Transcript

[Music]: [00:00:00] Knock, knock, hi, 

Dr. Andrew Lam: knock, knock, hi.

Will: Hello everybody. Welcome to knock, knock high with the Glaucomfleckens. I am Will Flannery, also known as Dr. Glaucomflecken. 

Kristin: I am Kristen Flannery, also known as Lady Glaucomflecken. 

Will: It’s New Year’s Eve. Happy New Year. Uh, to everybody, and how do you feel about, where are you with New Year’s Eve festivities at this point in your life?

Kristin: You know 

Will: Yep, that sums it up, that’s about right. Yeah, it’s kind of like, okay, like Um, 

Kristin: regret and shame that I am now too old to stay up comfortably till midnight. 

Will: It is not regret. Or shame for me. I, I could not care less about staying up till midnight. In fact, I love, I love being on the [00:01:00] West coast because you can put the TV on.

You can watch the ball drop at 9 PM with the kids. They’re not. They’re not young enough that we can trick them into thinking. They know what time it is. They know what time it is. Uh, but that was a good few years though. 

Kristin: That was. We would do like 6 p. m. Or sometimes I would even do when they were really, really little.

I would do noon because that’s 12 o’clock. 

Will: Yeah. 

Kristin: They don’t know the difference. I don’t know. It’s supposed to be nighttime, 12 o’clock. 

Will: Would you be interested in doing like an adult? Activity, like a, like a festivity thing. Like go to go somewhere. We’ve done that before. 

Kristin: Yeah. Look, New Year’s Eve used to be my favorite holiday.

Cause it was so fun. Like everybody’s just happy on New Year’s Eve. You know, if you’re out, everybody that made it out is happy. Everybody’s 

Will: drunk and making out. 

Kristin: Yeah. And it just feels like a time that’s hopeful and you know, you, I don’t know. It just feels, even though it’s just a big mass delusion, right?

Like it’s just another day, [00:02:00] but it just feels that way. Happy and fun. And so I used to love it, but now I can’t, um, stay up that late. I don’t like to deal with crowds. I don’t want to find parking and I don’t want to wear uncomfortable shoes. So, 

Will: wow. We’ll see. And just know what you want at 40. That’s 

Kristin: right.

It is what it is. I would love to have my, you know, everyone come over though. Like, you have people come to me, sure. 

Will: People come in and then they all go home by 10 p. m. 

Kristin: Yeah, perfect. Sounds ideal. 

Will: So that’s our, you know, but now that the kids, like we’re going to, we have to stay up now. 

Kristin: We do, and we’re starting to enter the years, we’re not quite there yet, but we’re very close where, where we have to stay up because we don’t know what they might be getting into.

Like, we don’t know what they’re up to, 

Will: you know, so we 

Kristin: got to be awake to make sure they make it home and whatever. So 

Will: the mischief level is going to increase very soon, you know, we got a nine and a 12 year old. So, but see, that’s 

Kristin: why I like to [00:03:00] try to be the house where people want to come over. 

Will: Yes, 

Kristin: because then you don’t have to worry about all that.

Everyone is there. And you can 

Will: see, like I had that growing up. 

Kristin: Yeah. 

Will: And part of that’s because my, my parents did make an effort to like make it a place that people, that my friends felt. Comfortable being at right, you know, 

Kristin: there was a lot of bribery and things, banana milkshakes. Like that’s how you do it.

Yeah. 

Will: Lots of game nights, video games, board game stuff. And I think that’s what they were doing. I didn’t realize it at the time, you know, but that’s, I think it’s so. That’s such a good thing to like be the house. 

Kristin: Yeah. 

Will: Because you know where your kids are, you know, and you can keep their kids friends and their parents.

You can keep 

Kristin: everybody safe. Yeah, 

Will: you know, you know, it’s so anyway. Especially, 

Kristin: yeah, because you don’t always know the kid’s parents either. Like you don’t, you don’t know where they are and who they’re around and who’s looking after them and that sort of thing. Maybe we’re just two very controlling people.[00:04:00] 

Will: No, you’re describing your, your ideal new years. And then the fact that you’re don’t trust anybody outside of our home. Uh, we go to the grocery store at two o’clock in the morning, everyone to avoid. No, it’s, uh, we’re, we’re sounding like hermits. 

Kristin: I know. I think we’re just getting old, whatever it is, what it is.

Will: Does anybody relate to this? Tell us, tell us what you’re. As you have gotten older, you, the listener, the viewer on YouTube, uh, what, how, how has your attitude toward New Year’s changed? I’d be, I’d love to hear if we’re the only ones and like, as we approach 40, you are already 40. I am almost there. Is there, is there any still excitement about New Year’s out there, like for people over the age of 40?

Kristin: You know what? For me, it’s more like, Oh man, I just got used to it being this year. And now I have to remember that it’s a different one. And sometimes I’ll still find myself flipping up and putting like 2003 on like, in the rare occurrence that I have to write a check or [00:05:00] something. 

Will: We need to take you to the doctor, I think.

I know. I think there’s something. 

Kristin: Something’s not right. I think there’s a lot of things not quite right up there. 

Will: Let’s get to our guest, shall we? Alright, let’s do it. Alright. 

Kristin: Speaking of me not being quite right, this guest. Right, we put 

Will: Kristen through a lot. Well no, the guest is lovely. The guest is great.

Thank you. 

