Ep.20-92Report

SPEAKERS

Will Bachman, Kimberly Moore Dalal

Will Bachman  00:01

Hello, and welcome to the 90 T report conversations with members of the Harvard and Radcliffe class of 1992. I’m your host will Bachman and I’m here today with Kimberly DeLong, who some of you may remember as Kimberly Moore, may name. And Kimberly, welcome to the show.

Kimberly Moore Dalal 00:20

Thank you so much for having me. Well, so excited.

Will Bachman  00:24

Thank you. So Kimberly, tell me a bit about your journey since Cambridge.

Kimberly Moore Dalal 00:32

So after we graduated from college, I was commissioned as a Second Lieutenant in the United States Air Force, I was the only Air Force ROTC graduate in our class. And most people who are com Kimberly Moore Dalal missioned, go right into the military to serve their active duty service. But I had left the Air Force no or asked permission to train in medicine. So they were very gracious enough to say, Okay, why don’t you go become a doctor, and when you’re finished, then you will return and serve your four years at that time.

Will Bachman  01:14

Now, some people, some people would have the military pay for med school, but then they owe some like infinite number of years, seven or eight, nine years, whatever. So you, you paid for med school out of your own pocket, and then you just owed them the four years from the undergrad thing?

Kimberly Moore Dalal 01:29

Yes, I did win a scholarship. But when I interviewed at Johns Hopkins, which is where I ended up matriculating to financial aid lady actually counseled me against taking more scholarship, because that would incur additional time of debt. And she said, You don’t know what your life is going to be like in a few years, and who else will be in your life and you probably want to be as flexible as possible. So she said, we have a good financial aid aid package, and everybody takes loan, so don’t worry about that. And so I chose to decline the scholarship for medical school. So yes, I only had a four year active duty service commitment when I finished all of my training. So after 14 years of deferment, so that was a medical school for four years. They allowed me to do a year of basic science research at the NIH that I had to plead for, because the Air Force kind of projects, when are they going to have these doctors coming in to service and so while they had predicted me at a certain date, every time I asked for additional time, I guess I had to be moved to a different spreadsheet. But then I decided to pursue residency training in general surgery in an academic program. So that was seven more years. And then surgical oncology fellowship was, which was two additional years. So that took me to 14 years. And then it was time to enter the United States Air Force. And so I was stationed at Travis Air Force Base, which is in Northern California. There are three hospitals or training centers that had surgical oncologists and Travis was one of them. So I was there for four years. And during that time, I was deployed to Afghanistan in 2007, where I spent four months there. That was really a transformative experience for me, I, even though I had applied for an ROTC scholarship, when I was a senior in high school, in 1987, I honestly never thought I would be going to war. At the time, I had my first son who was 10 months old. And so I was deployed and missed his first birthday, which again, I never thought would happen. And I was in anticipation of leaving, I was quite sad. Often crying, and I actually saw somebody before I left, because my father in law thought, well, maybe you’re really depressed you need to talk to somebody. And so as I sat on that psychiatrist couch, and then just kind of spoke as long as she would listen, she said, there’s nothing wrong with you. You are perfectly normal. And, but if you need to see me when you come back for more, I’m happy to see you Again, but so I spent four months there, as a general surgeon, trauma surgeon, and then I also performed cancer surgery in a humanitarian effort. And I was able to actually perform surgery on a 10 month old baby boy. So a boy in my son’s age, who had an abdominal tumor, the size of a soccer ball, and he hadn’t been able to really walk, eat, he had a feeding tube in his nose to obtain nutrition, tired all the time, not playing, not smiling. And I was told about this patient when I arrived. And I said, I’m not a pediatric surgeon. I’m an adult cancer surgeon. So, I don’t know if I can do this. And they said, well, it’s up to you. But it’s yours it’s no one. So, I reached out to my mentors from Memorial Sloan Kettering, and Hopkins, and they, I was able to actually send CT scans, photos, and they said, Okay, this is a tumor that’s pushing, it’s not growing into other structures. So just remember, keep the baby warm, and everything in a baby’s smaller than what you’re used to. And then you should definitely try it. So I assembled my trauma team with another trauma surgeon, my anesthesiologist who wanted to take on this pediatric case, and we were able to perform that. And it it really was probably the most memorable, professional experience of my life. This tumor ended up being a benign pediatric tumor, we actually had it analyzed at an Air Force Base in Germany. And this, this boy now lives, he’s he’s 15. And he lives in Houston. His father was a, an interpreter for the United States. And he was able to seek asylum, probably about, oh, gosh, maybe it was like six years ago. So he was able to come over to United States with his entire family, because I think he was at risk for personal safety. So, I’m actually in touch with them over Facebook. And it’s just remarkable what I was able to do for that patient and that family, I would also say that my time over there in a warzone, which is, I mean, it was just so different from anything I had ever seen or experienced here. We take so much for granted, at least I did that over there, you know, just freedom of education, and free speech and clean air. Maybe air was so dusty and dirty, clean water, green trees, these are basic things we take for granted. And it wasn’t until I came back home. And I was driving down the street that I used to drive every day. And I looked up into the sky, and I saw this huge American flag waving in the bright blue sky with clean air. And I said, Oh, my goodness, like, Thank God, I am so blessed to be an American and to live in the United States and to have all have the freedoms that, you know, I’ve had to pursue my educational dreams. And I think ever since then, as I live my life, and I have my children. I’m just very, very grateful for everything that I have. So that was that was my sort of my military experience. And then

