S04E86 Revolutionizing Plastic Surgery: AI, Mentorship, and Sustaining a Career with Dr. Edward Lee

What if the future of plastic surgery could be revolutionized by artificial intelligence and robotic suturing? Join us as we sit down with Dr. Edward Lee, the division chief of plastic surgery at Rutgers, New Jersey Medical School, to explore this exciting possibility. Dr. Lee shares his journey from private practice to academia, detailing his innovative work in microsurgery and targeted muscle re-innervation for amputee patients. Learn about his pioneering efforts in developing cutting-edge clinics and his visionary outlook on the future of plastic surgery.

Curious about the evolution of surgical training and mentorship? Dr. Lee's reflections on the shift from traditional techniques to advanced methods in breast reconstruction and orthopedic oncology provide a rich narrative on how surgical education has transformed. Delve into the importance of both formal and informal mentorship as Dr. Lee recounts invaluable lessons from his mentors. Discover how personal connections and structured learning opportunities shape a medical career in profound ways.

Struggling with burnout in the medical field? Dr. Lee's insights on managing burnout and maintaining a productive mindset are invaluable. He emphasizes self-awareness and the support of friends and family as critical mechanisms for overcoming professional fatigue. This episode also highlights the importance of teamwork in the operating room, the role of music in creating a conducive atmosphere, and Dr. Lee's ongoing goals to enhance research and patient outcomes. Whether you're a medical professional or simply intrigued by the intricacies of plastic surgery, this episode offers a treasure trove of wisdom and practical advice.

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S04E86 Revolutionizing Plastic Surgery: AI, Mentorship, and Sustaining a Career with Dr. Edward Lee

TRANSCRIPT

[00:00:04] Dr. Sam Rhee: As you listen to my next guest, Dr. Edward Lee, plastic surgeon. It may only take you a minute before you recognize him as a big thinker. He is the rarest of plastic surgery animals, someone who started his career in private practice and then found his way back into academia at a large medical center. He climbed to the top of the mountain as Division Chief of Plastic Surgery at Rutgers New Jersey Medical School and Residency Program Director.

But this particular big thinker is not a passive ivory tower Brahmin, even though he did go to Yale and Georgetown, two elite organizations. Dr. Lee is a doer, a dynamic mover and shaker, training future plastic surgeons in the field of microsurgery, managing multiple teams of surgeons and clinics, working on big ideas such as re innervating muscle in amputee patients, and as you will hear, even speculating about future advances such as artificial intelligence in plastic surgery, coupled with technological advances such as robotic suturing.

Dr. Lee is a leader in our specialty who is simultaneously hoping to dramatically widen the scope of plastic surgery, as well as render much of what we do as antiquated. Which is both wonderful and scary at the same time.

His approach is practical, down to earth, and he is a master at seeing situations from both the ground level, as well as the 10, 000 foot level.

Dr. Lee approaches challenges with inclusivity, finding ways to lead his division, community, and those around him, without leaving anyone out.

It was fascinating to cover so many different topics about surgery and life with Ed, and I know you will find him as thought provoking as I did speaking with him. Thank you very much.

Welcome to another episode of Botox and Burpees, the Surgical Series. And I have with me my very special guest, Dr. Edward Lee. And Dr. Edward Lee, I've known him for a long time, is the Residency Training Program Director of Plastic Surgery at Rutgers New Jersey Medical School. He's an Associate Professor of Surgery.

And Dr. Lee grew up in North Brunswick, so he's a New Jersey guy. Uh, and he attended the Lawrenceville School, um, for high school. Uh, doctorally graduated from Yale University with a double major in philosophy and molecular biochemistry and biophysics. And then you completed your, um, M. D. from Georgetown University School of Medicine.

Uh, you did your plastic surgery residency at University of Pittsburgh. And, uh, you have been at New Jersey Medical School for how many years now, Ed?

[00:02:34] Dr. Edward Lee: it's been quite a while, so I actually started out in private practice for three years. So I was based in Englewood Cliffs, uh, family was around there. Uh, and then, you know, I actually really enjoyed the academic side of things. So I had, uh, attended the Grand Rounds and, uh, enjoyed teaching. And Mark Granick, who was, uh, The division chief there, and is still there, um, asked me if I wanted to take a job.

So I took a part time job at the VA hospital, uh, really enjoyed my time there, and then ended up moving on to join the university full time in 2018. So I've actually only been full time at the university for about six years now. Um, but, uh, so it's been great. Uh, I've, uh, taken over the role as the Residency Program Director.

I started that back in 2011 or 2012. Uh, and then Division Chief over at, uh, Rutgers New Jersey Medical School and University Hospital. Uh, in 2018. So, when I moved over full time.

[00:03:40] Dr. Sam Rhee: So you are the face of plastic surgery at New Jersey Medical School, their residency, their program, their, their, uh, department. Division? Department. What are you guys

[00:03:50] Dr. Edward Lee: Uh, we're Division within the Department of Surgery.

[00:03:54] Dr. Sam Rhee: So, that's a lot of hats. Uh, You're a busy man, Dr. Lee

[00:03:59] Dr. Edward Lee: Yeah, it's a few too many hats, really. Yeah. Uh, but no, I, I mean, I've got great partners, right? So, uh, Mark Granick is still there. Uh, Ramazi Dathieshvili, who you probably remember from your time at NJMS is still there. And the two of them are phenomenal, uh, partners as well as, you know, leaders in thought in terms of what they do.

And so Mark's, uh, interest in wound care technology is phenomenal. He's constantly running different, uh, clinical trials. Cheers. Cheers. Uh, and so it's very involved with the students and the residents as well. And then Ramazi is one of the world's, uh, leaders in, um, replant, uh, whether it's digital replants or major limb replantation.

So it's great to have those two. And then we've hired a couple of new people. So we have got, um, a guy, Ashley Ignachuk, who, uh, is a well trained hand surgeon, he's Canadian. So of course, you know, he's a nice guy. But, uh, he runs, uh, a very interesting clinic we put together, uh, as a team, we put together something called the Targeted Muscle Re Innervation Clinic.

So it's a new procedure that people were doing to try to reduce phantom limb pain, uh, after major limb amputation. So below knee, above knee, uh, and then upper extremity amputation. So we have a specific clinic where we partnered with the Hangar Clinic, uh, a prosthetics company. Uh, in order to better serve these patients, right?

So we track them from the time of their amputation, whether it's traumatic, oncologic, or vascular. Uh, and then we will do TMR or RPNI at the time of their amputation and then track them as they go through. And we've seen some very good results for them. So it's a multidisciplinary clinic. We have a physiatrist.

