Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives, and thought leaders.
This podcast is made possible by Pacific companies, your trusted advisor and physician recruitment.
[00:00:20] Speaker B: Welcome to the Doc Lounge podcast, where we explore the latest in medical innovations and the stories of those who make it happen. I'm your host, Stacey Doyle, senior director of marketing at Pacific Companies. Today we have a very special guest, Doctor Jeffrey Beecher, a distinguished cerebrovascular and endovascular neurosurgeon. Doctor Beecher is not just a neurosurgeon, he's a pioneer in his field, uniquely trained to tackle both diseases and brain tumors. His expertise has significantly elevated patient care in the Wilmington region, making a profound impact on outcomes for those suffering from both strokes and brain conditions. Today, we'll discuss the cutting edge treatments for stroke, a leading cause of disability worldwide, and the multidisciplinary approaches that are shaping the future of neurosurgery. We're also going to hear some powerful success stories directly from Doctor Beecher's extensive experience.
[00:01:15] Speaker C: I want to welcome Doctor Beecher to the show. We're really excited to have you. Thank you so much for being on today.
[00:01:22] Speaker D: My pleasure. Thank you for having me. Glad to be here.
[00:01:25] Speaker C: And before we kick it off, we'd love to just hear a little bit about your background and what got you started and interested in becoming a neurosurgeon.
[00:01:35] Speaker D: Sure. So I wanted to be a doctor because like all little brothers, you want to do what your older brother wanted to do. And so he wanted to be a doctor. So did I. But I left for college thinking I was going to be a psychiatrist. And while I was in my undergraduate studies, there was a class called advanced biopsychology, where I very quickly learned that it's not the psychology component or the chemistry component exactly of the brain and the behavioral component that was so interesting and exciting to me, but rather the anatomic aspect of the brain, the interconnections of the brain, the real known functions of the brain, and then the pathologies also of the brain and how we can do things to fix them structurally. And my dad remembers a story very well where he came to visit me during, like, father's weekend, and there was a goat brain in my refrigerator because we were studying it and there was like pins in it for all the different anatomical sites. And he was like, oh, that's the moment I knew my son was going to be a brain surgeon. So that's when I kind of switched into wanting to be a neurosurgeon. And so I think, unlike most neurosurgeons, I went to medical school to be a neurosurgeon. That's what I knew I wanted to do. And then after that, I was doing my residency in Long island at North Shore back then. Now it's called Northwell University Hospital system. And there I very quickly realized that the cerebrovascular pathology is, to me, the most interesting pathology in neurosurgery. Brain aneurysms, brain avms, fistulas, carotid artery disease, and then later stroke, during my training, became part of that as well. I really lived. My training was really, you know, during all the stroke trials that were coming out and the rapid change to how stroke became not only a disease we began to treat with thrombolytics, but eventually into some of the things we're going to discuss today.
Anyways, I found out that cerebrovascular is the coolest stuff and most complex stuff, and that is what then drove me to do both my fellowships.
[00:04:06] Speaker C: Well, that is a great segue. I mean, we're really interested in always learning about trailblazers and trailblazers techniques here at the Doc Lounge podcast. Tell us what made you pursue both of them at the same time.
[00:04:21] Speaker D: Yeah. So often, especially nowadays, as a lot of the cerebrovascular pathology is moving towards being treated with minimally invasive techniques, which is the endovascular side of the cerebrovascular space.
So the open microsurgical side, where we actually go in and do a craniotomy, remove bone, manipulate the brain so we can get to the blood vessels, that part is somewhat contracting because if you could do something through somebody's wrist or their femoral artery and they go home the next day, obviously there's a lot of attraction to that, not only for the patients, but also just outcomes are often significantly better with that kind of technology.
The cerebrovascular open training really had to be paired with other complex pathology. So by the nature of the pathology and neurosurgery, complex brain tumors of the skull base just pair very nicely with the cerebrovasculature because the approaches can be often very similar.
And so there's been fellowships in cerebrovascular and skull based neurosurgery for decades. Endovascular really has picked up. I mean, it was probably kind of given birth in terms of a neurosurgical fellowship in the nineties and early two thousands.