Kristin: The topic matter I struggled with. 

Will: There’s some ophthalmology talk today and we all know how Kristen feels about eyeballs. Same way I feel about teeth. Uh, but we did, we talked to Dr. Andrew Lamb, uh, is a fellow ophthalmologist retina specialist. He’s a retina surgeon affiliated with Bay state medical center in Springfield, mass and assistant professor at the university of Massachusetts medical school.

Also, Uh, an author, he has a couple of books. He has a new book called Masters of Medicine. Uh, we talked a little bit about that and also a book called Saving Sight, uh, where you tell stories about growing up in ophthalmology, like becoming a surgeon, his upbringing, [00:06:00] things like that. Uh, great, great books, great writer, great storyteller.

Uh, we, we talk about some harrowing adventures in ophthalmology. So, 

Kristin: I almost had my own harrowing adventure, but I made it, I’m here. 

Will: Almost passed out over here. If that convinces you to watch or listen to the episode. So let’s get to it, shall we? 

Kristin: Let’s go. Here 

Will: he is, Dr. Andrew Lam.

Today’s episode is brought to you by Dax Co Pilot from Microsoft. To learn about how Dax Co Pilot can help you reduce burnout and restore the joy of practicing medicine, visit aka. ms slash knock, knock high. That’s aka. ms slash knock, knock high.

All right. We are here with Dr. Andrew Lam, a fellow ophthalmologist. Thank you so much for joining us. 

Dr. Andrew Lam: Thanks for having me. 

Will: I appreciate it. Uh, yeah, [00:07:00] so it’s, it’s always a pleasure, you know, the, the last guest we talked to was a dentist, which is very, uh, very outside my wheelhouse. And so I feel like, uh, like a warm blanket, uh, not in my comfort zone with talking with an ophthalmologist.

So I’m excited. That’s good. I’m glad. 

Dr. Andrew Lam: I’m glad to. Be talking to you guys, for sure. I’ve learned that every field is very important. I used to think, oh, you know, rheumatologists weren’t that important, weren’t as valuable a field until I saw a patient with a rheumatology problem, and that’s exactly the most important thing to them.

And same with dentistry, I’m sure, but I’m just love to talk about ophthalmology, so Well, you 

Will: you say that, because there’s a surprising Amount of overlap between ophthalmology and lots of different fields in medicine. People don’t realize that because we are very much in our own little world, but like a lot of, 

Kristin: would you say you’re in your own orbit?

Will: Oh man, you’re already starting in with the puns. That’s good. Um, but like rheumatology, dermatology, like all these [00:08:00] autoimmune diseases. I’m sure you as a retina specialist, because I hear there are some inflammatory things in the back of the eye. I don’t know. That’s just. That’s just a rumor that me as 

Dr. Andrew Lam: a 

Will: conference, that occasionally we do overlap with other specialties.

Kristin: Here’s what I know about, um, him as a retina specialist. I already know that he’s much smarter than you. 

Will: Oh, I don’t know. Well, yeah, probably. Well, it depends on smarter about what, because he did decide to do two additional years of training, and I wouldn’t want to wish that on anybody. 

Kristin: Yeah, that is debatable whether that was a smart decision, I guess.

Dr. Andrew Lam: I do remember my wife and I, I told her, I broke it to her, I was like, I think I want to do retina, and she’s like, oh, that might be tough. A little demanding, a little hard. And then for a while, I was like, Hmm, what if I did medical retina? Uh, and I tried to, she also, for some reason, didn’t think that that was going to be that, that, uh, you know, worth it.

And so in the end, I just had to follow my heart, I guess, and it’s worked out. 

Will: Well, it’s, it’s, uh, let me ask you this. [00:09:00] When you, when you reattach the retina, does it make a zipper sound? Is that true? There 

Dr. Andrew Lam: are definitely sounds, but we’re so much more focused on can we see, I can’t tell you how many times we’re trying to fix retinas and we can’t see what we’re doing, so it’s kind of like we’re using the force.

I used to follow my attendings and be like, I can’t see what you’re doing. How do you know what you’re doing? And I’m like, are you using the force? Yeah, this is, this is actually news 

Will: to me because so when you’re doing, let’s talk about retina surgery because this is, um, you know, actually let’s step back and just, let’s say a lot of people get confused about this because the eye is such a small organ that it’s shocking to people that there are, what, seven, eight different subspecialties?

Seven different fellowships you can do just with an ophthalmology. 

Kristin: Yeah. 

Will: You just pick a part of the eye and you can do like one to two years of additional training just learning about 

Dr. Andrew Lam: that. That does seem odd. It’s a great field. You know, yeah, you can, you know, all the things that all these people, when they go to med school, they say, I [00:10:00] want to do these things.

I want to have long term patient relationships. I wanted to work with kids. I want to like do pathology. All of that is possible. I want to do surgery and ophthalmology and depends on what field you’re going to, so. 

Will: And you know, so I, I did, I did residency and I was like, I was done. I was like, I, I didn’t, I didn’t like any one thing enough to do it all the time.

Right. I was just so bored by the end of every single subspecialty rotation I did that I was like, all right, maybe that’s the universe telling me that I should be a comprehensive ophthalmologist. Um, and so, but I, I remember what it was like to learn cataract surgery and you do too, obviously. Oh yeah. You know, stepwise, you do like just a little bit at a time, you know, get all the difference, you know, you, you, you spend, you practice inserting the lens and then you do the rexus and then you do the incision and you’re, you’re kind of stepwise doing it.