Uh, we have our, um, prosthetists, uh, and rehab people there as well. So it's a great clinic that he runs. And then we've recently hired Steven Ovadia, who's, um, a, uh, gender affirmation specialist, as well as craniofacial specialist. So that'll be a great, uh, great source of, uh, you know, experience for the residents and, uh, service to the community.

And then in April, we actually have Alex Wong coming on board. I don't know if, you know, Alex, but he's, uh. Microsurgery director at USC and then City of Hope and also has a translational science lab that's NIH funded.

[00:06:29] Dr. Sam Rhee: Oh, wow. What is your clinical focus? Ed? What do you, what do you focus on? Surgically. Mm-Hmm.

[00:06:35] Dr. Edward Lee: uh, my focus really is on traumatic and oncological reconstruction. So I would say most of my practice comes from either the orthopedic oncology or surgical oncology world. Uh, and then the orthopedic trauma or general trauma surgery world. Um, you know, they've tried to create, I guess people have created a bucket for it of complex reconstruction.

is the term that they're using for it. I kind of wonder, like, there were two, when I was training, there were two surgeons. One had a practice that we considered kind of elite reconstruction, and the other one had a practice that we kind of considered bottom of the barrel reconstruction. But honestly, both of them were doing the same procedures.

It was just slightly different groups of patients, and I think that I cover, uh, the full spectrum of both of those. Um, you know, so it's going from wound debridements to deep flaps for breast reconstruction, uh, or, you know, really nice like orthopedic, planned out orthopedic oncology procedures where we're doing free flaps for, uh, you know, muscle reinnervation and reconstruction as well as soft tissue coverage over the megaprostheses that they'll use.

[00:07:51] Dr. Sam Rhee: how much, uh, is your practice micro

[00:07:54] Dr. Edward Lee: Um, I would say probably about 20 percent of my practice is micro.

[00:07:58] Dr. Sam Rhee: Okay. Uh,

[00:07:59] Dr. Edward Lee: I really like doing it, but honestly, we, we kind of move away from it. So a lot of our traumatic reconstruction, uh, because Dr. Granick is such, has such a focus on wound care technology. We do use a lot of wound care tech, uh, whether it's the advanced wound care products like, um, Celera, Somagen.

Uh, Integra, things that sort of downgrade the, uh, intensity of surgery that's needed. So going from requiring a free flap to here's a product, put it on the wound, back it for, you know, a week or two, and suddenly you have a granulation bed where you didn't think you would have one.

[00:08:41] Dr. Sam Rhee: So you mentioned how you had, uh, mentors or, uh, people who you trained with who did fancy pantsy reconstruction, and then more of the blue collar stuff. What other kind of memorable training experiences or stories do you remember from when you trained that might've been formative or really sort of put you on the path to where you are today?

[00:09:05] Dr. Edward Lee: Um, you know, I, I think they're, they're all formative. I mean, that, that was part of training, right? That video was. You know, when I started the 80 hour work week, hadn't quite caught on yet. Um, and most of us, honestly, as trainees didn't believe in the 80 hour work week. We felt that it was better to spend more time in order to see more.

So we were happy to ignore the 80 hour work week and keep going. Um, but I think, you know, honestly, the training has gotten better. We've moved away from it. And part of it is that we, uh, as educators, we've developed opportunities to learn rather than waiting for opportunities to come along. So it used to be, you just, you're just in the hospital so long, you'll see Every type of case throughout your residency.

But since they, you're not going to stay in the hospital that long now. We have to create an opportunity for you to learn about it, whether it's through simulation, um, additional didactic time, uh, you know, courses that you'll go to in order to see it, mission trips that, uh, residents will go on in order to see more of the cleft lip palate, or congenital, uh, issues.

So I think the education has gotten better, and so the experience has gotten better. Now, formative experiences, like I said, and you've been there, it was kind of like war, right? You're like in boot camps for five, six years. And so all of them are formative experience. What really stands out, um, there, there's so many cases that are just mind boggling and, and, uh, and a little bit crazy.

Um, you know, I think really the, some of the formative experiences were not in the hospital, though. Right. It's like when an attending who you admire takes you aside and says, Hey, let's go grab lunch or, Hey, you know, why don't you come over to dinner tonight? I'm having some other people over for dinner.

And so I remember one of my attendings did that for me, uh, you know, invited me out, there were a couple of other attendings there with him in different specialties and, um, you know, it was a, he was very much into wine. So it was a wine tasting dinner. And, uh, the first thing I thought was, Oh my God, that's a lot of bottles of wine for very, you know, by the time you're like a TTY five or six residents, like you haven't really had anything to drink for years cause you're in the hospital so much, and especially as you're doing more microsurgery, you, I don't know about you, but for me, if I drink.

And then I try to do micro. It's just a little bit off and I don't like that feeling. It's probably similar to you for other surgeries or for, you know, a hardcore, um, hardcore workout, right? Like you don't want to go in a little bit hung over

[00:12:14] Dr. Sam Rhee: All right. Absolutely. Did they finish all the bottles that night?

[00:12:18] Dr. Edward Lee: Uh, they did. I stopped after a little bit cause I, I couldn't hang with them.

Yeah.

[00:12:24] Dr. Sam Rhee: those attendings back then? They, uh, yeah. That was old school being able to do that. Uh, so what kind of mentor, do you remember anyone in particular that was really special to you, uh, during that time? Mm-Hmm?

[00:12:37] Dr. Edward Lee: I mean, there were a number of people and they, there were mentors in different ways. So, uh, you know, there's a guy, Joe Losey.

[00:12:43] Dr. Sam Rhee: Oh yeah.

[00:12:44] Dr. Edward Lee: was our residency program director, and he was a craniofacial surgeon, and still is. He's one of the most meticulous guys. Uh, you know, and so, like, dedicated to his patients, to his students, to his residents, and to his craft.

Uh, and he's always improving it, but, you know, and I, I strive to be more and more like him, but I know I never will be. Um, and, but then the guy who actually probably had the most impact on me was a guy named Jimra Savage. He's the guy that you'll never hear about because he rarely publishes, but is, was by far the best plastic surgeon I've ever worked with.

Um. You know, the guy's kind of like, uh, the A team. Do you remember the, the, the slogan for the A team is like, if you have a problem batting up, if there's nobody to help, call, who do you call? You call Jim Rizavich. They, they also called him the pizza man because he always delivers.

[00:13:47] Dr. Sam Rhee: Mm-Hmm.