Will Bachman  09:20

I want to ask you about that a little bit more what you’ve probably saved many, many lives as an oncology surgeon. What made that particular surgery so memorable and powerful for you professionally?

Kimberly Moore Dalal 09:40

Well, in the United States and adults, a surgeon probably would not be performing a pediatric or baby operation. And so for people in the military, often we are asked are called to do things that we would never do as a civilian. And it’s not that we’re doing things that are unsafe, it’s just, you know, it’s, it’s, it’s up to you, if you want to take on that responsibility. And, you know, I was very fortunate I had mentorship, I had support there, it wasn’t just myself, it was a whole team. But I was able to do something that I would never otherwise have done in the United States. But also, it was, I think, very emotional time for me. And for me to have left my son, when he was so young, and to miss a one year, all the things the milestones of the one year birthday, right first steps and words and the birthday. And until I met this, baby boy in Afghanistan, I think I was a little bit focused on what I was missing at home. And then when I met this boy, all of my efforts and emotions just channeled to this boy, and making sure that I could do my best to well, my dream was secure him, but if nothing else, I would remove this mass, and he would be able to eat and play and do the things that my son was able to do in the United States. And so when I was able to perform this operation, and it was successful, and he left the hospital, and about seven days, and then I saw him and follow up since I was there for four months, and to see him smile. And in fact, I have a photo from right before he left, and I was actually feeding him bananas and Cheerios, right? This is something that all baby voices, United States, eat, that’s what my son was eating, and to just see him become the little boy that he he, he should, you know, have become and enjoy the the things in life that he and his family, were hoping for. I mean, that just it, it even when I talk about it, now I get tears. It’s very emotional. But like I said, I never would have had that experience if I hadn’t gone outside of the United States. And it’s very interesting, as well. As you know, my training, when we are going to take somebody for surgery, we always talk about, you know, the indications, why are we doing this, the benefits of doing the operation, all of the risks that could potentially happen in any alternatives. That was very important to me as I was training. So every time I would counsel somebody in surgery, I would go through my schpeel. And so for this baby, to be honest, I was scared. I mean, I was confident we could do it. But I was very anxious about the operation. Since I had never done an operation on a baby to size. You know, in my training, I had assisted but you don’t have that responsibility as a trainee. And so as I was going through the risks with the interpreter, you know, the, the interpreter said to me, you don’t need to say all this, and I said, I need to say this for myself, I need to let the family know. And after the operation. In Afghanistan, there was always a family member with a patient, whether the patient was an adult, or a child, there was always a family member next to the patient’s bed, who in that family member would usually sleep on a mat. And the father of this baby was the like I said, a young young man who wanted to practice is English. So every time I would come by to round on this baby, and I would see this baby maybe five times a day, and everybody would say, do not touch that baby until you ask him to that’s. But anyway, I would come by and say Oh, Dr. Dr. de la John, please sit down. How are you today? And he’s just start kind of a conversation with me because he’s trying to practice his English And then at the end, right before he left, he said, You know, when you tried to tell me all the things that were bad that could happen to my son, you didn’t need to do that. Inshallah, it was God’s will, whether my son did well or not. I know that, you know, you tried, you tried your best, and it’s all in God’s hands. And I just said, wow, you know, it’s there’s a very different way I think that other cultures, maybe look at what we tried to do in medicine. I think in the United States, we often are thinking that whatever we do, could somehow be litigious, if it doesn’t work out well. But for that, that family and that Father, to say that, to me, really, it was very, very meaningful.

