I'm going to transition over to Dr. Lombardi, who will just be known as Bill, because he always stops everybody and says, just call me Bill, and for everyone, please just call me Drew. Bill, I'm going to let you share your screens, and we'll get started, and then we'll take some questions here at the end. That was a wonderful talk, and I look forward to Bill's presentation on this, and we've got some questions in the chat. If any of the panelists would like to respond as well, feel free to jump on board with that. And Bill, I'll turn it over to you. So I'm supposed to develop a toolkit, so yeah. The one thing why I'll say Bill instead of doctor is because it's a hierarchy thing, and if we're all going to be the same, and we're all going to have the same stuff, then you use your first name. It's not derogatory. It's not that you don't deserve the work that you did to get there, but when you're a SEAL, the first thing the SEALs learn is nobody has a rank, and the reason is because it opens dialogue and opens communication. Yeah. And since my dad was a pilot, I always put the Blue Angels up because they're a high opportunity system. So one, tonight, I'm not an interventional cardiologist. I get to be an interventional psychiatrist, and we're entering a restricted area. My disclosure is I probably had more coronary perforations than any operator on earth, and I probably had more stable elective deaths than any operator on earth, and it sucks. And what hopefully I can do from the same as I teach from the experience of what I've done, maybe I can teach a little bit from some of the mistakes I've had in handling this stuff. A lot of this has already been discussed by Drew and Ahmad, and I think they've done a great job, and I think this is a culture shift that we're working on. So I want to actually move back a little bit to is why are we so punitive? Because if you really want to fix the problem, again, we tend in medicine to treat a lot of symptoms rather than curing the disease. So the symptom is we get traumatized, we get burned out, we feel bad, and we're struggling. But what's the disease? Well, the disease is competition. It's how we're trained. When you go to med school or when you go to undergrad, what do you have to do? You have to be the best. So you have to compete, and when you compete, it's to be the best. When you go to med school, what do you do? You compete because you've got to be the best. When you go to residency, got to be best so I can get the best fellowship. When I go to my fellowship, I got to be the best so I can get the best job. When you get the best job, what's success? As an interventionalist, you're told it's volume, money, and ego, and ego can be your own hospital, it could be your town, it can be your state, it can be the country, it can be the world. It's still just ego. And realize in a world where the pie is only so big and you're competing, the only way to get pieces of that pie is to put others down. We crush those around us to prevent them from getting into our volume. And that's how we're programmed. That's why Eminem is so evil. I want to beat on the young person because I don't want them to threaten me. I don't want to have to learn something new because I'm afraid to show that I didn't know in the first place and I may not be as good at them, so I'm not going to do it. And the challenge you have in this is none of you know how to be a leader. You know management. Management is I tell you what to do and you do what I say. I show you unconditional love because I want you to be greater than me and you'll get better. And physicians for the most part are not very good mentors because if you think of the academic world, how many mentors actually want to see their trainees outshine them versus how many use them to get a bunch of papers written and help promote them rather than truly unconditionally trying to see them succeed. So in this, when you step back, one, I want you to think about how is your competitive nature affecting your emotional response. And the second piece that comes with that is how much of your self-worth is from external validation rather than internal validation. So that's me as I'm going through my metamorphosis. That's the old, fat, broken down, drunk, bad person. That's my son on the same trip to remind me that there are better things and things that I value a lot more now than my job and my ego. And I've shown this slide a lot and I'll show it again. And it's the hard thing for everybody here to think about. Green is actually how good you are. The 35-year-old, the 57-year-old, the 67-year-old, on the green line, they actually exist. Now where that actually is, who the heck knows, but they're on that green line. That's actually how good you are. But realize those at the bottom have the greatest discrepancy between their self-perceived ability and their actual ability. You actually have to get to the top 10% before it flips. So what this means is you don't even know enough that you don't know what you don't know. And so instead of being vulnerable and saying, I