Is it the same way with learning retina surgery? Because in my mind, you know, you, I didn’t do any retina surgery as a resident, you know, so if I had gone to [00:11:00] do a fellowship in retina, I feel like it would have been starting all over to a certain extent. 

Dr. Andrew Lam: Yeah. Yeah, we did not do a lot of retina cases as residents.

We might like pass some scleral buccal sutures or something, but they’re not going to let you into the eye, the inner sanctum basically. But I agree, cataract surgery, I remember feeling like super confident when I went into it because I had seen it done as you have many dozens of times and it seems so efficient and elegant in five minutes, you know.

And I remember trying to like do the Rexis, I’m like, Oh my God, this is like invisible. Of course it’s invisible. You have to see through it. Right. 

[Music]: Right. And 

Dr. Andrew Lam: so it was definitely like challenging, but then you learn little by little and you get better and better. And retina surgery training is like that, except the stakes are a bit higher because like you’re trying to peel the internal limiting membrane in a macular hole surgery, for example, but unlike if I mess up the Rexis.

My attending could like just bail me out. Fix it. Or do a can opener and then I mess up the can opener and then he like just comes and bails me out. Uh, if you’ve [00:12:00] seen a way to open the 

Will: cataract. It’s, uh, Kristen’s looking at me like, what 

Kristin: is a can opener? I’ve got no idea what any of this means. Can opener 

Dr. Andrew Lam: is like, for the people who mess up the beautiful smooth rexes like your husband’s been doing, like.

Kristin: What’s a rexes? The rexes, 

Will: so the lens in the eye is like a peanut M& M. Okay. And doing the, that’s exactly what I would say is like removing the candy coating on the top. Oh, okay. So you can get into the cataract and you want it to be a nice, still got the 

Dr. Andrew Lam: chocolate and the peanut. 

Will: Yeah. Gotcha. You want it to be a nice round circle, but if you screw it up, sometimes it’s not a nice round circle and your attending has to save you.

Kristin: I see. Okay. Yeah, 

Will: but he’s, but there’s a lot of, 

Dr. Andrew Lam: yeah, in retina surgery you do a lot of tentative, you know, uh, you know, if you’re a. Conscientious trainee, you’re just being very cautious, which is why I have so much respect for my, you know, attendings and, and mentors because my, you know, it, it must be heart stopping to watch these trainees like you and I were, uh, learn, right?

Cause you have the responsibility and, and we might mess up and it, at the very [00:13:00] minimum, it takes forever, right? You’re waiting and waiting for this guy to like, do something. It sort of reminds me 

Kristin: of like, if you’re a parent teaching a teenager to drive, right? And they’re in your car. Oh, that’s 

Dr. Andrew Lam: torture.

It’s torture. 

Will: And you are 

Kristin: trying to be instructive and encouraging, but also going every four seconds. We 

Will: haven’t gotten there yet in our parenting journey. I’ve 

Dr. Andrew Lam: taught three kids to drive. It was torture. 

Kristin: Which do you think is worse, teaching a kid to drive or being an attending to a resident learning eye surgery?

Dr. Andrew Lam: Well, there were a few times when I grabbed the wheel of my, of my daughter. So I’ve never had to grab a trainee’s vitrector. Uh, but the worst, absolute worst moment as a parent is when your oldest kid drives away with the rest of the kids in your car and you and your wife or your spouse are watching them drive away.

Kristin: Yeah. There’s nothing quite like that in 

Dr. Andrew Lam: surgery. 

Will: Right, cause you’re, cause you’re, It’s like, I guess it’d be like, you know, as soon as the ILM peel starts happening, you’re, you walk out of the operating room, which you would never do. Um, 

Dr. Andrew Lam: right. That yeah. [00:14:00] Totally unsupervised, I guess. Yeah. 

Will: In the ILM. So he’s talking about peeling.

This is a, a relatively common, it’s a common surgery for them, but how thick, how thick is that tissue you’re pulling off of the retina? We’re 

Dr. Andrew Lam: talking like 10 microns or less. If the macula is like 250 microns, it’s very, it’s very, very gossamer. Yeah, that’s why we get to say we’re neurosurgeons because we’re working on neural tissue that’s connected to the brain.

Yeah, technically. All right. All right. That’s a stretch. Yeah. 

Will: Um, so let’s go back a little bit, uh, and talk about your training, uh, because I, you went to Wills for residency. So Wills eye hospital is one of the most famous eye hospitals. It’s in Philadelphia. Uh, I interviewed there. Um, I was very fortunate to get an interview at Wills.

I was very excited about it and it was the first time I had ever seen an eye emergency room. 

[Music]: Yeah. 

Will: Tell, tell the people about that because that’s, that’s a very strange, unique thing that only a few places around the [00:15:00] country have. 

Dr. Andrew Lam: Yeah. Wills is great. I was really lucky to train there and they have this, an emergency room just dedicated to eyes.

So you can imagine there’s a few maybe a few places in the country that might have that and it basically becomes a huge dumping ground for everyone’s eye problems around the tri state area or the area like as an ophthalmologist in the area or even an emergency care doctor, you must love it because you’re just like, oh, there’s an eye problem, just go to Will’s essentially.