Now it's just massive, and everybody or a lot of people are very interested in pursuing that.
And, you know, I had mentors that kind of already, you know, kind of showed me the way, if you will, and then also helped me pave my way. You know, I always give a lot of credit to Dave Langer. You certainly put me in touch with the team at UT Southwestern in Dallas, where I did my open supervascular training and skull based training, as well as the Buffalo team for my endovascular training. So. And a lot to him.
[00:06:31] Speaker C: Well, I feel like you always need a great mentor, and that's something. Yeah, we've always, here on the doc Lounge podcast is just about having that someone that's guiding you and kind of showing you what they think is kind of the next latest and greatest within the field. Now, tell me, what are some of the latest innovations and kind of stroke treatments that you are incorporating in your practice, and how is this kind of moved or advanced from maybe more of the traditional approaches? You were talking about some of them just before this.
[00:07:06] Speaker D: Yeah. So mechanical thrombectomy is the interventional side of stroke, meaning there's a procedure being done rather than just kind of putting a medication, which is what we call thrombolytics, TPA or TNK. Those are the medications we give to try and do break up the clot or the clot busting medication. And that treats stroke about 30% of the time. Well, and that's maybe on the high end, I'd say. And then all the trials came out demonstrating that we can do this procedure, mechanical thrombectomy, and actually have an intervention with the procedure going through the artery up to the brain with wires and catheters, and we can remove the clot with various different techniques that we have. We can either, you know, suction the clot out with aspiration. We can deploy basically a stent on a wire called a stent treever across the clot and pull it into the aspiration catheter. Or we can even give thrombolytics directly to the blood vessel that's blocked there if that's what we feel is needed. And we can deploy stents that stay. We do all sorts of different things, and that's the technology that's just growing and growing and growing.
There's certain studies already being performed trying to even investigate how can we use our aspiration systems to more scientifically remove the clot from the blood vessel to have a higher rate of success on the first pass. Because everybody always, you know, preaches the mantra, time is brain time is brain. Time is brain. You see it everywhere, right? And it's totally true. Every single trial is ever shown. The faster you get to somebody, the faster you can treat them, the better they're going to do. So if we can get the clot out the first time, those patients are going to do better. So it's obviously something we're always striving to do and trying to find better techniques to do it. A lot of endovascular procedures have traditionally been done transfemorally.
Something that I personally champion and find myself kind of an expert and leader in is radial approaches, not just for endovascular in general, but for strokes specifically. So that means instead of going through the groin artery, I go through the wrist artery, where you feel your pulse. The radial artery is where you typically feel your pulse if you're going for a run or something. And through that small artery, I can do the same thing, go all the way up to the brain and take the clot out. And in my opinion, it has a better safety profile. You can't bleed out in your wrist because there's not enough space, but in your thigh, you can bleed and a leader into your thigh before somebody maybe even knows it, or you can get a pseudoaneurysm. You can get injury to that artery a lot easier. And if you injure the femoral artery, you're talking about somebody's leg or foot at that point. There's certainly complications with that. And sometimes you got to use some pretty big devices through these arteries. And so with a closure, devices can lead to complications as well. When you're done, you got to seal up that artery in a safe way. For the wrist, you just put a bandage that's like, almost like a watch over it, and it just holds pressure, and it's very safe and effective. And knock on wood, I have, like, no radial complications. I know they exist, and, you know, someone could be critical of me, saying, I have very, very few radial complications, but it just simply is the truth. If you pick your patients appropriately, you can keep those complications real low and with the same efficacy in terms of getting the clot out very quickly. I mean, at this point, my colleague and I, who splits, call with me. We have kind of a competitive little fun, you know, competition between the two of us about who can get the clots out faster. And he told me today that he thinks he did one over the weekend in two minutes. And I'm going to have to check with the staff, gonna have to see if that's accurate. But it was in the basilar artery, which is a real easy artery to get to through the wrist. So I think he might be right. But we really try, and at this point, we're striving to stay under five minutes for our procedures. And, you know, that's. That's exceptionally fast. I used to think I was fast when I was at ten to 15 minutes. And, I mean, we're just shaving off time left and right, and the patients get to reap the benefits of it, so it's pretty cool.