Will Bachman  16:02

But a powerful experience, you know, being away from your own son and having this boy almost as a stand in who you were his life? What, tell me about being a trauma surgeon? Is it? You know, are there kind of differences from how you do surgery in a trauma environment? And you need to maybe triage and work quickly and it’s not scheduled versus how you would treat a same similar in injury, if you were in a full medical hospital? Like, how was it? Are there some things where you, you kind of need to patch person up and go to the next person or just talk to me about that a little bit?

Kimberly Moore Dalal 16:43

Right, so I did trauma surgery as a resident, and then in the Air Force when I was deployed, but I’m actually a cancer surgeon, which is a different specialty of general surgery where most everything is elective. So it’s carefully planned in trauma surgery, right? You’re you’re trying to obtain as much data and information about injuries as possible, and then to make decisions on what can be life saving. And in Afghanistan, I was in at bat Bagram Airbase, which at that time in 2007, had a fixed facility. It was a not a tent. It was a standard hospital, just like anything you would see if you’re walking around the United States. It had a CT scanner, a dissection microscope for the neurosurgeon and the plastic surgeon, an eight bed ICU, really state of the art facilities to take care of injured American and NATO forces. But and then we weren’t on the very, very frontline, we would receive patients who would write, they if they were bleeding, they may have a tourniquet or something that just stabilize them, and then they would come into our emergency room. But if somebody had, like a perforation of their intestine, or they had a broken bone, then we would do the appropriate operation. For example, for preferred intestine, we do an abdominal operation, we try to remove the injured piece of intestine, and so the twins back together, that’s possible. And then we stabilize them, and then we would send them on to an Air Force Base in Germany, who would then send the patient on to Walter Reed Army Medical Center in Washington, DC.

Will Bachman  18:58

So I’ve heard that American forces have become much better about quickly getting injured soldiers off the battlefield. And I think it’s called the golden hour where they have been much better about getting people that historically might have might have died of their injuries, but we’ve done a better job of getting people into medical facilities so they can get get treatment. Talk to me about that a little bit.

Kimberly Moore Dalal 19:32

Well, I think one of the main advances has been in you know, hemostatic agents. So that’s, that’s been very important. But also, like you said, we just have greater technology than we had, you know, years ago and other war times like in Vietnam. And there is a system for trying to arrange for people to be able to be transferred to higher higher levels of care. to definitively take care of injuries, but yes, I think the people on the front lines, they are very skilled at hemostasis, which is trying to, you know, stop bleeding, and then moving them quickly to where they need to be.

Will Bachman  20:34

You told me a little bit about the hospital, paint a picture of me, what was the kind of living environment that you were at? Is it almost like a little modern, you know, town or city that that was? Did you ever leave the base? Like, what was? What was it? Kind of walking around? What was life like, while you were there for four months?

Kimberly Moore Dalal 20:52

Yes, it’s like a little city. Again, a military base. The the hospital and the dining facilities were fixed facilities mean, they were buildings. And they were like any other building that you would enter here in United States. Our sleeping quarters were hot. So they were they’re a step up from tents. But they were, you know, they were they were very. They were clean. They were safe. We were at Bagram. And they would tell us that the most dangerous part of being there was landing and taking off in the airplane. Because we could be fired upon. And otherwise, yes, we did not leave the base. It was not safe for us. But you know, as any military base, they had a little shop, they have dining facilities, they had, you know, athletic workout facilities. A church. And yes, it is, like you said, just like a little town.