Yeah, know it’s there, 

Will: it’s open all the time, 24 7. Yeah, like why should I even bother 

Dr. Andrew Lam: learning how to look at someone’s eye, I could just send them right there. So, but, um It was great as a resident, obviously, because you literally see everything every time you’re on call. It was one of those things where it was like, Oh, it was the busiest.

It was the most, um, stressful, but also it was the most learning. So we all enjoyed it. Um, and we all liked it a lot. Um, so, uh, it was, yeah, just everything under the sun. Every like, there’s a book called the Will’s Eye Manual, which is kind of like very popular. And I still [00:16:00] use it. We have them in our clinic.

It was written by the residents. It’s back in the like 90s, I think that was the first edition, just because of all the things that came through that ER. And then when I was a resident, I basically realized that after a few months, I’ve seen almost so many things in that, in that manual. And um, I felt like it was really lucky to kind of just have that all experience of course.

Uh, well, who was staffing 

Will: it? So when I was 

Dr. Andrew Lam: there, back in the olden days, this was before the 80 hour work rule and a lot of other supervision was occurring, a lot of times it was basically a second year resident was in charge and a first year resident was learning, and you’d have one second year resident and two first year residents, and they’re You know, there might be no attending and in which case it was like, we weren’t even, you know, it, it was not great.

And then, or a lot of times there was an attending during workday hours, like from nine to four, but at night there wasn’t. And then they said, Hey, let’s just have some of these fellows who might want to moonlight and make some money and sign off on the charts. [00:17:00] Just be there overnight if they want to, but it was, um, it’s basically the residents handling everything.

Will: Yeah. And that’s obviously something surgical like open globes come in, which I imagine you get a lot of those. 

Dr. Andrew Lam: There were a lot. And then the third year resident gets woken up and to do something. And then the fellow is taking care of like, Staffing that essentially. So how about your residency? 

Will: Well, you know, I was like, yeah, so I went to Iowa and, um, we didn’t have our own eye hospital, but we just had a massive catchment area, right?

So the Midwest, everything’s so spread out. So we had four different States. We could get South Dakota, Nebraska, some parts of Nebraska. Uh, what else is around there? Uh, what’s. So some Southern Minnesota, Illinois, Missouri, just so many pages. So we got a ton of trauma, you know, farmers, you know, the things happen on the farm.

So, um, uh, and so we were. The, the, the most challenging part about it though was it [00:18:00] was home call. So, so it was basically an excuse to like make us work clinic the next day after our call shift because we technically for some of those hours we weren’t in the hospital even if we weren’t able to sleep because we were fielding phone calls from patients and stuff.

Dr. Andrew Lam: Right. 

Will: Uh, and so not that they were trying to be like malignant and like make us work, it just so happened that like we’d be on call overnight and even if we didn’t get much sleep, we, we would be in clinic. Like all day the next day, which was a bit brutal, but, uh, um, it was a great learning experience, you know, and as you mentioned, you know, honestly, we should probably should have just had our own eye because I, I still have nightmares looking at the ed board and it’s like six or seven.

I, I just, I problem, I problem, I problem, I problem. And you know, when you have access to residents. Right. What’s going to happen? Like you’re going to get called about, about, you know, any, any eye problem that comes in. And so it just, I mean, it’s great learning experience, but also makes for a very busy clinic.

And what I didn’t realize, [00:19:00] but it’s just very different out in the community, you know, so, which is kind of where you’re practicing right now, right? You’re, you have more of a community based practice. 

Dr. Andrew Lam: I’m in Western Mass, uh, just to. You know, retina practice that’s filled with bread and butter, macular degeneration treatments.

We’re the only uh, retina group around this western part of the state and we, so we draw from like southern New Hampshire and southern Vermont but um, so we’re doing tons of retinal detachments and um, the basic surgical stuff but of course as you know, Retina practices are full of just injection clinics essentially for people getting anti VEGF or drugs like Avastin, Lucentis, uh, Ilea, Vibismo now for not only macular degeneration but also vein occlusions associated with macular edema or diabetic retinopathy so, uh, you know, obviously we’re thrilled to have these medicines.

I was, I’m not, I’m not so comfortable. All that I don’t remember what it was like before we had them. It was really sad when someone would come in with wet macular degeneration, you’d [00:20:00] tell them, I’m going, you’re going to go, you’re, you’re, yeah, I’ll see in six months. I’m so sorry. There’s nothing we can do, you know?

Will: Yeah. So what do you, what, how do you, how does it make you feel to think of getting an injection in your eye? 

Kristin: Not great. I, I’m not a fan of that idea. No, 

Will: I’m sure there’s probably a big part of your job because I, I can send all these patients, you know, to, I, I, I did a lot of injections in residency, but now we have, we work with a retina specialist in our practice.

And so if it all goes to them, um, I’m sure a lot of, there’s a lot of handholding involved in like telling patients it’s going to be okay. That doesn’t hurt as much as you think an injection in the eyeball is going to do. 

Dr. Andrew Lam: You know, yeah, it’s a lot. It’s not a lot of fun. None of us would want to do it.

Right. I mean, I had my, I had my students will watch me and it’s, it’s like, it’s like, it’s horrific to watch it, but in reality, it’s, it’s actually so routine for us. And, and of course they get used to it and they’re so grateful to not go blind in there with that eye or with both eyes [00:21:00] is quite commonly we treat both eyes.