don't know, I need to learn, who do I learn it from? What we tend to do is pretend that we know. How many of you have lied to an attending or a partner, oh, this is what's going on when you have no idea. Because you're much more afraid to admit you have no idea than to be honest about it. Because it's grilled out of us. Don't say you don't know because you'll get in trouble. People will make fun of you. Right? The number one reason people don't do imaging is because they can't read it. Nobody says that because nobody has the courage to just admit, I actually don't know how to read it. Well, you can learn, but to learn, you have to admit, I don't know. Most people can't learn, they don't know. So where are you, right? And the real question that is, you can't answer that honestly, because your self-perceived reflection of you is clearly wrong. So the real question is, who do you trust to tell you? And would you believe them? If I sat and walked in your lab and said, hey, gosh, you know, really sorry, but you probably need to work on your bifurcation technique. And here are some things I would think about. And these are the ways we do purposeful practice. Are you going to be like, oh, he's an asshole. He doesn't care about me. He's just trying to show how great he is and put me down. Or would you accept it with, gosh, he really cares and wants me to be better. Most people, right, would take it as the unmean, right? What I would love to do if I had the money and time, I would love to be able to just walk into cath labs and coach people every day because I'm pretty good at my job and I've done a lot and I've got a lot of experience. But do you know that 90% of interventionists would not want me in the room because it would threaten them? How sad is that we're so competitive that that makes us feel threatened rather than embraced, loved and cared for? So these are my coaches. On the left is Aaron Grantham from Mid-America Heart Institute. He doesn't look quite normal because he's a little bit drunk and he just caught that fish off the back of my boat. The ungainly guy in the middle is me as I'm falling apart. And the other is my son, who's my youngest son, who's on the spectrum, who's gone through a lot of issues growing up and has made me a much, much better person than I ever would have been because he taught me about how to have grace and compassion and stop judging based on my view of the world, but allow him to be judged on his view of the world. And I can report he's now a sophomore at the University of Montana studying geology. And I'm thrilled because I never thought he'd get out of high school. So I've been blessed that he, despite my challenges, has really shown up and shine. That's my two sons and my wife. And these remind me what really matter when things go wrong. If you have a bad day in the lab and you're struggling, do you go home and kick the dog, which is your family and your partner, or can you sit down and just cry? Can you tell them I'm hurting? Can you tell them I'm hurting in a way that gets them to hug you rather than run away from you? That became my issue with my wife. When I wanted a hug and I needed help, I wouldn't get it fast enough and that would make me angry. And when I got angry, she ran away, which just made me more angry and it started a vicious cycle that went on for a decade. So here's the issues for us to work on. Are you being listened to? So at the same complications course that Ahmed brought up, Aaron Grantham got up, a good friend of ours in Minnesota had a horrible complication and a patient died. And Aaron heard to the grapevine about, and Aaron, like most people's like, I'm not going to talk about it. I'm going to leave him alone. He's kind of scared. And we've been working a lot together on something because, you know, actually I'm going to call him. So he called him up and said, Hey, I heard you had this really bad thing happen. Are you okay? And the other person's response was, no, I'm really struggling. And his second thing was, you know, I've been in this job 20 years. That's the first time anybody's ever asked after a complication, if I'm okay. So if you take nothing away from everybody's talks tonight is, can you just show up for people differently by saying, are you okay? Right? Today was a great example. I had 57 year old air embolus. That's me. And I meet with a lawyer about it on Thursday because the family's angry about it. And we also reviewed today at M and M another case that I was involved in that didn't survive. And I told everybody at the end, I was like, I'm really traumatized right now. I'm, I'm, I don't, I've got to do a live case. It's super hard. It's super high risk. I'm not sure I'm, I'm going to be okay today. And three of my partners came up after M and M and gave me a hug and just said, we love you. You're a good man. We're here for you. That's a good environment. We've helped build that, but you've got to build that for yourself. The second thing comes up is, are you a different person at work than home? And if so, why? Right? An authentic