[00:13:49] Dr. Edward Lee: But you know, this is one of the guys who was oral maxillofacial surgery trained, then general surgery trained, then plastic surgery and microsurgery trained.

And And, uh, it was one of those things where his attitude and his ability to, uh, train residents was phenomenal. And one of his attitudes really was. Um, how do I, his quote was, I asked him, why does it, why does he stay and train us? Uh, because he would sleep on the couch for hours while we're operating till the wee hours of the morning.

And then if there's any issues, he'd come in and fix whatever it is, but no matter what it was, he could fix it. And we knew he could finish way faster without us. And it's kind of like, well, why are you doing this? And he said, his argument, One, you should train everybody. So no matter who it is, if they're, if they're slow, if they're bad, it's your job to make them better. Two, he was like, he was like, one day I'm going to be old or I'm going to get injured and I'm going to look up. And, and if I know that you were a bad surgeon and I hadn't trained you. It was like, that's going to fall on me. It was like, so, you know, you want your friends to, when they go to see a plastic surgeon, to know that they're good.

And the only way that you know that they're good is if you've helped train them and make them better.

[00:15:13] Dr. Sam Rhee: That's awesome. Oh my God. Yeah. I mean, that resonates with me on a couple of levels. One is, uh, that selfless dedication that, that I've encountered as well in mentors. Uh, the fact that, uh, he would let you operate and then be able to fix anything that wasn't right. And then also the multi, the multi, the triple threat, the OMS and the General surgery, plastics, micro, I mean, I knew a couple of those guys and they were in training until they were almost 40 and yet they were the best surgeons I had ever seen in my life.

Like the ones who had gone through all that training, I don't know what it was about them, but, um, crazy, crazy impressive. So, uh, and the fact that he wasn't like a flashy academic, like big shot guy, like they were in the trenches teaching. Like, I feel like the best clinical specialists are the ones that I have seen.

Not be like up on podiums, you know, like presenting, doing all that kind of stuff. Like these were the guys that were really busy clinically. And, uh, like, a lot of the unsung heroes of residency programs, I feel like, are, are guys just like your mentor, for sure. Like, that means a lot. So, um, so, tell me, uh, in your journey to becoming where you are, give me, uh, one method or way that you became better as a surgeon, uh, for yourself.

[00:16:40] Dr. Edward Lee: Um, you know, I, I saw this question and I kind of ignored it because it's one of those, it's one of those things that's a little bit hard to answer,

[00:16:50] Dr. Sam Rhee: Yeah, yeah, it is hard.

[00:16:53] Dr. Edward Lee: I think more than a method, it's sort of a mindset, right? And it's one of these mindsets of always being humble, always being curious, right? How do you get better at something?

You have to accept that you're not good at it. Or if you are good at it, that you're not the best, then there's a better way to do it. And to be curious, to say, hey, well, how is someone else doing it? And how can I do that better? And so I think it's more of that mindset than any particular technique, you know, uh, all of us read books in all sorts of different aspects of the world.

We're not focused primarily just on medicine or plastic surgery, right? You'll, you'll read, uh, you know, something from, what's the name, Adam Grant or, you know, the guy who wrote Blink. Um, like these are great books and how do you apply that then to medicine? And you know, like, it's, it's that, uh, I think that mindset to say, how can I do better, uh, more than any particular technique. then obviously you, you take that concept, you focus it on what, what it is that you're doing, and then try to. Um, I guess, adjust it or make sure that it is safe, whatever it is that you're doing, that it's safe for your pages. You're not going to wholesale change exactly what you're doing. You want to do it in a measured capacity that you're able to then, uh, sort of see what the results are or what the change is

[00:18:29] Dr. Sam Rhee: Have you done something where you saw something and said, you know what, I think I can make this better, and you played around with it and figured out something that made that operation a better operation, for example, for yourself.

[00:18:43] Dr. Edward Lee: for myself.

[00:18:44] Dr. Sam Rhee: I mean, you know, cause we always say in our hands, so. Uh huh. Uh

[00:18:51] Dr. Edward Lee: Uh, yeah, I mean, I think, yeah, we're constantly playing around with it a little bit, um, you know, so even something as simple as, you know, I don't want to say simple, as common as a breast augmentation,

[00:19:02] Dr. Sam Rhee: huh.

[00:19:02] Dr. Edward Lee: know, how are you choosing where to put your incision for an inframammary fold? There are a number of papers about how to, how to do it, right?

There's the ICE method, there's I 5, there's, and they're all slightly different measurements. And so you, you, you keep playing with it until you're like, well, this one kind of matches what I do and how I would do it.

[00:19:23] Dr. Sam Rhee: Uh.

[00:19:24] Dr. Edward Lee: and so, you know, even something like that, yeah, that that's worked out. And same for, and then, so I guess.

What have I changed?

[00:19:33] Dr. Sam Rhee: Yeah, so how do you do your breast augmentation incision planning then?

[00:19:38] Dr. Edward Lee: honestly, I let the residents choose their representation and decision. No, no, so that we go through all of the different steps for

[00:19:47] Dr. Sam Rhee: see

[00:19:48] Dr. Edward Lee: Uh, and the different methods. Um And then, uh, usually we, we end up choosing sort of along the high five

[00:19:56] Dr. Sam Rhee: Okay. Got it.

[00:19:57] Dr. Edward Lee: yeah, so it's, it's something where I would like them to read what other people have done, analyze their data, and then compare it to their own methods.

Um, the, and so oftentimes I'll have them mark the patients. We talk about it ahead of time. Uh, they, they get to see the patients ahead of time in the operating room. We're doing the operations together. And then I, you know, if they are not in post op clinic, then I'll send them pictures. From post op clinics, so that way they can see sort of what the results are and how it matches what they thought it would be,

[00:20:32] Dr. Sam Rhee: That's awesome. Um, what is one of your favorite surgical procedures that you really still enjoy doing at this time?

[00:20:41] Dr. Edward Lee: you know, I, uh, I gotta say, uh, unfortunately, I'm probably a little bit burnt out at this point. Um, you know, honestly, I, I like operating, um, and I enjoy, like, historically, I really love microsurgery. I love seeing the anatomy come apart. Uh, and then I loved seeing the anatomy go back together again. I felt like it was one of those, uh, great expressions of a plastic surgeon where you're actually taking one body part, molding it and making it a different body part, whether it's a deep flap, a free fibula that you're then making a jaw out of, or a free fibula that you're taking to reconstruct a femur or humerus with osteomyelitis.