So, and it’s to the point where, you know, I’m doing it many dozens of times a day. And nobody’s, I tell my staff sometimes, I tell, you know, I’ve just done it like many, many times, nobody in our office is screaming, you know, it’s going to be okay, it’ll be over before you know it, and that’s all true. 

Will: So since we’re, we’re on the topic of, we’ve been talking about emergency type stuff, let’s, let’s help clear up some things for our, uh, for my non, uh, Ophthalmology, you know, healthcare professionals out there because there’s a, I feel like there’s a lot of confusion around flashes and floaters and retinal tears, retinal detachments on how quickly they need to go to surgery.

So what’s the latest, what’s the latest for a, for what I 

Dr. Andrew Lam: generally say? Yeah, 

Will: let’s hear it. 

Dr. Andrew Lam: I would tell people it’s very common to get. Lashes and floaters, but very uncommon to get a retinal tear, which can lead to a retinal detachment, which might need a procedure like surgery. So, for those who aren’t in retina, as you know, the retina is the lining inside the [00:22:00] eye.

There’s a vitreous jelly in the eye that’s, like, very clear when you’re young, but as we get older, it starts to shrink, liquefy, and pull away from the back of the eye. And because it’s sticky, it can tug on the retina. And when it tugs on the retina, it can cause a flash sensation. Doesn’t mean there’s a tear, but it makes you concerned a little bit that maybe I need an eye exam.

Little collagen fibers within the bitrate jelly become opaque, they cast shadows in your retina, which you perceive as a floater. Also, frankly, harmless, but sometimes if you get a whole lot of them, it can be indicative of this process where the jelly is separating from the retina, that process starting.

So, you know, generally You know, people are being, can just see their general ophthalmologist or even an optometrist floaters, and the vast majority of those people will find nothing will be wrong. If that doctor sees something concerning, like blood in the eye or a few specks of red blood cells or certainly a retinal tear, then they send them to a retinal specialist.

And if it’s just a tear before a detachment occurs, then they Then you can just do an office laser and that’s very easy. Sometimes if you’re unlucky, you [00:23:00] can get through the tear onto the retina, start to rip the wallpaper off the wall, for example, and then you have a detachment and then you get a black shade that comes across the vision.

But like flash and floaters generally aren’t like an emergency where you necessarily absolutely have to go the same day. Um, I think within a week to see a provider is fine. 

Will: See that’s, I guarantee you that’s, that’s different than what’s being taught to, for most emergency. I think it’s more urgent or something like that.

Oh yeah. Yeah. Yeah. And, and so there’s. I mean, I think that’s a problem we have in ophthalmology, um, is the disconnect between us and other specialties that do see eye problems. Um, flashes and floaters definitely feels more emergent, I would say, than, um, than it actually is to other fields. So, uh, what about a retinal detachment?

Like, let’s say the emergency department, they, ’cause they, they, they do their ultrasound. They’re pretty good at it. They’re pretty good at ocular [00:24:00] ultrasound. They, they see something, they’re pretty convinced it’s a retinal tear or re, sorry, retinal detachment. Okay. Um, what, how quickly, what does the data tell us about how quickly a retinal detachment needs to be operated on?

Dr. Andrew Lam: So cer the vast majority just to, just in case now, I’m worried that like everybody’s generally thinking reib stuff because it’s so, uh. They’re not familiar with it. Their, their instant reaction is to hurry up and do something. The vast majority of times, this does not have to be seen that same night.

Okay. So sending the next day to a retina specialist is perfectly acceptable and fine. As, as you and your, and the audience may know, there’s a difference in our minds between what’s called a macula on detachment and a macula off detachment, wherein the macula being the center of the retina is what we use to see straight ahead.

It’s observed central vision is very valuable, very precious. A lot of times, frankly, Patients don’t realize they have a detachment until the macula is unfortunately detached. If the macula is detached and the center is totally dark, that actually makes it a much less urgent [00:25:00] situation because kind of the horse is out of the barn.

So we generally fix those within days. If the MAGLA is attached, however, we generally want to try to do it sooner, and generally within, within a day is fine. If I see someone with a MAGLA on detachment, I might do something in the office, frankly, if the, if the detachment and the tear that caused it are in the upper hemisphere, then I can just do an office bubble.

That’s very common now, but if it’s somewhere else needs surgery, I’ll just, we’ll just do it the next day, essentially. 

Will: You have any follow up questions? 

Kristin: Well, that just, I mean, I’m barely following the conversation here, but 

Dr. Andrew Lam: I’m sorry. These are a lot, there are a lot of comments, but most people are asking people at cocktail parties about LASIK surgery.

Should I get LASIK surgery? There’s a lot of Ophthalmology program questions and stuff like that. Yeah. Cocktail party questions. 

Kristin: I’m just thinking like from the patient perspective, if you tell me I have, you know, a macula issue, I’m like, well fix it right now, please. Yeah. You know, like to me as a patient, that would feel Really urgent because like you could tell me the logic of like it’s probably fine to wait up to a day But I’m just [00:26:00] thinking yes, but every moment we wait is another opportunity for it to you know Get worse or or be irreparable So that I don’t know what you tell patients like that because 

Will: that the photoreceptors are hanging on for dear life They’re just waiting to be reattached to their underlying Corroid.