[00:11:40] Speaker C: Time is the brain. Okay, I'm going to remember that. I love that saying. And it sounds like you and your team are really doing an amazing job. Well, tell me, tell me about a success story that you've had with this new approach.
[00:11:53] Speaker D: Yeah. So we have a patient that always comes to mind, because he's.
I want to say he's either 32 or 34 years old, and, you know, just somebody who was not really taking good care of themselves. Smoked cigarettes, didn't really do anything for his health in terms of exercise. He was obese. He already was having heart problems, which undoubtedly is why he probably had his stroke. He had an ejection fraction of about 25%, meaning, like, very low ejection fraction, giving the ability for blood to pool in the heart. And then when it breaks off, it goes to the brain, because the great vessels are just right there. And that's certainly what happened to him. And he was at one of our outside hospitals, so not at our hospital. But one of the great things about stroke is it has really led to just amazing breakthroughs in medical technology in all sorts of ways. So there's certain applications that you can have right on your phone. In fact, you saw me using mine right before we started this, where images from all my surrounding hospitals go directly to my phone, like, the moment they are done. So it cuts out so much time waiting for a radiologist to review the images, to diagnose the occlusion of the blood vessel in the brain, and then to have them tell the ER, and then the ER to call their stroke process, and then to finally get ahold of me at some other hospital, right? So the images go straight to my phone, and I just go, there's a middle cerebral artery that's blocked. And this young gentleman was unable to speak, so that's what we call aphasia. And that was his only deficit. His motor function was fine, but he was completely mute. He could not speak. It wasn't expressive at all. It was not just a solitary aphasia. It was a complete aphasia and saw the occlusion totally fit his clinical scenario that they described to me on the app. And I said, send him over. So they get the helicopter. This is like 02:00 in the morning type thing.
I come in, I actually have a picture of me driving up the hospital, you know, roadway with the helicopter landing. You can see it landing through because I have a jeep top off. So you can see it's a pretty cool picture. And they're landing right when I'm pulling up, my team comes crashing in because I call them my. My little ninjas, because they. I swear, if a stroke's happening in our hospital, they pop out of the walls, drop from the ceiling. Team's amazing. And everyone rallies to get the patient to the IR suite, go through his wrist, first pass, get the clot out right on the table. He starts saying complete full sentences, talking to us, saying how horrible it was to not be able to talk and gets emotional and starts crying and just saying thank you to us. And so the team at the other hospital did all the work to find it. So through that same application, I'm able to send images from our angiographic suite saying, hey, look, here was the blockage. Here is the blockage now gone and open blood vessel. And here's a picture of your patient saying thank you, and giving a thumbs up and just wanted to say thank you back to you guys. We're doing such a great job getting them to us, and that was really cool. So, obviously, he had a great outcome, but we did a follow up with him not terribly long ago, and he's changed his life around. I mean, amazing. Like, it's really profound. I mean, he's way more slender than he was. I think he lost around 80 pounds. His ejection fraction is near normal. He doesn't smoke. He doesn't drink. I mean, he lives for his kids now. I mean, it's really, really cool, actually. I think it's on our YouTube channel. It's a pretty long interview, but it's pretty cool.
And that one just sticks with all of us because he went from not talking to just full, full sentences right in front of our eyes.
[00:16:15] Speaker C: Wow. That is incredible. I mean, that is. I mean, I guess this was what makes, you know, what you do.
[00:16:21] Speaker B: So fulfilling.
[00:16:22] Speaker C: And I can only imagine how happy that patient is. So love that story. We'll definitely check it out on your YouTube. Thank you for. Thank you for sharing that. Tell me, so, how important, really, is patient and family education in, I would say, stroke prevention and recovery. Tell us a little bit more on the education front. I'm sure you're an advocate for that, so I'd love to learn more from you.
