort of really challenging scenario. How do you think is, is best recognizing individual variability for us as colleagues to be supportive of that of that person, particularly, within ad maybe, you know, maybe when it peaks different for sure. But within a sort of a surgical culture box that tends to be, you know, as we’ve talked about, really, you know, in the podcast already, head down straight ahead, work hard. You know, keep to yourself, go go go.

Lawrence Gillman  38:32

That’s a tough question, man. I wish I wish I knew the answer. I’m not sure I’m good at that role, even having been through what I’ve been through supporting others. Because I don’t know that there is a right answer. Like you said, I think everyone’s different in what they need. I think being there open asking sort of what people need is important, I would say. I would say it’s a it’s a double-edged sword. So in some ways I need support of my colleagues and my colleagues are very helpful with you know, always certainly at the time, I was off for almost a year really picking up my clinical load and helping with that. Being understanding when it comes to scheduling and things like that, especially around holiday time when really leaving the kids without anyone else is really hard on them. So in that way, being there, and being supportive is important. But on the flip side, you also don’t want to be treated differently either. You kind of just want to be you kind of we’re all in the mindset, we just want to do our work right and just want to put our head down like you said, and do our work and you don’t necessarily want to be treated differently. So everyone is a little different. And probably people go through both those feelings. I certainly do. In some ways, I love the understanding but in some ways I also just want to be want to be a normal surgeon and I have to say my outlook on work has changed completely. So I obviously like all of us used to find work very stressful, brought a lot of it home, a lot of the emotions, a lot of the decisions, right, you bring home with you. After this, it’s completely switched, and I go to work to get stress relief. And it’s amazing. Like we have one of the most stressful jobs yet. I feel so low stress at work, because it’s so normal. And it’s life as usual, right. I come home, and I get reminders of what life is and the challenges and kids are, as you know, difficult and drive you crazy. And work is just predictable. And I know, I know what work is about, I don’t know, home life as much. And I’m not as comfortable with it. And so now I go to work to always say I feel better at work, and I feel more relieved, and I find work easier than I then I do at home most of the time. So it’s amazing how that mindset changes as well.

Chad Ball  40:59

You know, when I when I got divorced, it was it was odd to me because you sort of I went into work every day, you know, worked goofy hours, like we all do cranked away. And nothing really, no one really said anything and you know, had this discussion with a number that was sort of a cluster of divorces to be honest at our institution over a very short period of time across a whole bunch of surgeons in our group. And, and a lot of us talked about it after years after and we kept expecting sort of someone to come over you almost do and tap you on the shoulder and say, hey, you probably shouldn’t work right now. Or, you know, it’s it’s just interesting how, again, the the clash between the traditional dogmatic surgeon and surgical culture sometimes doesn’t doesn’t reconcile super well with what an individual’s is going through. You know, and I, I really like what what you said that, of course, everybody’s different, but maybe the most important thing is to, to address it and, and just sort of be there for whatever that person in whatever their situation might, might be. You know, I’m curious what your thoughts on that are. I’m also curious, you know, again, just from a purely logistical point of view, you mentioned having a nanny and certainly lots of single parents in that outside of surgery, of course do that. But you know, beyond that, what are some of the logistical things that that you’ve learned or tricks and tips what are the you know, you can’t missus and maybe can miss events or things in terms of the kids? How is your how is your, the structure of your of your of your family work?