Yeah. I don’t know. I, you know, I think part of it, um, yeah, I, I’m sure that, I mean, that there have been studies that have looked at like timing of like how, you know, quickly, you know, you can risk, you need to restore, you know, the retina to its normal location, but also, you know, It’s, it can be tough to like get, it’s such specialized surgery, it can be really tough to mobilize that in the middle of the night, you know, or after hours, especially if you’re out in the community, it’s just not always a, a possibility to do it like, you know, right then and there, at least do it like a safe surgery, so, I don’t know.

I mean, generally it’s 

Dr. Andrew Lam: very, very rare for [00:27:00] me to be operating at night, you know, it’s, It is, I think that it’s probably true that the concern that the general practitioner out there or emergency room doctor has about like the urgency of it is probably, it can be, it can, it’s not as urgent as, as the, as people think at first thought.

Will: Well, let’s take a quick break and then we’ll come back and talk about your book a little bit.

Hey, Kristen. 

Kristin: What’s up? 

Will: You know, it’d be great to have. 

Kristin: A million bucks. 

Will: Sure. But also a little bit of disability insurance. 

Kristin: Hmm. That would be. We 

Will: kind of dropped the ball on that. 

Kristin: Yeah. Both of them. Cause you got testicular cancer twice and then had a cardiac arrest and now. You’re basically uninsurable, but I love you anyway.

Will: Yeah, it does make it a bit harder. And it’s a disability insurance is something that every physician needs to have. It’s 

Kristin: true. 

Will: Cause our, our job, our bodies and our ability to move our bodies are so important to the work we do. 

Kristin: That’s right. 

Will: Well, let me tell you about Pearson rabbits. 

Kristin: Tell me. 

Will: This is a company [00:28:00] founded by a physician, Dr.

Stephanie Pearson, a disabled OB GYN, who has now dedicated her career to helping physicians avoid similar oversight to, you know, us. 

Kristin: Very 

Will: important word. Exactly. She’s helped over 6, 000 physicians get disability insurance. To find out more and get a free one to one consultation, go to Pearson Rabbits, that’s P E A R S O N.

R A V I T Z dot com slash knock knock. Again, that’s www. pearsonravitz. com slash knock knock to get more information and protect your biggest investment. You.

All right. We are back with Dr. Andrew Lamb, uh, Andrew. So I, I’ve read some of your, your book Saving Sight, which, uh, right up my alley, lots of, lots of, lots of eyeball. Lots of eyeball stories. Um, uh, it’s kind of your journey in, in learning surgery, [00:29:00] learning ophthalmology, and also your upbringing. Um, and, uh, one thing I, I really appreciate how you, you wrote it is you definitely wrote it in a way that, that anybody outside of Of medicine really can, can understand because it’s so complicated.

Like I can already tell, like some of the things, things we’ve talked about, Kristen is just, her eyes just, what? Well, part of 

Kristin: that is because I’ve been listening to eyeball stuff. I don’t understand for about 20 years now. 

Will: Well, the people love it. Okay. But you did, you did a really great job in this book about, um, uh, you know, trying to present these complex.

You know, not just talking about surgery as if everyone understands it, but really getting down into exactly what you’re doing there. Uh, and so tell us about. About your, I want to hear a little bit more about your upbringing and, and I know that you’re, you’re, you’re exposed to the world of [00:30:00] surgery and, and medicine pretty early in life, right?

Dr. Andrew Lam: Yeah, I grew up in central Illinois. My dad was an interventional cardiologist in Springfield, Illinois, and he did, 

Will: there 

Dr. Andrew Lam: were a lot of, uh, heart disease there. And, um, I, I learned a few things from him. I saw how fulfilling like being a physician could be, but I also learned, I said to myself, if I’m going to be a physician, I’m not going to work this hard because we rarely had dinner together.

He never came to watch my games, you know, and he was a great dad, but he was just, you know, going in all the time to open up people’s coronary arteries and stuff. So he had to do it. Um, but I loved history actually more than anything else. So I studied history. I would have loved to kind of be a history professor, write history books and stuff, but it was his influence showing me like how fulfilling medicine could be that made me want to do medicine.

And the book that you were kind enough to mention, Saving Sight, wasn’t supposed to be about me at all. You know, I had gotten this idea that, you know, I’d studied a lot about World War II in China [00:31:00] during college. And when I was a resident at Will’s, I said, I actually said to myself, It’s really a shame I can’t share all this knowledge I have about what the Americans did in World War II in China with people.

And so I, I said, I don’t have time to write a nonfiction book, but I thought maybe I could write a novel because, you know, I’ve seen every war movie ever made and like, I could dream up a romantic epic war story and use that as a way to, uh, convey this history that I love. And so I wrote this novel, I got a book agent, and then when you have a book agent, you spend all your time thinking what else can I write about, because now I have something very valuable, which is access to publishers and stuff.

And I said, oh my god, I’m a very historically minded ophthalmology resident, I think these are stories about like Harold Ridley, who was World War II ophthalmologist who basically invented the artificial lens we use in cataract surgery because he saw a downed fighter pilot with plexiglass in his eyes, or a doctor named Charles Kellman, yeah, there’s some amazing stories, a lot of them have to do with military history, which is my passion, and Uh, this guy named Charles Kelman, who invented phagoemulsification, which is how we [00:32:00] take out cataracts.

And he just had this epiphany when he went to the dentist’s office and he was using this ultrasonic probe. And that’s basically how we got our, our, um, techniques. And I said to my agent, I got it. I got a great idea for my next book. It’s gonna be a book about ophthalmology’s heroes. And there was like complete silence on the other side of the line.