[00:16:49] Speaker D: Yeah, absolutely. So there's another mnemonic or slogan in stroke that used to just be fast, and now it's be fast for balance. Eyes, face, arm, speech time, because, again, time is braindead. And those are the signs that you can familiarize yourself with so that you can identify as stroke. Because just the same thing with the same case we were just talking about, his wife was the one who was like, you're having a stroke. We're going to the hospital. And had she not done that, I mean, people always, even he would be like, you saved my life. I'm like, well, I think your wife saved your life because. Because she's the one who got you there and identify it. Because too many times somebody goes and sleeps it off or, you know, somebody's not there to find the patient or whatever it may be. And because too much time passes, there's less that we're able to do. And that still happens. Less and less, but it still happens. So, yeah. Education on how to spot a stroke is, you know, critical to the general population.
We do a lot to try and get that message out. We have a stroke coordinator and a stroke research coordinator, and they do not only like a follow ups for our stroke patients to see how they're progressing, but they do organize a ton of education, not only for the surrounding hospital systems, but also for the public. And I personally and my team, we all try and do different little events to try and get that information out, but it is really challenging. You'd be surprised how challenging that is. So appreciate you having us on here to do this, because this is obviously a fight against that battle.
But I think I try and go to different religious events, churches, synagogues, et cetera. Certainly, stroke is a disease of the elderly more than the young, even though our example was of the young patient.
And so we try and go to different retirement communities and kind of just get the word out about that or to them and make sure they're as knowledgeable as they can be so that they can help each other and identify their loved one if they're having a stroke. So we're always doing that. And there's organizations like the Brain Aneurysm foundation, obviously, the AHA. And the work they do on stroke, and they're always trying to get information out, too. And certainly anytime, like a famous person has a cerebrovascular event, like, I think everybody knows about Doctor Dre and Amelia Clark, and, you know, oh, man, my dad would be really mad. Neil Young. There we go. Neil Young.
Because they all had brain aneurysms, and that's a different type of stroke. But still, it brings stroke and cerebrovascular disease to the forefront of conversation for about a day. And so at least there's something, and we're trying. And then for recovery, that is an area that there is a lot of interest in, in a lot of companies. You know, the Penumbra company is a company that made a lot of the initial stroke devices and catheters that we use, and they do a great job of still pushing that part of the aspect of stroke. But they, amongst others, are also now looking at the rehabilitation side. And what can we do now for the patients after a stroke? Is there more we can do to improve that rehabilitation so that they can have a better quality and a better outcome after they've already had this successful procedure? You know, we use different scales to assess somebody's functional return to society, and so we want to improve that number and get them as close to normal as possible. And recently, there's also been advances in the use of different implantable devices. There's something called a vagal nerve stimulator. And so people who have, like a, like, specifically an upper extremity weakness after stroke, but they have to have some function, can be potentially a candidate after six months. So it's considered chronic for a vagal nerve stimulator to be implanted. And there is significant data to demonstrate that that can lead to improved function faster and also, like, a better sealing than without. So the patient can get not only faster, but also more gain from their therapy that they have.
[00:21:44] Speaker C: Love it.
I want to switch gears a little bit into the prevention side. Tell us, what would you recommend? I mean, when you're speaking with your patients or friends and family, what is kind of the biggest thing people can do in terms of preventing a stroke?
[00:22:02] Speaker D: Yeah, it's a great question. I think one thing that is, like, super obvious, and I had a discussion with a patient of mine today about this, not necessarily about stroke, just about in his general self care. I think it's pretty obvious. But don't smoke.
Like, it's amazing how awful cigarettes really are and how they just really, truly trash blood vessels and the human body. I mean, it's. I think it's probably obvious by now, but we will have patients who have different types of cerebrovascular disease. Maybe it is a stroke in the past, and maybe it's a brain injury, whatever it is, but they're still smoking. And we'll talk about these patients in our conferences about, like, hey, what would you guys do? Or so on and so forth. And it's really hard to want to invest time, energy, effort, and risk of your, you know, of something bad happening and what that does to you emotionally in a patient when they can't quit smoking to help you help them. So, like, that is imperative. Like, they need to quit smoking.