Will Bachman  22:17

Let’s fast forward a week, I could spend this whole episode and multiple just learning and hearing about your experiences in Afghanistan. But let’s fast forward because there was before we started recording you were telling me about an area that you’re really passionate about now, and it’s been some time volunteering to help out is helping make sure people have the right information to choose a physician particularly for for oncology surgery. Talk to me about that

Kimberly Moore Dalal 22:48

a bit. So I retained in surgical oncology at Memorial Sloan Kettering Cancer Center before I went into the Air Force. And so my training was very much a multidisciplinary process. So every time I was on a different team, we had at least one or two meetings a week called multidisciplinary tumor boards, which is where a new patient is presented. We talk about their, their symptoms, we review their imaging like CT scans, MRIs, and their laboratory results, their pathology and then taking that into account with their other medical problems. We come up with a plan. So it is what’s called prospective meaning. We no one started any treatment yet. And we plan together surgery, medical oncology, who gives chemotherapy and radiation oncology against radiation along with a radiologist pathologist, and then since I’m in gacha, in Toronto, LG oncology. We usually have a gastroenterologist there. And we then come up with a plan in many communities, community hospitals, which is where I now work, so after the Air Force, my son said, Okay, let’s time for you to find a job in this area, Northern California rents right outside of San Francisco. And I, although I had an offer at Stanford, I had two young kids and I really didn’t want to commute that far, because I had been commuting when I was in the Air Force. And so I we knew where we wanted to live and I then okay, well, I’ll apply for a job at the local community hospital. And I had been in community hospitals in training and anybody in medicine, who listens to this podcast will understand when you are in, in an academic training program, and you’re at university hospitals, you think like, that’s the Mecca, and then the Community Hospital is well, maybe not as impressive. And you, you do your time there, but everybody wants you back at the big house. And so when I came to the My community hospital, I really didn’t know what to expect. But I was very pleasantly surprised that when I would attend, we did have this these tumor boards. And they were very thoughtful, educated, collaborative, people who would join in this discussion. And but a lot of these meetings were, oh, the surgeon would say, I took out the tumor. And let’s show how big it was on the CT. And let’s show the pathology. And I said, I am not really used to the show intellitype meeting, and many times, the patient may have benefited from receiving chemotherapy first, or now, with advances in understanding the disease, and the etiology and the the cell cycle and all of that there are what’s called targeted therapies that are specific for the machinery that’s allowing for the tumors to grow. And now there’s immunotherapy. So there are a lot of different therapies that are sometimes used before someone takes a patient to surgery. So Nevertheless, I said, let’s turn this around. And let’s try to talk about these patients before anyone has started treatment. Because in some ways, when you go to a barber, you get a haircut. And if you go to a surgeon, you’re going to have surgery, but maybe you should have something before you have surgery. So I’ve been at my community hospital for 12 years, and the culture has completely changed. Now, nearly every patient who is diagnosed with a tumor mass growth is presented at a variety of these conferences called tumor boards. And it really has transformed their care. And all of the providers all of the doctors who are involved in the care appreciate the ability to sort of see the patient at the beginning and to to give their input and I think the patient outcomes are so much improved. So about six years, six, five or six years ago, I I’ve been very involved in trying to make sure that, okay, we make sure that our patients in our community have this type of access to the tumor boards and your follow up clinic and surveillance, survivorship. But not everybody in the United States has that and so I attended a national, pancreas and liver conference. My specialty is pancreas cancer, liver, bile duct, esophagus and stomach, sort of the upper GI, Oregon’s and I, I said, you know, we really should be establishing standards for patients who are diagnosed with these cancers and are going to be considered for surgery. I’m involved with the American College of Surgeons, and most surgeons are part of this fellowship in the United States and abroad. And there are quality programs for breast cancer surgery and rectal cancer surgery and pediatric surgery and bariatric surgery. And I said we really have an opportunity to do something in the upper GI area. And so I actually just went up to the president of the Society and I said, this is what I’m thinking, what do you think? And she said, Oh, the American College of Surgeons is actually putting a program together. And I’m going to tell them about you. So I then You know, found out who the chair of that committee was going to be. And I contacted him and, and to their benefit, my benefit, they offered me a position. And what was really notable is that I’m the only private practice Pancreas Surgeon on this committee, everyone else is in university. And I think it’s important because 80% of patients receive their care in their community, they’re not necessarily going to the big cities, to the university. And they want to be close to home, they don’t want to have to pay for parking in the big city, they want to be cared for, so that in a way that their family can be close by and they can support them and be with them at visits. A patient’s also want to make sure they have the highest quality care. Sometimes though, patients don’t know what the highest quality of care is, I mean, we get more information sometimes when we’re trying to, you know, look at how to buy a new car. But nobody knows how to choose a doctor, really, and they don’t know who’s going to provide the highest quality of care. And they don’t know that it’s actually a team and not necessarily one person. So over the past few years, the American College of Surgeons has been putting together standards and guidelines to make sure that patients with pancreas cancer, liver cancer and esophageal cancer are really, that patients are provided with the highest quality of care, meaning, you know, which patients should be offered chemotherapy first and surgery first? And what types of scans like CT scans should be done? And what at what interval of time? And should they have a special gi procedure called an endoscopic ultrasound, and what you know, what Gu makes sure that these facilities that offer these operations provide to patients with regard to very technically technologically advanced procedures, either before surgery, and sometimes after surgery, because these are this programs called high risk, gastrointestinal surgery. And these operations are very high risk. So if you remember when I was telling you about all the potential complications that could arise in that little boy in Afghanistan surgery, well, every day for these pancreas operations, liver operations, not the deal operations, I’m going to the same spiel, because there are many potential complications that can happen from a surgery, we try everything we can not to have a complication, but just by the nature of the disease and the operation. These are possible, and sometimes patients do have these complications. And so how do we look for these complications early? How do we jump on these complications and treat them so that patients still have a, you know a great outcome and can move on to, you know, they need additional chemotherapy or radiation or just moving on to doing the things they love to do with their families. We need to make sure that we have the each facility offering these operations has the capacity and expertise to do special gi procedures and radiology procedures. And so we’ve put these standards together. They’re being tested, or evaluated in several hospital centers. And one of my hospital centers was granted this accreditation, and we hope that once we do a couple more beta test sites that this will then be launched as a national accreditation program to be spread throughout the country to ensure that patients have the access to the highest quality care and to take care of patients with these types of cancers who then under go, you know, then undergoing operations for them.