And she goes like, I, I, I, I’m sorry, I just don’t think that’s going to work. And I said, why not? I was crestfallen. And I said, these are amazing. And she’s like, I just don’t think people are going to buy a book about ophthalmological history, the general public. And after I thought about it, of course, she’s right, like, she doesn’t want to waste time with a book that’s not going to sell well, and I shouldn’t waste my time, uh, writing a book that’s not going to sell well.

But I didn’t want to give up on these stories, and then I thought, what can I do to make it more marketable? And I said, what if I brought the reader into the operating room, to see what it’s like when i’m trying to save site or trying to learn or more interestingly what it’s like when i’m coming up against a tough complication and frankly don’t know what to do or there’s no good options and i think that obviously is what made it this [00:33:00] a pretty pretty successful book and and actually the master of medicine which is my newest book it only came because people said Your Saving Sight book was great.

It inspired me going to medicine or the stories were incredible. You should do that for all of medicine. And that’s why that book came about essentially, because we want to share how all these other fields have incredible unsung heroes who invented techniques and cures that we use today. 

Will: Yeah, just being able to relate to a general audience is such a valuable skill.

It is a for our whole careers are just so. into all the medical jargon and terminology and just being able to think outside of ourselves and relate these complex ideas, um, is, I think we need more of that, you know. Tell us about a, tell us a story from, from Saving Sight, um, about, I want to hear about intraocular foreign bodies.

You know, so traumas. Sure, yeah. Traumas happen, people. [00:34:00] You, I’m sure you saw some of those in residency, right? Oh yeah, I’ve seen them. I saw. I saw a rather large BB, uh, that was an intraocular foreign body, uh, which was the first time I saw a magnet. So I’d love for you to tell people about doing those types of surveys.

Yeah, I actually related 

Dr. Andrew Lam: a great story in Saving Sight about one of these incredible intraocular foreign body stories. So, when you have an intraocular foreign body, it’s usually a situation where there was a high velocity piece of metal near the eye, often an auto mechanic or someone’s grinding metal with no safety glasses, um, and so the patient comes in and, A ruptured globe is a very bad situation.

The eyes like a squash grape basically. And if you come to a regular emergency room, they might not even see it because the eyelids are usually so swollen. They don’t, they, they, they can’t, they’re not kind of confident enough to pry the eyelids open and press ’em against the orbital rim like we as ophthalmologists are.

So you go there and you see telltale signs like [00:35:00] chemosis, which is like a way the, the conjunctiva looks swollen or just. Clearly like, you know, a cornea that’s been lacerated and you do a CT scan and there’s like metal in the eye. So when you take them to surgery, your primary objective is to get the metal out and sew the eye shut.

And that can be very challenging. Um, there are definitely times when getting the magnet out, getting the, getting it out with a magnet is the best option. And there’s a couple ways you can do that. There’s a couple magnets we had in training where one is literally like some sort of, I think it was like a rare earth magnet where it was like the size of a shampoo bottle and you could step on a pedal and it would activate.

And I’m thinking like X Men, the guy with the metal coming. The X Men guy with all the metal, literally it will draw whatever is in there very rapidly to the shampoo tip, right? And so, if you’re in a situation where like, there are definitely times when that’s a useful thing, but it can be very abrupt and you have no control over that metal.

A more elegant way to do it is [00:36:00] sometimes you have like a little stick, like the end of a, like a lollipop stick with no lollipop on it, and you can insert in the eye, and it’s kind of always magnetized, and if you have, Your scope, like a biome, and can look at the retina, you can literally just bring it close, and the metal will attach to it and you can draw it out of the eye.

Except sometimes, there’s no like I think 

Kristin: I might have a little vasovagal in a minute. 

Dr. Andrew Lam: I know, there’s a lot of My kids might listen to this and they might faint, I don’t know. But basically, the problem is, the problem is like, there’s never like a standard situation. The whole is never standard. The hole was not, like, you might make an incision, but it might not be big enough.

And you might try to bring it out, the hole’s a bit bigger, it falls back into the eye, and you’re terrified you just cratered the retina again because it fell in the back of the eye. And there’s, there’s never, uh, there’s, it’s always different. Um, but that’s, those are, those are satisfying to do because very few people can, can do it, but, It’s also requires a lot of empathy, obviously, [00:37:00] because these are very traumatized eyes and their prognosis is going to be very poor.

So, how about you? Did you have any great stories where people, you saved eyes that you didn’t, the best is when you do a ruptured globe and then a year later, you see the patient again. It’s like, wow, the body is amazing. I didn’t believe it could heal this well. I mean, did you have 

Will: any of those good stories?

Yeah, I mean, I’ve had a few traumatic open globes or Almost always poor prognosis. Like it’s just, you know, something that’s, some trauma that’s bad enough to cause an open globe, it’s, it’s generally not going to be a good thing. The, the, the, the best prognosis ones are actually often in kids. Or like young people, like they get, it’s like a, something sharp, like a pencil or something.

It just small little puncture wounds, you know, you can just go in, you just, you can, maybe it’s like a self sealing corneal, uh, lac. 

Dr. Andrew Lam: Arbitrious in a young person is so formed, it’s. It’s [00:38:00] very forgiving in some ways. 