Beyond that, I would say I think some other very kind of straightforward things.
Having a healthy diet, trying to make sure we're exercising, and maintaining an active lifestyle.
I think also, really, the whole not sleep it off or take things very seriously when they happen is important. I'll give another little anecdote, which one is rather personal, I guess.
My wife last may had an episode where she couldn't speak clearly, and her left arm started floating away while we were having people over at our pool. And she had just lifted our youngest child out of the pool, thank goodness. And then it happened, and she thought, you know, oh, I just. I don't know. Just couldn't speak for a second. And then she tried to speak again, and it still came out very garbled.
And then she snapped out of it. Okay, if it wasn't my wife, and, you know, she's a nurse practitioner. She's known me, obviously, for, like, last 13 years.
She might have been somebody who just said, oh, that was weird.
I'll see if it ever happens again. And then that just did the end of it. Okay. But she came to me. I examined her. She's totally fine.
Of course, now being in medical, we're like, oh, man, let's make sure nothing crazy is going on, like a brain tumor. So we got her an MRI very promptly. That was negative, fortunately. But I was like, okay. I mean, from the moment she described it, I go, that's a tia. That's a transient ischemic attack. You probably had something happen, who knows what. That went up to the brain for a moment, and then it passed.
We need to make sure you don't have something called a patent frame in a valley. So a pFo. And sure enough, she gets her echo bubble study, and she gets a tee, and she's got a PFO. And now she starts doing a deep dive on the literature, because the literature is a little mixed on whether you have a PFO closed or not. We talked to our primary care doctor. We talked to my cardiology colleagues. Ultimately, because shes 37, I guess at the time. Shes 36 because shes young. It makes very good sense because shes got such a long time to live to have it closed. Ultimately, she did have it closed. It went great. Shes offered dual anti platelets already and just on aspirin, but if it wasn't who we are and who she is, that type of thing probably just goes unnoticed all the time. And then somebody has a PFO and they're at risk for having a stroke. I don't know if you want me to just keep telling you anecdotes, but I had a 42 year old in training that I'll never forget as well. She had a pFo, and instead of having a tiny tia, she had a massive basilar occlusion, meaning that she had a clot that must have gone from her leg through the hole in her heart all the way up to her brain and occluded like the brain's widowmaker, if you will. So the lad of the heart is called the widowmaker. Our widowmaker is the basilar artery.
85% to 90% people before all the stuff we got now, who had a basilar apex occlusion died, and obviously that number is significantly better. Anyway, she came to us, one of the highest stroke scales I've ever seen. She was basically just comatose and she was breathing on her own, which is amazing. And we whisked her up to the IR lab and all I remember is the husband going, right before I go up, he goes, she has two children. And I'm like, that's. Thanks, thanks. That's what I needed right now, is a little bit more pressure. Thank you.
So we take her up, obviously, she does tremendously well. Get the clot out. She's, I mean, perfect recovery. No deficits whatsoever. And she had a pFo. So a PFO is not always going to be causing a small stroke. It absolutely can cause a big stroke as well, or a very serious stroke, I should say. So.
Not just writing things off as it'll be okay, is a. Is, I think, the most important message that I always try and express to people so that you get evaluated to make sure things are okay.
[00:27:50] Speaker C: Great advice. No, thank you. I think not enough people know about that, you know, and just like you're saying, they would just write it off and then, you know, not get the subsequent, you know, treatment or see the follow up care that they need. So appreciate you sharing both of those stories, and I hope that, you know, anyone listening, listening can take that home and kind of share that with their friends and family as well. I think the more awareness and more education we get out about strokes and what they can do and kind of the signs are really important.
Tell me, I would love to learn from you where you think the future of stroke treatment is headed and are there anything that you're really excited about?
[00:28:36] Speaker D: I'll be brief about one of those and the other one I'll go into. I'm currently interested and excited to see if we can make a device that I think will streamline things very nicely and maybe make us even faster and maybe it'll make. Maybe it could kind of even the playing field a little bit and make everybody kind of equally fast.