It's pretty neat. Um, and very few people get to do that sort of thing. Um, at this point, I think what I actually enjoy doing more is kind of seeing some of these technologies and how things are a little bit different. Uh, so one of the things we're playing around with now is, um, there's a, a, I think it's lyophilized, um, placental tissue, uh, and sort of what growth factors does that have?

Uh, does that sort of bring to the field or cause the field to, um, secrete that will improve wound healing? And it's one of those things like you kind of don't believe it at first, like you see the papers and you're like, and just another thing that somebody's using, like, you know, like the paper was clearly paid for by the company, but then, but then you, you, you trial it and you're like, actually my patient's wound does look better.

So then what's going on with it? So that's where having a guy like Alex Wong coming in, who has a research lab, who can then start playing around with, um, you know, sort of breaking it down to what are the processes that are going on, uh, is incredibly valuable.

[00:22:38] Dr. Sam Rhee: no, we definitely see a lot of potions and things in plastic surgery. Someone always has something new, but if you find something that actually works, that, that's invaluable for sure. Um, I've talked to a bunch of surgeons and surgeons, our generation, I think a little bit of burnout is really, really common.

And it's kind of funny because ostensibly we're at the peak of our, surgical skill, knowledge, experience. We have years and years and years under our belt where we're still very physically, you know, on point. So why do you think so many of us are a little burnt out and how do we combat that at this point when supposedly we should be at our, I don't know, most productive or at, at the peak of where we are surgically, maybe, I don't know.

[00:23:24] Dr. Edward Lee: Yeah. I don't know. It's something that we talk about a lot, particularly in academic medicine, because there is burnout. And obviously we worry about our residents burning out and, uh, the training for it. And, um, You know, sometimes when I think about my own, like how I feel tired, uh, you know, my dad's voice pops into my head and basically he's just telling me I'm lazy and keep going.

[00:23:50] Dr. Sam Rhee: Yes, I hear that all the time.

[00:23:52] Dr. Edward Lee: And so then I wonder like how much burnout was there in previous generations because nobody really measured it and they just sort of kept going and work through it. It's kind of like when you're working out, right? Yeah. You're at a CrossFit workout. You feel that burn. Do you say, Huh, I got to stop this.

Or is there a level where you say, Okay, I can maintain this. Or you know, you're going to bonk and you're, you know, you're, you're going to use up all of your glycogen stores and then you can't, yeah, you can't finish the workout. And so I think being able to measure when is the stress leading to greater productivity, Or greater growth versus when is that stress going to harm you? And I think that's the question. So are you really burnt out or are you a little bit tired because you're, you are growing and growing is hard.

[00:24:48] Dr. Sam Rhee: That's true. That that's a really good point. I think previous generations, it was survival. If, if they didn't do what they had to do, they, they would basically have nothing like their family wouldn't eat and like, it'd be a real problem. So, uh, I think we have the luxury a little bit of being able to look at ourselves and say, wow.

You know, am I, like you said, am I, is this real? Is this something where I'm changing? Or, um, is this something where I really, it's affecting me in some, some negative way, but you're right. I, I think, um, it's tough. And, uh, how do you feel like you manage it better? Like, what is your way of sort of identifying it and then sort of managing it?

[00:25:30] Dr. Edward Lee: Yeah, I kind of rely on friends to tell me that. One of my friends says as I walk around the hospital, he can see me hunching over more and more. And so, they'll tell me when I seem to be hunched over more. And if it looks like you need to talk. But I think that's a, you know, it's a joke, but it's not, right?

[00:25:57] Dr. Sam Rhee: All right.

[00:25:57] Dr. Edward Lee: know? And I think one of the ways we know is our interactions with others, right? Like your interactions with family. And, and, and I think that's one of those areas where burnout, uh, is most destructive because if you're not enjoying the work that you're doing and then you come home and you're upset, but you're even more tired now, and then you're kind of, you have no reserve for the people that you love the most, meaning your family, friends.

Um, then, unfortunately, they do suffer with it. And I think that's where trying to identify burnout, trying to deal with it, um, is the most beneficial. Not necessarily for our careers or for development as a surgeon. Uh, but for development as a, as a human being.

[00:26:47] Dr. Sam Rhee: I get

[00:26:48] Dr. Edward Lee: so how do I deal with it?

[00:26:49] Dr. Sam Rhee: I'm

[00:26:50] Dr. Edward Lee: Uh, you know, when I'm feeling burnt out, I think I do try to carve out more time for myself then.

Uh, you know, whether it's a morning workout or taking a weekend off to go away somewhere, uh, just, just to have some peace and quiet, uh, turn the phone off, uh, avoid, you know, whatever social media or other things that you're supposed to be reading or doing. Um, and then really this, uh, you know, how to, again, I don't want to blame my parents, but you know, because we should, we should have out, we should have grown, outgrown our parents conditioning by, by now, but it's hard not to hear their voices.

Right. uh, you know, one of the things that was always said that you can always do more, you can always study more, you can work harder. Um, you know, the, that I think leads to burnout, right? It can push you to do better, but that can also lead to burnout. So the idea of self acceptance. Hey, what I did was, was great. I can do better, but right now I can't. And to accept what it is that you've done, who you are at that moment in time, and just sort of being a present in that moment in time, um, not, and I don't want to get too like new world, new age, um, you know, but, uh, Uh, you know, that sort of, uh, Buddhist thought of just being present, uh, and accepting everything as it is, uh, I think is very valuable.

[00:28:21] Dr. Sam Rhee: Yeah. That is. Um, so when you're in the operating room, I know you work a lot with residents, that's, that's such a huge, uh, focus for you. Do you have any rituals or any sort of things that you do in the operating room, which are always the same or very similar? Um, every time you do something in the operating room,

[00:28:44] Dr. Edward Lee: Uh, I mean, the, the most, the most consistent is going to be when you do your micro surgical and asthmosis. Um, yeah. You know, you want to have the same setup. You want to have your hands positioned properly, your body positioned properly. You want the field to be totally dry so that there's no bleeding, uh, or if there's anything losing its control through a suction drain, you just want it to look like a picture textbook.

Uh, of what an anostomosis should look like and then, and then get started. Um, so that it's exactly the same. I think for me, like, um, I do a lot of different cases. So my practice is very broad. Um, and so I, I. I don't think I do things, um, I don't think I, I enforce ORM as rigid, um, sometimes. Uh, and so I'm willing to go with the flow.

We often have a different team in the OR for each case because of whatever union contracting or what have you. We often have a different scrub, a different circulator, different anesthetist, uh, from the morning case to the afternoon case. And so some of those routines are hard to maintain, uh, but within yourself, like for me, I always think about doing the operation, you know, as they do the operation three times in your head before you actually start, right?