Will Bachman  34:48

I pick up on a point that you made earlier, so you said you know we have more guidance on how to buy a laptop or a couch than to choose a Dr. Let’s say that, you know, a listener of the show has, you know, maybe a cousin who has been diagnosed with, with cancer. You know, trying to give that person some advice. What, what advice would you give someone who maybe they don’t, you know, to your point, have the wherewithal or desire to go to major academic center, they’re going to go to, you know, they’re going to opt if possible to go to some local community hospital. What are the questions to ask to find out? Because it’s super hard to judge, right? You don’t have report cards, or at least they’re hard to really read necessarily, or know which ones to trust? What should you ask to know if you’re getting the right doctor who has the right skill level, the right team of doctors, and that they’re following the right. set of set of guidelines? What should people ask?

Kimberly Moore Dalal 35:54

I would say the first question is, do you have a multidisciplinary tumor board where all of the cases especially my case will be presented? And who attends? And then you can ask about the number of cases that are performed in your facility, and how many cases that surgeon has performed? So that’s kind of a default? Not a difficult question. But that doesn’t tell the whole story. So everybody wants to know, Okay, how many of these pancreas Whipple operations have you done? Well, that’s a good question. But more importantly, you want to make sure that you have a team that works together, that performs these operations together. And that’s one thing that I make sure I tell patients is, how long I’ve been doing it and my volume, but more like how long have I been working with this particular team. There are also patient advocacy groups that are, provide a wealth of information. So for patients with pancreas cancer, there’s an advocacy group called pan cam. And one can, you know, look it up on the computer. It’s called Pancreatic Cancer Action Network. It was started by a woman who, whose father was unfortunately diagnosed with pancreas cancer, but she’s made it her life’s mission to be able to provide so much information to patients and families. They have a list of facilities that perform high volumes of operations having to do with pancreas cancer, they also will provide avenues for research and also address questions about quality of life. So that’s one thing that I haven’t talked about yet. For patients with cancer, it’s really important to make sure that we identify what what do the patients value, right, first of all, they come to us and they’re very scared, of course, the diagnosis of cancer. But, you know, many of us are focused on Okay, can I do this surgery? Or can I do this chemotherapy? And the main question is, well, what do the patients want? What are they hoping for? What are they afraid of? What are they willing to go through? And what’s important to them, and long time ago, I read a book by Atul Gawande, who is a surgeon with whom I trained at the Brigham Women’s Hospital, and he wrote a book called being mortal. Sure that I took notes, voluminous notes, and that’s not something that is necessarily taught to doctors, or to even some cancer doctors or surgeons. I mean, I think maybe now it is but that is something that I make sure I ask patients about. And there’s also a field in medicine called palliative care. Often people think about palliative care, with regard to hospice and end of life and that’s not how we should be thinking about palliative care. Palliative care is a field where we’re trying to optimize patient symptoms and quality of life. So very often for patients who are diagnosed with upper GI malignancies I We’ll refer them to palliative care, not because I’m not on the curative pathway, because we all want to cure patients as much as we can. And we want to be aggressive or thoughtful about it. But I think it’s very important from the beginning for patients and families to consider, what are my goals? And what do I want? And some people say, Well, my son’s getting married next June, and I want to make it to that, okay. Or my, you know, grandsons having something. And so when we talk to them, and we understand what are their goals, then we can work with them, to make sure that we, you know, achieve them. And so