Yeah, there's definitely a lot going on in terms of advancements for stroke.
I think that the catheters and the devices we have are just rapidly improving. I think one area that I think everybody knows is currently lacking. And I think at some point a company is going to figure out that we need to design catheters specifically for radial access to navigate challenging anatomy in the arch, because you have to come up through the arm and then you go down through the subclavian artery, and then you go into the aortic arch. If you're going to go to the left side to go to the right, you don't have to, which is nice, but to go to the left, you often do, unless the patient has what's called a bovine arch, which is a little abnormal or not abnormal, excuse me, just a normal variant, which makes the access a little easier. Anyways, if we have catheters that were specifically designed for access here and supportive in a certain way, it would probably widen the amount of people using radial access to do stroke. And I think that would make people a little bit safer, potentially a lot, you know, a lot faster. And in terms of devices, you know, there's always the different companies looking for, whether it's techniques or with the devices or devices themselves, to help us more regularly get the clot or the thrombus out of the blood vessel. And they have, I mean, it's pretty awesome already. Like, I mean, we're obviously pretty good at what it is, but we always do want to try and get better. So not only are we trying to make the devices more successful on the first pass, but they're also trying to figure out if we can administer maybe a medication or do something in the field with the patient to delay the onset of injury to the brain from the stroke to bias time.
It's almost trying to treat stroke from the other direction. Instead of trying to get to them faster, which we are always trying to do, we're trying to delay the injury that the patient's suffering from the stroke so that it gives us more time to do what we have to do. I mean, if we got to the point where we have an injectable to where if you think somebody's having a stroke in the field, you can provide them that. And hopefully, obviously, this should have a very low side effect profile so that if they're not having a stroke, you know, you're not causing any harm, but hopefully you're doing something that's neuroprotective. And so there's a lot of interest in neuroprotective agents right now to see if maybe there's a way that we can provide a larger window. Everyone always talks about windows. Are you in the window for lytics? Are you in the window for intervention or extended intervention? So trying to make that window as broad as possible is certainly a goal of all of ours.
[00:32:31] Speaker C: I hope that all of the medical device companies and pharmaceutical companies are listening right now, because that sounds. Yeah, I mean, that sounds very smart and something that could do so much good. And like you're saying, buy you time. Time is brain. So thank you. Love that. Now tell me, obviously, you're very inspirational, and it's really inspiring to hear all your work and all the lives that you're helping save and all the impact that you're making to people and their families. What is kind of your personal motivation throughout your career? What has been driving you to improve stroke care?
[00:33:10] Speaker D: Ooh, inspiration.
Stacey, that's a tough one.
I guess I would say it may.
[00:33:26] Speaker C: Just be your passion about what you're doing.
[00:33:28] Speaker D: I just love what I do. I do. I mean, I'll tell you, one of my colleagues, that's our stroke neurologist here, said he's never seen a neurosurgeon who loves being a neurosurgeon as much as me. And I just love what I do. I mean, I hope that it's true in the way I behave and the way I interact with patients.
I really enjoy taking care of patients and helping people, especially when they're in such a time of crisis and need.
It's what I think really did make it solidified my attraction to neurosurgery when I was going through medical school.
And I don't mean to speak ill of any other subspecialty, but I just distinctly remember going through different rotations, and I guess I just need instant gratification I need to know that I've done something. I needed to see that I had directly impacted somebody's life and made it better. And so, I mean, that's what I guess motivates me and makes and drives me, makes me show up every day, is I just, I love what I do. I love how we get to take care of people and how we get to do it in really cool ways. You know, this is going to deviate a little bit from stroke care, but in the or on the microsurgical side of things. So for brain aneurysm clippings and brain avms and complex brain tumors, I use what's called a 3d exoscope. And so instead of, like, a traditional microscope, wherever you're looking through binoculars and you got these arm or handles that you kind of drive it with and whatnot, that's something we've been doing since, like, the 1970s, I want to say. And the technology for the scope has improved dramatically. But I sit there in a very relaxed, upright position.