So you, you do the operation in your head when you see the patient, you're like, okay, this is what I'm going to do, but you're not as detailed about it. Um, and then do the operation the night before. And then do the operation as you're scrubbing it. So this way you're reviewing the process of it. And I think this, this is something that I try to impress to the residents.

Um, you know, it used to be that we would have to sit there and read a textbook and you have to like, imagine the anatomy, right? Because it's hard to find a great picture of some of the anatomy. You know, you would look back at the anatomy in textbooks and then trying to find like cross cut sections of where things are, because oftentimes it's easy to see like the Longitudinal and latitudinal sort of orientation of anatomy as it's drawn out in a netter text, but then there's like depth to it and like kind of coming around a muscle or around the bone.

And the only way you can really think about that is through your imagination, right? There were now, I feel like video is great, and all of my residents, honestly, they probably YouTube more of their study than, uh, anything else. Most of the videos, when you look at them, they lay out the anatomy for you, but It's laid out for you so well, because they've chosen a great video and a great example of what it is that they're doing that you're not using your brain to think about, okay, well, as I'm cutting or moving through this layer of tissue, what is it that I expect to see before I see, so like, let's say you're, you're looking for a perforator coming out for a deep flask.

Um, you know, as you dissect along there, or even like as you're lifting the PEC muscle to do a sub PEC OG, right, what is, what will that look like as I'm getting closer to those internal mammary perforators that I don't want to ding, because they'll bleed like stink and then you're in a lot of trouble, or what will it look like as I'm coming across the Um.

Um. Uh, insertion, uh, or origin of the pack. Uh, cause there's always like that one vessel that bleeds like sort of in the central aspect of it, like, what is that going to look like before I hit it? So that way I know to grab it with, you know, an insulated DeBakey or something or, or slow down so that I can cauterize it nicely before I come through it. Um,

[00:32:47] Dr. Sam Rhee: so true. I remember as residents looking at netter or Mathis in the high and trying to figure out like, but you, like you said, like the approach. will change your perspective on finding that particular muscle or that dissection or that plane that you're looking for. Um, it does take a lot of imagination to do that.

And, and I think, uh, we never had the benefit of YouTube, so, so we never were able to see any, any videos like that. Uh, the pre vis, I think, is something that I hear a lot of surgeons talk about, pre visualization of the surgery. I love that three, that times three aspect of it, and, uh, I never thought of it that way, and I probably, that's a, I might actually start thinking of it that way.

That's a really, really good tip. Three times is, uh, is a really good way of sort of approaching the pre visualization of surgery. That's amazing. That's pretty cool stuff. Um, what do you listen to in the OR then when you're doing all of these different types of cases?

[00:33:50] Dr. Edward Lee: yeah, um, yeah, I gotta say, I let the residents choose the music. Um, you know, I, I work with so many different residents, I, I like to hear what they're listening to. Oftentimes, honestly, they, they have better taste in music than I do.

[00:34:05] Dr. Sam Rhee: What do you, what do you, what do they, what do they play that you happen to like? Like, what is it that they might

[00:34:09] Dr. Edward Lee: know, like, like just yesterday or was it two days ago, you know, they were listening to some Vibey Lounge music. But if it was like perfect for the case that I was, but, but I would never have chosen that. I'd probably choose something like classical, classic rock. I do listen to a lot of like pop music.

Um, but it's nice to hear what they're doing. And honestly. When I'm operating, um, I actually am not listening to the music at all. Um, it, it kind of like, for me, uh, you know, when I used, when I, when I was in college, uh, I liked to go to like a cafe to study. I like to have background noise as I'm doing things, but I, what the, what the noise is doesn't necessarily matter.

Um, and so honestly, like, if it's an intense case, I won't even know what's, what's playing or not playing. Uh, it can be on repeat a thousand times and I won't recognize that until that, like, intense portion is open, over. And that intense portion may be hours. Um, so I don't really notice it. And if any of my college friends watch this, they will laugh because they'll say I never studied in college.

Ha ha ha ha.

[00:35:25] Dr. Sam Rhee: Yes. I think the smartest people I knew in college never, never seemed to study, ever. So you, you, you were one of those guys For sure. I'm sure. Um, so as, as part of your team, either in the OR or outta the or who's really important in terms of your success as a surgeon, uh, you know, who is integral to what you do?

[00:35:48] Dr. Edward Lee: I mean, honestly, everybody is, like, you know, it's, uh, it's such a team sport now. I think surgery used to, surgery used to be more of a, Um, a captain running the ship and being in charge of everyone and controlling everybody around them. Uh, but I think medicine as a whole has moved so much more to a team sport.

Uh, and so like the, in the aesthetic world, things may be a little bit different because you're coming in, you have very consistent team. Your patients are a little more consistent. The operations are more consistent, but the number of my patients are, uh, are very sick patients. And so I'm often operating with another surgeon.

Uh, and we're doing two or three different, there may be two or three different surgeons involved in the case doing different portions of the case. Uh, and so, and our anesthesiologist is incredibly important, obviously, um, you know, the people who are in the room with you, circulators, scrub techs are all very important.

Um, and then, you know, the medical team who's taking care of the patient. Whether it's me, my residents, uh, my PA, uh, they're all incredibly valuable. So I don't think there's a one person that I would point out as being, uh, particularly valuable to my, to sort of the success of the operation, but I really think it is everybody.

I do think it is important that there is somebody who is. Sort of calling the shots and running everything. Um, you know, there was a guy who was that guy from SEAL Team 6. Um, Jocko

[00:37:26] Dr. Sam Rhee: Yes. Mm-Hmm. . Mm-Hmm.

[00:37:27] Dr. Edward Lee: I mean, he wrote that book. It was like a extreme ownership, right? And the, the idea that you have to take ownership.

And understand and, uh, really be in charge of every part of what's going on. You can ask people to do stuff, but you gotta know exactly what they're doing. And I think that is very much appropriate for the operating room. Um, but it's still a team. It's not an individual doing everything. Uh, every team member really needs to be invested and they all have to buy into that investment.

Uh, in the care of the patient.

[00:38:03] Dr. Sam Rhee: Um, you're now division chief. You're, uh, pr uh, program director. You've sort of achieved the pinnacle of what most plastic surgeons would aspire to. So what are your future goals now at this point of your life now that you've achieved these, uh, these achievements at this point?