Will Bachman  40:53

give me an example of how, like, the standardized, you know, industrial kind of approach might recommend, like, Oh, here’s the X, you know, here’s what we typically do in this scenario. But give me a scenario where x would be normal, but then, when you actually spoke with a patient and understand their goals, you might say, well, actually, for this particular patient, given what they’re, you know, what they want out of life. And we might actually do why instead, like, what would an example of that be like, you might not do the surgery, because they’re gonna have a, or not do chemo or something, because they, you know, they’d rather you give me an example of how you might adapt it based on someone’s needs.

Kimberly Moore Dalal 41:37

Right, so for, for example, for me, when I say if I have somebody with pancreas cancer, and for somebody who has cancer that can be removed by surgery, the treatment is a combination of surgery and six months of chemotherapy. And more and more, we’re giving a little bit of chemotherapy first, but if you know, patients say, I want to have surgery, but not now, because in two months, I want to make sure I go to Australia, for a family event, then we would say okay, let’s work with our medical oncologist. And let’s give you your chemotherapy. And you need to have a month off before you have surgery anyway. So let’s give you your chemotherapy inland, let’s just time when your little holiday off chemotherapy is and you can go on your trip, then come back and we have you scheduled for surgery, then there are maybe older people who say I don’t want surgery, I am afraid or or they’re frail. And maybe they’re not the best surgical candidate. So then you say, Okay, what else do we have in our armamentarium? I had a very an elderly lady who said, I don’t want surgery, and I don’t want chemotherapy either. And so we said, Okay, well, she was very frail, she was quite elderly. And then, you know, our tumor board met. And the radiation oncology doctor said, you know, I can give radiation, it’s local, it will not really affect her quality of life, but it will target those cancer cells, and we can prolong her life, maintaining quality. And giving her a little bit more time.

Will Bachman  43:36

I want to ask you a question that is kind of ignorant, but I have the chance I’m going to ask it. I often think about surgeons as being like this incredibly high dexterity people. And so is that the case? Like you know, I imagine there’s sort of this two by two, you have to be you know, there’s like an intelligence level on one axis. And there’s also kind of just physical being really, is that true? Or it could just sort of your ordinary average just about anybody learn to do the physical motions, or is it super tricky, like these tiny little knots that only someone you know, is? So that’s the question.

Kimberly Moore Dalal 44:15

Yeah, that’s a good question. I honestly think anybody can be trained to be a surgeon. Some may differ in their opinion, but I think one just one needs to have a passion for it. It is physically demanding and grueling. I say that now. As I’m 51 I, I get tired more easily than I did 10 years ago, when I started this position, but you I think if you have a passion for it, and you, you know, it takes study and training and a real dedication to it’s not just the technical aspect of surgery, there’s also an art component to it as well. And and you need to also, you know, understand anatomy and understand biology. That it is it is a very rewarding field. I thought you’re gonna ask me a question about personality. I think that when I went into surgery, people expected a certain personality that we used to see on TV and in movies. And in fact, when I was being interviewed in for medical school, somebody asked me, an interviewer asked me, What do you think you’d like to do? And I said, Well, I’m taking this vertebrate surgery course in college, and I may wish to do surgery. And she was a pediatrician. And she looked at me and smiled and shook her head and said, Oh, no, you won’t be a surgeon. And I said, Oh, what do you think I’ll be? And she said, Oh, I think you’ll be a pediatrician. And I said, a Why do you think that is? She said, Oh, you don’t have the personality for a surgeon. And I don’t know if she could tell that of me in like, half an hour interview. But I will tell you that I, I, I probably don’t have the typical personality of a surgeon. I am. I’m very collaborative. Not to say the surgeons aren’t collaborative. But what I’m saying is that I, I really try to build consensus, and build the team. And I give a lot of credit to my team. But my my personality is not your typical, like, overconfident, overbearing person. And I would say that, over probably the past 20 years, people going into surgery are probably more and more similar to how I am. And there are also many, many more women who are going into surgery. And my graduating class, I was the only female I graduated from the Brigham and Women’s Hospital. But I actually had started out at UCSF in San Francisco. And in my internship class, there were six women and four men and the chairman of surgery and the director of the residency program in surgery, they were both women. What about the kind of a West Coast phenomenon? But I think just in general, in the East Coast programs, also, there are more and more women going into surgery.