I have 3d glasses on, and there's a camera head that I control with my foot pedal that rotates wherever I want it to go. I have complete, you know, six degrees of freedom, and it goes wherever I want it to go with the control of my foot while I sit there very comfortably and calmly, you know, operating. And there's a screen that I see, and then there's multiple screens for everyone else in the or to see. And it's just, like a very relaxing and pleasant experience for me. I don't. I don't because I don't have to, like, lean over the scope and, like, do different things. I'm not sore when I'm done operating like I used to be when I use the scopes. And it's just like, it's like a place of Zen, almost.
And, you know, when you. When you operate and when you go through all the training that we go through, surgery has become a dance. I mean, it's a dance with your scrub and your assistant and, and obviously the patient and their anatomy, and. And you just kind of go through the motions of that, and it just happens very naturally. And being in there, I mean, that's what I love to do. And so I am excited to show up for work because what we do is really cool, and I feel like I do it in a really, really cool way.
[00:36:42] Speaker C: Well, that is inspirational. And to hear that you feel Zen in the or, I mean, wow, that's amazing. I think that, obviously, your passion for this specialty makes so much sense. It sounds like you're the perfect person for it. And on that note, I'd love for you to give any advice to aspiring neurosurgeons about. Obviously, this is a high pressure specialty and field, but tell me, what advice would you give to somebody that is thinking about getting into neurosurgery?
[00:37:16] Speaker D: I'm laughing because not too long ago, put a YouTube video out on that exact topic. And so I can tell you five things.
Let's see if I remember them all.
Yeah. So, number one, you have to be very patient centric. My chairman, when I was a fellow in Dallas, was hunt major, and he said something that's always stuck with me, and it's something I learned in residency, too.
But the way he just articulated it to the incoming interns in residents and the medical students that were interviewing at the time just really resonated with me. And that is, you have to be so patient centric that the patient comes before everything else that's before yourself, that's before your family, before anything else in your life, because there will absolutely be moments where you were hoping to do x, y, or z, but your patient, whether you're on call or it's your patient, that you already did something and something's not going right. Whatever it is, you will have to stop doing whatever it is that you really thought you really wanted to do and were excited to do, and you are going to have to go do something for that patient. And you can't even flinch.
It can't even be like a thought. You have to be already in the mindset that you're just going to take care of your patient and immediately. Right. So, like, that's one difference between neurosurgery and some other areas of medicine. It is like, that level of acuity and that level of seriousness is. And there's no shift work, right. Or at least that's not how we do it.
You are there, and if your patient needs you, then you're there.
So first of all, patients first and before all else. So that's number one. Number two, I don't know if I'm gonna remember all five. Number two, if you do something, you need to be somebody who does it right the first time. Right.
You really need to have that characteristic. You have to be able to have that self insight, too. Like, to be able to identify that, you know, do I tend to really do it to that perfect level, or is it going to be, do I often find myself being like, I think I'll be okay getting away with this and then rarely maybe, or maybe more than rarely having to go back and do something else. If that's kind of something you, a pattern you find yourself falling into, then neurosurgery might not be the right thing. You have to do it right, and you have to do it right the first time because you could be in your 8th hour of surgery on the same patient, 10th hour of surgery, 12th hour of surgery. And you can't cut a corner. Like, you can't be like, oh, I've been doing this for 12 hours. I'm just gonna, blah, blah, blah, blah, blah. No, you have to grin and bear it and persevere and have that discipline to stay and see it through. So you really have to be able to do it right and do it right the first time.
Yeah, I'm definitely not gonna remember.
[00:40:43] Speaker C: Lucky three.
[00:40:44] Speaker D: Yeah. Let's see if I can get get three. And then only people in suspense for what they can go to the YouTube video and see which ones I forgot and maybe they won't be as important.
Okay.
What else would I say? You have to be a neurosurgeon.
Oh, this one's a little bit sillier.