[00:38:23] Dr. Edward Lee: Uh, yeah, it's funny that you say that, you know, I told you I'm a little bit burned out, so, uh, you know, every now and then I do buy a lottery ticket and hope that that will be the finish. I love my AG,

[00:38:38] Dr. Sam Rhee: I get it.

[00:38:41] Dr. Edward Lee: but I think that there's lots, lots of little goal, so there's lots of things to improve on. And maybe this is something that you were talking about with. How are, how do you become a better surgeon? It's the same sort of thing. Like, I don't know what large goals I have at the moment. I haven't, it is something I'm kind of working on and writing out for myself.

And you know, it'll be one of those things that I write out, this is what I'd like to do in five years or 10 years. Um, but there's lots of little things that I want to improve. So like I, like I said, we just hired, um, Alex Wong, who's a good friend of mine. Um, who's coming to Rutgers. So that's phenomenal because he brings a research component to it.

Um, but then we, we've got to add more, right? It would be great. Like I, I work in Newark, right? We have a number of underserved patients. We have a large minority component. It's a majority minority community there. Um, and so, why do we not have more patient, uh, reported outcome measures that are focusing on the outcomes, uh, for reconstructive surgery for minority patients?

Uh, because that is a large area of concern. Uh, research, uh, in a way that we can become better. We know that outcomes are worse for minorities in many ways, but how do we make that better? So I think teething out some of that, uh, would be, would be exciting. Um, you know, the other exciting thing to me really is AI.

I mean, what a, what a fascinating technology and how are we going to utilize it in healthcare? Um, you know, the, the hardest part is that, um, you know, with healthcare, you worry about hurting anyone, right? Like even something as simple as. Uh, if you use an AI technology to, uh, uh, like decide whether or not to get an x ray for a patient, a judgment call that's being made by a computer.

And will it be right? You know, the CMF has asked for all patients. everybody using an EMR to start using decision support software, which is slightly different than an, uh, an AI program, right? It's the decision soft support, decision support software has like an algorithm built in. And so, but it would not surprise me if they quickly moved to an AI technology that can then scan or read through the latest literature in order to update what it's suggesting as an appropriate study for a patient. But when we look at AI, we also know that AI has what they call hallucinations, right? Where for some reason, it will go off the deep end for, for an unknown reason, for an unknown question. Uh, and so like governance of the AI is important. So how do we know what data it was looking at, how it made its decision and how it produced that outcome?

Um, is something that people are still, uh, are, are spending a lot of time and a lot of energy working on.

[00:41:57] Dr. Sam Rhee: Yeah.

[00:41:58] Dr. Edward Lee: but I think that would be fascinating. Like, wouldn't it be great if you had a chatbot slash AI that could do the intake for your patients, um, and then convert all of that to ICD 10 and CPT coding,

[00:42:16] Dr. Sam Rhee: Mm-Hmm.

[00:42:17] Dr. Edward Lee: or, you know, for the case of aesthetics, the different options for operations and say, okay, well.

You know, you can do X, Y, or Z, and that's going to be, this is the gold, you know, the gold package, the silver package, and the bronze package, uh, and why they're better or worse, and then generate a picture outcome of what each might look like, right? So for like facial rejuvenation, yeah, you can, you can get the facelift with that grafting.

Or you can have a chemical peel. The chemical peel will improve your skin a little bit, but it's not going to tighten much more than X, Y, or Z. Um, but be able to generate those different outcome pictures for the, for the patient.

[00:42:58] Dr. Sam Rhee: that's crazy. That, that is, both those possibilities are science fiction within the, within the realm of reality. Very soon, like the fact that our EMR could actually help us with. Charting, billing, coding, like, I know people are chomping at the bit for that, like, yesterday, like, uh, with EMR. Uh, for aesthetic medicine, to be able to, say, scan a person's body, and then say, Here are the 20 different treatments you could opt for, and this is what it might look like, and here you go, would be Amazing.

Uh, I think it does sound like something that I might have even seen in a movie like 15 or 20 years ago. So that's, that's, I had not actually thought about that for aesthetic medicine, but that would totally be within the realm of possibility within the next couple of years, I would imagine. So that's crazy.

[00:43:51] Dr. Edward Lee: I think that would be cool. You know, you get so many patients who come in and they're like, Oh, I just want liposuction and you're looking at them and you're going, that is not going to fix this problem and,

[00:43:59] Dr. Sam Rhee: that's right. You're right.

[00:44:01] Dr. Edward Lee: but to be able to have a generative AI, you take a picture and you say, okay, liposuction, we'll do this.

Liposuction plus the abdominoplasty will do this, or abdominoplasty followed by liposuction would look like this, um, and you know, because the problem is that oftentimes you're trying to tell a story to the patient, um, and even if you show them other patient's photos, they'll look at it and be like, no, no, I'm different, but you're looking at it and they're like, no, no, you're, this is the problem that will happen.

[00:44:35] Dr. Sam Rhee: That's right. That's amazing. Um, so, okay. So if you have little goals and, and some other bigger program and, and institutional and society goals, um, how long do you envision yourself operating, being a surgeon, doing what you do at this point?

[00:44:56] Dr. Edward Lee: It depends on if my lottery numbers hit.

[00:45:01] Dr. Sam Rhee: Uh, those lotto numbers better hit, I guess, pretty soon.

[00:45:04] Dr. Edward Lee: No, I mean, honestly, I, I, I'm actually pretty in a pretty good place. I say I'm a little bit burnt out. Um, but it's not bad. It's more along the lines of, I think this is a steady state that I could do for a long time. Um, but I'm not sure. Right. Like, you know,

[00:45:22] Dr. Sam Rhee: right.

[00:45:22] Dr. Edward Lee: know, as you're going, particularly like, I hate, I hate the erg, the, the rowing

[00:45:28] Dr. Sam Rhee: Yeah. The concept

[00:45:29] Dr. Edward Lee: know, I, I rowed in college. You know, it was like the bane of my existence. Being out on the water is fine, being in the tank was fine, but the erg, there's something about it. I think part of it is that as you're going, you're listening to that hum and that whine, and you see your split times, and you're like, ah, this feels pretty good. You go a minute in, five minutes in, and then you're like, oh, no, no, this pace was too much.

[00:45:57] Dr. Sam Rhee: I, we recently did a 2K row for time at our, in our gym, and that was one of the worst experiences anyone has ever had. Like we always say, the best PR you'll have will be the first time you do a 2K row for time, because the next time you don't want to go. You don't want to go to that place to, uh, uh, cause it just hurts so much.