person is an authentic person. If you can't be yourself at work, then we have to work on your environment work and we have to work about your vulnerability and we have to work about the vulnerability and communication of those around you, right? Because we should be able to be the same person. It's too hard to remember two different lives. It's a lot of work, right? It's very confusing to remember who's saying what to whom and how you do that. And then the last piece is, who do you really need to be accountable to? Right? I bring this up for people. If you're spiritual, not an atheist, and you believe in a higher being, do you think that higher being would ever talk to you about you the way that you talk to yourself about you? And the answer, for the most part, is no. So first of all, why are you holding yourself to a higher standard than you hold others? And why are you so critical of yourself compared to others? And why do you put others down to make yourself feel good? Why don't we just all accept that we're imperfect, right? As Andrew brought up, how many of us have never had a complication? Zero. And if you haven't, it just means you read echoes and you don't do cases. And the second is, even the people who read echoes, they actually harm more people than you do in the cath lab, because acts of omission, which are all about risk aversion, actually harm far more patients in the United States than acts of commission. Acts of commission are just easier to track and easier to know what's going on. So we can do better. I like to fish. It's a buddy of mine's son looking up at the fish I just caught. So what are some of the things you can do to change, not just to allow yourself the ability to feel healthier, more vulnerable, and less traumatized, but those around you? So number one, realize the only thing you really control in any discussion is your response, right? So my internal values, when I started teaching CTOs, all I wanted to do was see doctors do a better job, mostly because I knew patients were getting harmed because they weren't getting treated. But if you met me 10 years ago or five years ago, you'd be like, he's a super critical pretentious asshole who just judges everybody and critiques everybody, and he's just mean. Now you'd say, gosh, Bill's really thoughtful. He's compassionate. He's got grace. He's comparing. Same internal values. But my response and my communication and my behavior, totally different. So when you watch a behavior that harms you, bullies you, traumatizes you, be careful that you're not passing that on. So think about, how would I like to be treated before you open your mouth and unload on somebody? The other is, build horizontal communication. As we talked about, Ahmed brought this up, right? Talk to your team. Everybody in the room is as equally damaged as you are. Actually, I will tell you who the most traumatized person in the room is, the nurse, because they're the last person who saw the patient and their family alive and unharmed. Now the hard part is, you have to show great EQ of, I'm really sorry. This happened today. My tech twice gave me the wrong balloon, and I just look at her and I sort of, I was with a live case about to come up, but it slowed me down. I got a little frustrated. I'm just like, that's me. That's my fault. My bad communication. I am not being clear about what we need and where we need to do. I'm sorry. Let's, you're doing great. Let's figure this out. This is what I need, right? But in the moment, I can't blast them and say, you suck. You're slowing me down. Jesus Christ. I asked for this. What's wrong with you? I have to make sure I take ownership of that and make them feel safe. The second is, I'll tell you, you're all never going to get good at anything if your culture doesn't allow complications and doesn't allow failure to occur. And the reason is you'll have risk aversion. And what risk aversion leads to is a culture that suppresses. And the reason it suppresses is unproductive failure. You cannot learn something that you never try. And the way I highlight this is, have you ever been at a meeting and someone on the panel, some very well-known, famous person on the panel says, that will never be widely adopted. What that person is saying is, I am afraid to learn it, and I sure as hell don't want you to learn it because then that makes me look bad. And so I want everybody in the room to have unproductive failure because I don't want to look bad because I don't want to learn it because I don't have an environment that lets me fail. Right? What I've done in CTOs, there's nothing special. It's just hard work, learning, changing mindset, changing approach. What Jamie McCabe does in our lab, I'm sorry, Jamie does not have magic fingers and a magic brain. He's got art, he's got great mental capacity, great grit, great willingness to fail and great opportunity to keep learning. That's what you're looking for. And you have to build that environment, they don't just happen. That is me about two weeks before my life functionally ends with my two kids