You better not be somebody who needs a lot of sleep. Okay. Like, you have to be able to perform at that level that you perform at kind of all the time because you might get called in at 02:00 a.m. to do a really complex case. You know, it could be the most complex stroke case you've done all month. You don't get to pick when that comes in, it's going to pick it for you. And so you really need to be able to, like, snap out of it and be there and be on your a game pretty quickly and immediately. So if you're somebody who really needs all that beauty sleep, neurosurgery might not be the appropriate field.
And, you know, I'll say, I just remembered one more. One last thing. So I guess I'll get probably four of them out of the five. You have to be able to, despite any stigmas that neurosurgeons might have developed over the years, you have to be able to remain cool, calm, and collected even in very stressful situations. And I think this even applies outside of the or nowadays. But, like, if you're treating a brain aneurysm and the aneurysm ruptures, it is absolutely something. We are trained from the beginning of training throughout fellowships, and I practice if that situation arises. Still to this day, you just calmly ask for a larger suction you tell anesthesia, anesthesia, the aneurysm has ruptured. I'm going to work on getting control over it. You might need to augment blood pressure. You might need to get blood into the room or hang blood. You might need to do x, y, or z, and you do it in that very controlled, almost even monotone way.
You are the captain of that ship, and if you demonstrate a loss of control or panic, then that is going to resonate to your team and everybody there. And that is when things can spiral and be unsafe. So this is not something unique to Jeff Beecher. This is something we train residents all the time to be able to do. But like I said, I think it extends outside of the OR in 2024 and the years and going into the future.
There used to be, obviously, stories about these neurosurgeons who just like scream and yell and, you know, berate maybe a hospital administrator or another doctor. Totally inappropriate nowadays. I mean, not that it was appropriate then, even, but certainly not allowed to. And so you better be able to hold it together and control your emotions and speak very appropriately to another individual who's just there trying to either help you do what you need to do, or take care of the same patient as you. Maybe they didn't understand something you understood, but you got to be able to control that. So to be successful as a neurosurgeon, you need to be able to have that skill set in the OR and out of the OR. Because I assure you, also as a neurosurgeon, you kind of have a target on your back because everyone wants to see you not do something right.
[00:44:37] Speaker C: So you gotta be cool, calm and collected at all times is what I'm hearing.
[00:44:42] Speaker D: That's right. That's right.
[00:44:44] Speaker C: I love it. I love it. Well, it sounds like, you know, leadership qualities obviously are very important in addition to just, you know, having a passion like you do, which came through today. So I really, really appreciate you sharing and also just your time with us today.
[00:45:04] Speaker B: Doctor Beecher, let us know, is there.
[00:45:05] Speaker C: Any way, if somebody wants to connect and learn more, tell us more about your YouTube channel and we'll share that with our audience as well.
[00:45:12] Speaker D: Sure. Yeah, it's just Doctor Jeff Beecher. I think we came up with the kind of title after that is the Stroke doc, because it initially started with just some stroke videos, but then my ninjas, my IR team really kind of got into it. And so now we also have an Instagram called urovascular on the coast, and they do a great job of really putting out content just about education, about stroke cases. We've done our Elvo tracker, just demonstrating, you know, what kind of times we're doing for the last month, because our team posts that down our hallway every month just to let the team know how awesome of a job they're doing. And, yeah, so I would definitely say follow at neurovascular on the coast, the YouTube videos are a mixture of stroke cerebrovascular. There's some spine on there as well. I also do spine surgery, and there's some really cool videos on there that got some more attention than I would have anticipated based on the topics.
Anyway, I think it's pretty good.
[00:46:32] Speaker C: Exciting. Well, I'm sure our audience will love to connect and learn from you on both of those channels. So again, thank you so much for your time, and we are so honored you were on our podcast today.
[00:46:46] Speaker D: Oh, my pleasure. Thank you very much for having me.
[00:46:49] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure to hit that subscribe button. And a big thank you to Pacific companies. Without you guys, this podcast would not be possible. If you would like to be a guest, please go to www.pacificcompanies.com.
[00:47:06] Speaker B: Thank you.