So I, I, I understand, but like you're ostensibly at the peak of your surgical powers. You have all the experience in the world at this point. Do you see yourself operating like this for another five years, another 10 years? Like, is that something, we know surgeons who will operate until they physically cannot operate anymore.

And then we also know surgeons who will say, listen, this is enough. I don't want to sit here for eight or 10 hours doing, doing this case anymore. And they, they, they pivot. So what sort of is your perspective with that?

[00:46:52] Dr. Edward Lee: my perspective with it is that it's a little bit different, I guess, than most people. So one, I think the medical licensing process that we go through in the U. S. Uh. It tries to be protective, but it is not, um, it is not, uh, progressive at all. So the fact that you go from, oh, you were a medical student to now you're, you finished one year of residency and you can get your license or New Jersey two years, and you can do anything under the sun.

It is a little bit crazy to me, right? Like, why do we not, or even within surgery, that you graduate from a surgery program and suddenly you are theoretically capable of doing any procedure that you want to do. that falls under that. Um, and, but we all know that there are residents and there are, uh, colleagues who you're like, you know, you probably shouldn't do that procedure.

That's, it's a little more complicated. And I think we, we all come up with that on our own. Right? Like we look at things and like, I will not do a cleft lip or palate. I didn't do a fellowship in it. Could I do one? And could I do a nice job of it? Maybe, but like, There are people who are so much better at it.

Why wouldn't I send it to them? Um, and so like, I think that the medical licensing is to all or none, right? Like, why don't we have something that says, well, you can be a great lumps and bumps surgeon. Well, how did you do lumps and bumps? Uh, you know, you can do, uh, you know, some other graded complexity. Um, you know, instead of saying, oh yeah, you have a medical license.

You can do. Uh, you know, like these BBLs that are being done down in Florida. There's like that one County that has like the highest mortality rate. Uh, and it's like a outlier in the nation. Like that, that's kind of ridiculous. So the same thing, I think for the wind down of the career, right? Like at some point, I think every, but like most plastic surgeons, I know a lot of people were doing free flaps, right?

And then at some point they say, you know what, I don't really want to do that anymore. Okay. Well, you can voluntarily opt to not do that. Or should there be like a decreased sort of, uh, licensing almost that goes with it. And so like, I think over time. The number of procedures that you do and the complexity of the procedures that you do slowly decreases.

So, you know, I could see myself not wanting to do free flaps after about 10 years, because that'll, you know, that'll put me at around 60. Um, or if I find that, you know, there are, uh, Other people in my practice who are doing it way better than I am. Go see them. Um, and like, I think that goes along with that sort of humility, uh, or being humble about who you are and accepting who you are.

So yeah, so I could see that sort of winding down. But then the other part of it to me is we should be inventing technologies to make surgery easier. So one of the jokes right now is, uh, going around the OR is button surgery. Right? So, have you ever used the VersaJet?

[00:50:10] Dr. Sam Rhee: Yeah. Yeah. Yeah. Yeah. It's the, uh, instrument that has the, uh, high pressure water that's, that is leaked almost like a scalpel. You could use it as a scalpel.

[00:50:19] Dr. Edward Lee: It will basically plane the tissues using a high pressure water jet. Um, and so, it takes out the technical component of retracting on the tissue, creating traction and counter traction in order to use it nice. Or a scissor to cut through the tissue, right? You just kind of rub over it.

You press the button with your foot and rub over it. Um, but then there's a lot of bleeding, right? So then how do you stop the bleeding? Well, you have to like dry and pat and use your, use your bovi, which is more button, or you can use the Aquamantis, which is, uh, it's a, uh, radio frequency. Uh, irrigating bipolar. basically, instead of having to wipe away the blood, it just irrigates the blood away for you and the bipolar, it just runs between the tips. So you just run it over the tissues. So you versa jet it, and then you bipolar it. And look, lo and behold, it's all debrided and it's all cauterized. But so why do we not have more button surgery, right?

It, it gets rid of the technical aspect. of surgery. So like for instance, when you're, when you're watching or looking at robotic surgery, right? It's pretty, it's pretty amazing, uh, what they're doing with robotic surgery. Why is there not a button to push? Like when you have things kind of lined up, let's say for a microvascular anastomosis, right?

And they want to put a stitch. Why, why can we not line it up,

[00:51:51] Dr. Sam Rhee: the

[00:51:52] Dr. Edward Lee: point on the, on the screen, put a, put the needle here, put the needle here? And you push a button and it's a segmental portion of the operation that the robot then commits to on its own and goes, puts in a stitch, ties it.

[00:52:12] Dr. Sam Rhee: That makes sense. Like, if you could 3D image it, put the dots where you want the sutures, and then hit go, then it's like a sewing machine. It just, like, does the knots, and, you know, does the, like, the three stitches you want, or whatever number you want. Like, that sounds feasible to me. I don't know. Has that been invented yet?

[00:52:32] Dr. Edward Lee: I don't know. I haven't heard about it, but I'm sure it's coming. I mean, there's a bunch of robotic companies and those robots are not cheap. So, um, and the other thing is, you know, like looking at very task specific robots, right?

[00:52:46] Dr. Sam Rhee: Uh huh.

[00:52:47] Dr. Edward Lee: To me, the fact that we still suture skin in the same way that the ancient Egyptians did, it's a little bit crazy.

We have better materials.

[00:52:58] Dr. Sam Rhee: very crazy. I think about that every time I'm suturing, like, an abdominoplasty or something where there's, like, a million Inches of, of, uh, skin to sew. I'm like, yes, we gotta do something better for this.

[00:53:10] Dr. Edward Lee: Yeah. And we came up with the, with the stapler, right? The skin stapler. And then there's the subcutaneous stapler, the Inzorb. But honestly, it's, it's not that great. So even a task specific robot to do that. If you can set it up so that it does it nicely, it would be incredibly valuable, right? Then you take the art of plastic surgery in terms of skin closure, and you've now mechanized it to a robot so that it then democratizes it so that everybody can use it.

So your ER doc, when they have to sew up a laceration, they're like, Oh, bring over the robot. They numb it up, set it up for the robot, the robot goes ahead and closes it. They get a plastic surgery closure for the cost of the robot.

[00:53:56] Dr. Sam Rhee: you're, uh, technological, our, uh, specialty out of business, basically, that, that would be your goal in the future, which is a great goal, honestly. I, I would, I would love for plastic surgeons to take their intellect and ability and, and apply it to the next level of things to do, for sure. Mm-Hmm.