Lawrence Gillman  42:43

Yeah, so to answer your first question, I think I was lucky again. Our at the time, Deb Wirtzfeld was our section head, she was extremely supportive. She’s also a very blunt person. And actually, we have a nanny because of her really, it was shortly after Carrie got sick. We had always been the family that like I said, Carrie loved being the homemaker. And we always just did everything ourselves. Which is partly why I guess I’ve been able to cope so well as I certainly was a always an active participant in the family. I was up in the middle of the night feeding children and changing diapers. And so I never got a I always was involved in it. Certainly to a lesser extent. But Deb, I remember I was talking about coming back to work. This was when after Carrie’s surgery, and when things were going well for a while. And she she basically told me you’re not coming back to work till you get a nanny. And that was it that she’s very blunt. She was like, nope, you’re not coming back till you have a nanny. And within a week, we had a nanny. And so having someone like that certainly made things easier, because she had no problem telling me what I needed to do. And having been through some stuff herself as well probably helped. But also in my situation, it is different. I think I think I do get a lot of sympathy, obviously. And then other people do in other situations and everyone’s situation is different. So it is hard, but I still think trying to be open and asking where you can help is probably the only way. But it’s I’m not good at it either. So I don’t know. I don’t know the right answer. In terms of family life, really we’ve just kind of flustered through and trying to figure it out as we go. Like I said, we don’t have a live in nanny. Certainly it would be easier if we did in a lot of respects. Call is really difficult. I actually have people sleep over when I’m on call just in case I have to go in which is really challenging. But we just for us as a family we never sort of envisioned having someone else live in the house. And so that’s the the route we’ve taken and it has its advantage but it has its child has its challenges as well for sure. Other tips I’ve learned, we have something called a Cozi app. Cozi  is an app where you put in everyone’s schedule, everyone gets a little dot, and you can share it amongst family members and amongst the nanny and everyone and Ivy. And so it tracks everyone’s schedule it has everything in there. So all the activities and but activities are probably the worst. Like kids are everywhere at every moment. I rely heavily on friends and teammates on hockey teams and dance friends. It’s amazing what people do to help me like, it really is a village to support this family. And without them, I wouldn’t be able to do this. There’s no question people pick up the kids. People grab the kids, when I’m just not there, or one of us doesn’t make it in time. People will take the kids for lunch after a hockey game, just to help us out. And so it’s amazing what the community has done to help us. Otherwise, we rely heavily on family. And that’s been a real stumbling block with COVID, actually, because both Carrie’s parents are super involved in the kids as well as my mom. And were doing a lot of the child care, but they’re obviously older. I am obviously high risk, as are the kids for transmitting COVID. And so we haven’t seen them. And they haven’t, they haven’t been involved in family life for really the last four or five months. And that has been super challenging. Because we went from having this huge village looking after the children to really just myself, Ivy our nanny, and Amy, who’s Carrie sister. And so between the three of us, we’ve had to figure this out. And they’ve been amazingly supportive. In terms of things that are important to the kids, I would say two things. One, schedules are super important and routines. So maintaining some sort of routine for the kids has been really important. Bedtimes, routines on weekends, my kids love routines. When things get off, and there’s no routine, that’s when things start to fall apart. And so so finding some way to maintain some form of normality, and some sort of routine has been really important for my children at least. And I think a lot of children sort of thrive in that environment. And if you are disrupting that routine, frequently, it makes it really challenging. Predicting, having some predictability. So my kids hate when I have to change calls last minute. Last weekend, I forgot somehow that I was on call and realize sort of half an hour in that I had to leave that really throws them off. So trying to warn them ahead of time is really important. And then life events are really important to them. I’ve never been a person about dates and birthdates and holidays, it’s never been sort of an important part of my life. But wow are those important to the children and being there for their dance recitals, being there for their important hockey games. They understand I can’t be there for everything. But planning those ahead, I put those in my calendar and book them off. And it’s really challenging, because there’s so many of them with all the kids. But it’s so important to the kids, especially in our family where there’s really no one else that kind of fills my role. If I’m not there, then they don’t feel the same as having like the grandparents there. You know, it’s just not the same important level not not to downplay the grandparents, but obviously, they want their parent there. So those have been the real things we’ve struggled with is being there for for them for those events.

Chad Ball  48:40

Yeah, I mean, the the impact of COVID on I think everyone has been obviously such a struggle and really every facet of life and you know, as a single parent, there’s no question that the impact is, is almost beyond a measurable entity. But you know, I would say that your your kids, I would predict, you know, years down the road are going to look back at this year and like I hope mine do and and maybe think of some of the fun things are unique things that might have happened in this, you know, one to two year window that that maybe will become good memories as well, despite all the struggles at least that’s my, my, my optimistic hope. We’ll see. No doubt.