Will Bachman  48:24

You talked about personality? What about is there a different sort of type of intelligence that a surgeon requires? That at least my my guess would be that you might say something like, kind of that spatial intelligence that perhaps an architect has or that a fashion designer has been able to think in three dimensions? And is, is that that’s kind of very different from just being good, maybe at calculus or being able to write a good term paper in college? Like, is there a different sort of intelligence that you need to be successful as a surgeon?

Kimberly Moore Dalal 49:03

I don’t think so. I will say that people in plastic surgery, they people who are reconstructing or making, you know, making things look normal from abnormal, I do think they need to have probably more of an artistic background and understanding. I also saw this in when I when I was rotating on pediatric heart surgery. I think those surgeons are incredibly special. Some of these poor babies have to have repeated operations and every time there’s an operation, there’s scar tissue. And then to try to carve out the the heart of scar tissue and then to kind of reconstruct I often make new valves or, or something like that. It’s it’s incredible. But otherwise, no, I just think like, as I said, just having a passion and continuing continually learning and trying to improve one’s experience, and knowledge. And that comes from, you know, attending meetings and reading journal articles, and just collaborating with people who are not just in your own facility, but in other institutions as well.

Will Bachman  50:43

One question I like to ask guests on this show is, what if any classes or professors that you had at Harvard, really affected you or stayed with you professional or, or not necessarily professional, throughout your throughout your life since leaving school?

Kimberly Moore Dalal 51:07

Well, as I said, in my senior year, I took this vertebrate surgery course, which was offered, I think through like veterinary medicine, but over the medical school, and I think that’s what really turned me on to the possibility of doing surgery. I will also say in senior year, I took a, an art course, by a professor named Simon Sharma. And he taught a course on Baroque forms of authority. And that was the first time that I had really, any Introduction to Art. I grew up in a small town in Maine. And I had never really been exposed to art. And as I took this class, I just thought it was so very interesting. And for the first time, I thought, am I right concentration, should I have contemplated a different concentration? I think I was so focused on becoming a physician and being pre med, and I was a biology concentrator, because that was the straightest path to where I wanted to end up. But now, whenever I talk to anybody who’s interested in becoming a physician, I say, study the humanities, study all the things that you’re interested in, don’t worry, you’ll get your all of your biology and math and physics, when you have to, but you know, study English literature and the history and art. Another thing I would say is with fat, you know, fast forward, I have two children. And in their elementary school, there was a program called Art in action, which was a volunteer organization, or organization, where parent volunteers would actually help to teach the art curriculum in the schools. And so in every year, I think, from kindergarten to fifth grade, the students would have maybe five art lessons talking and looking at different types of art and time periods. And I had to go to a, I chose to volunteer, and I had to go to a introductory course. They talked about, you know, perspective and lines and shading. And it made me think of my my course at Harvard, but it I think that course just gave me a greater appreciation for art. And I do believe that that is something that really should be offered to every young student. I guess it was incredible how you go into this classroom of rowdy girls and boys and they would just be silent. And they would be working on their art. And I was truly impressed by the boys who, you know, they can be distracted by anything but when it was art, they, they really loved it.

Will Bachman  54:53

What a wonderful, wonderful story. Kimberly, it’s been so amazing speaking with you. Thank you So much for agreeing to come on the show.

Kimberly Moore Dalal 55:03

Thank you for having me. I’ve been so impressed by all the other classmates, and I hope that you make it through the rest of our class and that people will volunteer to spend time with you. I thank you for doing this.

Will Bachman  55:21

That’s very, very kind of you to say, and listeners, you can go to 92 report.com That’s nine to report.com. To sign up for the email, we’ll I’ll notify you of each new episode. Thanks for listening