[00:54:14] Dr. Edward Lee: I think taking some of that technical, uh, I don't want to take the technical skill away from it, but being able to, uh, uh, what's it called, mechanize it, uh, I think is valuable. Like when you look at, so, so for instance, if you look at like thoracic surgery, right? Um, the Ravage It didn't decrease the amount of thoracic surgery being done.

If anything, it increased what everybody was doing and the complexity of what they were doing. Because now suddenly, well, this part where we were so worried about it leaking, so worried about leading, that's all, that's all passe. I no longer have Focus on how I'm doing that, how I'm doing that. We can focus on why and improve what else is going on with it.

The fact that we don't have anything great to improve scars still, right? Like we have, there's a lot of stuff on the market for scar care, but nothing is really proven to, to make it that much better instead of spending our time learning to suture, we could be learning about all of the different. Uh, growth factors and methods to try to improve that scar healing and wound healing.

[00:55:28] Dr. Sam Rhee: Good goals. I like that. Um, so you, you do train a lot of residents. You do work with a lot of medical students and other, um, um, people who are learning. What do you tell them when they look at you or they're like, you know what? I want to be like you someday, Dr. Lee. I want to do what you do. I want to Be in the situation that you're in.

What kind of advice do you give for, for your young students?

[00:55:58] Dr. Edward Lee: Um, you know, one of the things I tell them is that, uh, you know, oftentimes the students are coming in earlier and earlier, right? So they, they used to come in somewhere during third year, then second year, then first year, and now we even get a bunch of college students who are eager and excited about plastic surgery.

And, you know, my advice to them is to go, go after everything with 110 percent energy. Be passionate about what it is that you're doing. And so if your interest is plastic surgery, that's fantastic. Do it 110%, but always have an open mind because you may see something that suddenly captivates you. And you're then very passionate about that or excited about that.

And that's okay. You're young, you're, you're early on, or even when you're later in your career, if there's something that's, uh, that captivating, give it some time to percolate in the back of your mind, but if you want to go after that instead, do it. And it's not that you've wasted the time that you were excited about plastic surgery and going after it. Whatever you learn during that period is translatable, right? If it's a different field of medicine, the way that you learn to study, the way you learn to think about a problem, uh, and then try to answer that problem, those are all valuable skills. So, you know, that's, that's my advice to them usually. Um, you know, the applications process for residency really is, uh, is getting more and more challenging.

Uh, uh, with. It's, uh, it's like a, an arms race, right? Like the upper,

[00:57:40] Dr. Sam Rhee: much harder is it now than it was back in the day when we were applying? Really?

[00:57:44] Dr. Edward Lee: um, a lot harder, a lot harder. Um, you know, basically anytime you set, set a standard, right. Or a goal, and you have a number of high achieving, high energy individuals, will find ways to exceed that goal and keep building on it. And so you keep setting the bar higher and higher. Uh, but is it at the detriment of the, their development of other aspects of their life?

It's similar to, you know, if you're working so hard at. You know, your job and then you come out, comes home kind of burnt out with less to give to your family. Is that a good thing? I don't know. Um, you know, it's, I think there's a lot of people in education who are really like focusing on that question and trying to answer that question.

Uh, I think a lot of it comes down to who you are as a person and just trying to build up the person that you are, not necessarily the plastic surgeon that you are. Um, you know, it's, uh, a lot of, uh, uh, how do I, how do I put it? Just, um, I don't want to say your moral compass, it's more just like your, your baseline, um, your baseline sort of thoughts and, um, you know, how do you, how do you approach life?

[00:59:13] Dr. Sam Rhee: Mm,

[00:59:14] Dr. Edward Lee: So,

[00:59:15] Dr. Sam Rhee: That's true. Wow. Well, ed, you have done amazing things over the past. I don't know, was it 10, 15 years that you've been at Rutgers? You've, you've taken it to the next level. You've, you've put your stamp on it. It's been, uh, and I can see how much you've accomplished there. I, I see the residents coming out.

I see how successful you are and how the program has been. And I am, I am in awe because for you to, Um, to be able to do that, uh, shows a lot of skill sets, not just as a surgeon, as an administrator, as a team builder, as someone, as an educator, like, I think a lot of people would look at you, um, who have started or are starting in surgery and look at your life as a blueprint and be like, this is a pretty good way to achieve some amazing success.

So I really hope that anyone who listens to this or watches this. Sort of takes a look and listens to what you have done and said, and, you know, sort of take that advice and your experiences to heart. Cause that, I think it means a lot. I think, uh, there aren't that many people that can do that and it's, it's just super impressive.

[01:00:29] Dr. Edward Lee: well, thanks, Sam. I really appreciate you, uh, taking the time to talk with me and, uh, inviting me to, uh, be part of your show. It's, uh, I think it's phenomenal to see what you do, you know, I mean, the looking,

[01:00:43] Dr. Sam Rhee: Oh, you mean finding successful people and talking to them and see what they do? Like, yes.

[01:00:47] Dr. Edward Lee: it's, it's, it's, well, what does it do? What is it? It's humility. It's curiosity. It's those two things.

And, you know, the, and part of that humility is you taking on a new venture. Like we were joking about technology and difficulties with technology and, you know, your podcasting, when, when did you start five years ago, six years ago

[01:01:11] Dr. Sam Rhee: Yeah. Oh,

[01:01:16] Dr. Edward Lee: think is admirable. And, you know, the whole CrossFit journey, uh, I mean, honestly, I wish I looked like you.

I,

[01:01:28] Dr. Sam Rhee: thank you very

[01:01:29] Dr. Edward Lee: to a, I went to a CrossFit class probably what, four years ago. After my first class, uh, it was the, uh, it was what, uh, what is it, e mom? Uh, every minute on the minute, it was rowing, burpees, and then moving on to, like, uh, sit ups, and then pull ups, or thrusters, or something, and

[01:01:48] Dr. Sam Rhee: uh huh.

[01:01:50] Dr. Edward Lee: I got in my car to drive home, and I felt like I had had a stroke.

I pulled over after about a minute of driving And laid down in the back of my car and fell asleep for about half an hour.

[01:02:04] Dr. Sam Rhee: Uh, if you ever decide to try it again, I would be happy to do something that would be more appropriate. Like, uh, that, that would be a horrible workout for anyone. That sounds like they really put you through the wringer, there's no doubt, so.

[01:02:19] Dr. Edward Lee: But it was fun. It was fun. But, and I really should get back to it, but my goodness,

[01:02:25] Dr. Sam Rhee: Well, I understand. Thank you so much, Ed. And, uh, I hope to see you soon. And, I really appreciate you taking the time today.

[01:02:34] Dr. Edward Lee: All right. Take care of them.