and a big fish. I've changed a little bit. If you notice, I look a little different. So do you want to get better? One radical acceptance. What does that mean? When you're angry, you're frustrated, you're cowering, you're about to say something you shouldn't, ask yourself, why am I that way? Is the current emotional state going to help? Is what I'm about to say going to fix the problem? If the answer is, it's not helping, I can't fix the problem, and I really don't want to spend the time and effort to fix it in the first place, then let it go. Don't let other people take your joy. So as Ahmed brought up, be curious, not judgmental. Number one person to be curious with, start with you. Why am I feeling this way? Why am I defensive? Why am I angry? When somebody points the finger at you and starts beating you up at Eminem, why don't you look at him and say, how is this helping me? I already feel awful that this person got injured. I'm already traumatized. This is not helping that. I am not learning. The second piece goes back to build intrinsic worthiness, right? I've talked about this a lot. My therapy started with, I am a good and worthy man. You're a woman, I'm a good and worthy woman. Actually, it's my mantra, make up your own damn mantra. But I had to say that, I still say it. And for a year, I didn't believe it because I was worthless. I can tell you what worthlessness feels like, I lived it. And what happened is as I built my internal worthiness, great case did not give me a high. But also when a bad case or complication is, a bad thing happened. That does not make me bad. Too many people in our profession, when a complication occurs, I'm bad. I did bad. I'm horrible. I should suffer. No, you shouldn't. You're a good person. You're doing your best. You want to be able to learn from it. That does not make you bad. So you have to separate your worthiness from the event, which then gives you the emotional stability to critique the event, not from good and bad, but from what can I really learn to get better? And the last thing in this is vulnerability to be able to say, I don't know, to say other people do know we need to learn isn't a weakness. That's how you get better. I can tell you in my world, I'll look to anybody to get better. And if you can defend why it's better, and I do it, and it makes me better, then I'll keep going. If you can't defend it, or I can't figure it out, then it's just BS and I'll ignore it. But I'm never going to critique you unless I've been there. Here's some things about narratives. We talked about having a narrative and bringing it to the table. So you can read this. And then when you get done, read them the other direction. Instead of reading them Western, read them Eastern. It's amazing what happens when you say confidence kills doubt, peace kills jealousy, growth kills ego, dreams kill fear. Think about what you say to yourself manifests your outcome. There are a bunch of books that I've been through. They're all for sort of different things. Andrew brought up Daring Greatly, which is about shame and vulnerability. If you want, you know, the talks live, you can get this book list. We can talk about what each one's about. But these are things that I read. When you read them, I'm going to give you some advice. One, read them with an open mind. Be vulnerable that what you've been isn't what's going to get you where you need to go. Two, read them like a textbook. Take notes, thumb pages, highlight. Four, three, when you're done, pick one to three action items to purposely practice to change things that you're going to try to do differently and fail at to get better. Sometimes these forms are really tough for people to be open with a big group. Plus I know this is also being shared online and being streamed. So I'll bring up one. I do a podcast that covers a lot of these topics. Actually, Andrew was on discussing suicide with physicians, and that was a really important topic to me because I have considered suicide and I know others out there have thought about harming themselves. And I think it's a really important topic for us to discuss. Those are my two emails, one's from work, one's from personal. Yes, it's a stupid name, but it's my nickname and deal with it. There's my cell phone. And as Ahmed brought up, the complications course, this year it's three days. July 10th, which is a Thursday, will be all structural complications. The middle day will be the psychology and legal issues in regards to complication and building cultures, as well as sort of some crossover of access and human dynamics and other things. And then the coronary day will be on Saturday. Registration will probably open sometimes in February, March. My guess is it's going to sell out this year, so if you see it, block out the time, we'd love to have you. And again, Andrew and Ahmed and everyone on the call, thank you for having me. I really appreciate the opportunity. I hope you find it useful. Thank you.

medical culture

emotional intelligence

personal growth

vulnerability

mentorship

intrinsic self-worth