Lawrence Gillman  49:27

You know what, you’re not wrong. Like it’s been a real family building and yeah, sort of building that core family for sure. Because our evenings were a disaster like you’d have. Like my kids don’t do a lot they do two do dance and two do hockey but you take two in competitive dance and two in pretty competitive hockey. That’s a lot of nights and days. They’re often things and you would run. Like we would we’d never have dinners at home. They’d be eating in the arena or eating at dance. Now we’re every evening we’re together. We ever I mean, yeah, it’s boring. Yeah, we’re trying to kill each other on most days. But we’re also spending time together. We’re playing board games, doing puzzles, we’re going sledding. So I agree, like, it’s been a struggle, and it’s been a challenge, and they need those activities and they miss them. But it’s also been really good for the family element and sort of building that family core that it’s probably lacking in a lot of people’s lives. Just because of the way our careers are and the way our kids are, and the ways sort of activities work and life works nowadays in the society.

Chad Ball  50:35

Yeah, it’s so true. I mean, a lot of this is has made me reflect I think all of us has made us reflect on so many things. And I, you know, I realized that driving my kids, you know, in between all those those events is, as you say, in an evening and eating, you know, dinner in the in the vehicle and everyone cheering each other on is is something I completely miss in that COVID era, and I never found it really stressful, I just found it so enjoyable. And I do miss that elements. I think the the kids even now I know at my kids age, which are similar to yours look back and, and, and they really have a new and, and profound respect and fondness for for that for that car activity activity world. But yeah, I agree. You know, this is a, this is a different time as well.

Ameer Farooq  51:25

One of the things that we we try to ask most of our guests, at the end of the show is, if you were to go back and give yourself advice as a trainee, having kind of lived the life that you’ve lived and had the career that you’ve had so far and having experienced the things that you’ve experienced, if you had to go back and give yourself advice as a trainee, what would that advice be?

Lawrence Gillman  51:48

Yeah, that’s a great question. I always wonder if I would even take this career, knowing sort of what it brings with it and the challenges. I love what I do. But I also see the impact on my family. And I see the impact on the kids. And I saw the impact on Carrie when she was with us. And you wonder if maybe you’d even choose this career, necessarily. The the challenge is I think most of us don’t know what else we would do. We love what we do, but we also hate the impact that it has on on those around us. So that would be the first thing I would I would think about and think about alternate careers to be honest in some respects. But I think I would probably still end up where I am. I’m not sure I would push my kids to this career, though. And I’m certainly pushing them, letting them take their path, but pushing them away from medicine as best I can. But we’ll see what they end up doing with their unique personalities. In terms of career advice, I think, follow a path stay open minded. Let your career guide you and like I like this experience with STARTT, this experience with simulation, I’ve sort of been open minded and let my research path go where it leads and kind of followed it along, rather than trying to be too dogmatic about it and to guiding and been open to new experiences and to new things. And when people come to me with research ideas, I kind of say, yeah, let’s give it a go. Why not? Let’s try something new. And collaborating with others has been a huge learning experience from a research perspective. From a clinical perspective, I think, really, it’s important to focus on balance and realizing the importance of family and those among you. I wish when Carrie was around, I spent more time with the family. I’m certainly way more involved in family life than I was back then. And I wish I had taken the time to be more involved at the time. And I see now how important that is to everyone. And you don’t necessarily realize that when you’re young in your career, you’re focused on sort of performing and focused on working as hard as you can. But the work is endless. There’s you will never do enough and you will never feel like you’ve done enough. And there’s always more and sometimes you just got to take a step back and know your limitations as a person, know how much you can do and realize that these life moments aren’t going to be here forever. These kids aren’t going to be young forever. And it’s important to spend those times with them, go to their dance competitions, go to their hockey games, be at home with them, do a puzzle, play with them. And focus on family life as well as career because they’re important as well. And they’re a very finite entity for sure.

Ameer Farooq  54:42

You’ve been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback. So feel free to email us at podcast.cjs@gmail.com or connect with us on Twitter @CanJSurg. Thanks again.