Will: And so, and so it does seem like the younger you are, and I don’t know if there’s any truth to this, but the younger you are, the, the, the more likely you are to be able to, you know, maintain good vision.

Um, but I’ve had plenty of the opposite, you know, where, uh, you, you kind of know You know, you’re going to eventually have to just remove the eye, but you always try, you always, you always try, you always close up the eye to form it. And then, because, and that’s the classic teaching in ophthalmology is, is you never do what’s called a primary enucleation where bad trauma, you just take out the eye, unless there’s literally no eye to like fix.

You always try to fix it, you see what you’re left with in terms of vision. Have the, allow the patient, work with the patient to come to the conclusion that, okay, this eye is not going to see, or it’s going to be painful for them to have the eye still, which is a common thing, [00:39:00] but we call it blind, painful eye, no one wants to live like that.

And we can do amazing things with prosthetics now. And so, um, And so often they, it ends up with a enucleation. You’re doing great, Kristin, you’re really, you’re hanging in there. So how about that writing process, huh? 

Kristin: Let’s see. 

Will: Um, but it’s, uh, you know, there’s one thing, uh, I really appreciate having retina specialists in my practice in part because, uh, sometimes I have to give you, um, Business, that’s, that’s my own fault.

So, um, yeah. And so I, just in case there are, there are trainees listening to this or are interested in this. And one of the most challenging things as a new surgeon is having complications. Absolutely. And 

Dr. Andrew Lam: we all have them. 

Will: We all have them. Uh, if you, the only way to avoid complications is to not operate.

And one of the complications that [00:40:00] is probably the, one of the most common complications as a cataract surgeon is, remember I talked about that? The peanut m and m? Mm-hmm . Well, if you break the candy coating shell. On the back end, then sometimes the lens can fall, the cataract can fall into the back of the eye, which is a place I dare not go 

[Music]: as 

Will: a cataract surgeon.

Uh, and, and that’s, that’s a complication. You don’t want that bag, that capsule bag to break because then. You have to, all the vitreous, that jelly in the back of the eye, it starts to come forward. You have to clean that up and then you can’t fish out the little pieces of the cataract. Yeah, tell me more.

Uh, and I used to be like, so, I mean, it’s obviously. It always sucks to like, have a complication, um, and whenever, you know, I was at the beginning of my career, or as a resident, it always seemed like the end of the world, like, oh my gosh, like, this [00:41:00] patient, it’s, it’s, this is, I’m never going to be a practicing surgeon, I’m never going to have a successful career because I made this mistake, or, feeling like my retina colleague is, absolutely hates me.

Because I’m giving them this really difficult, challenging job to do, cleaning up my mistake, and one thing I’ve learned in practice is that 

Dr. Andrew Lam: it’s not 

Will: a big deal. 

Dr. Andrew Lam: Yeah, so if there are cataract surgeons out there or residents, please drop lenses for a retina surgeon, it’s no big deal. It’s easy, we don’t want you to touch.

We don’t want you to try to be a hero. Don’t go into the vitreous cavity. Don’t try to levitate anything. Basically just put a stitch in your wound. And if you can put the lens in, that’s great. Cause I don’t want to have to put the lens in, but it’s very routine and easy for us to get the pieces out. Uh, and the patients often do extremely well.

And that’s, that’s not, not, not, that’s not a bad one to be honest, but I do know what it feels like to feel very bad that you messed up. I mean, like that happened in all residents have that experience. 

Will: Right. And [00:42:00] that’s the thing. It’s. Most of the time, it never ends up being as bad as you think it’s going to be in your mind.

And the patient, the eye is very, can be very resilient and, uh, they come back and they end up doing okay for the most part. So it’s, but it’s, it’s still, it doesn’t feel good. And, but complications, like you said, they happen. I mean, I’m now, you know, 10 years into my career and dare I say you’re a bit farther.

Into your career than I am just a little bit 15 years out. Maybe yeah. Yeah, and things still happen You know, it’s just it’s just a fact of practicing medicine. So, you know, what? 

Kristin: Well, everyone makes mistakes in their job I think everybody can relate to that no matter what your job is. 

Will: Yeah, just you for saying that 

Kristin: Yeah, 

Will: yeah 

Kristin: like You know, sometimes you reply 

Will: all on accident.

Kristin: Right. That does happen. Sometimes you thought you buy 

Dr. Andrew Lam: CC’d 

Kristin: and sometimes it gets you fired and sometimes you drop the 

Dr. Andrew Lam: lens and sometimes you Yeah. 

Kristin: Insulted the CEO or [00:43:00] something. Yeah. Like it, it happens everybody. Sometimes you take 

Dr. Andrew Lam: someone’s lunch out of the fridge, even though it says don’t 

Will: eat. That’s right.

Kristin: But 

Will: I think sometimes we’re our own worst enemy as physicians. ’cause we are so perfectionist. Yes. Yeah. And we. I don’t know how many times I’ve had 

Kristin: to remind you over the years that, um, you know, you are a human, in fact, and this is just a feature of being a human. It’s not a bug. 

Will: How was, uh, Andrea, how was your, uh, what did your dad, uh, think whenever you decided to be an ophthalmologist?

Dr. Andrew Lam: You know, and, um, I think in his day, training in like the early 70s, um, the best and smartest went into medicine, right? Like the people who were dumb, quote unquote, went into surgery because they’re just technicians. Like the smart cerebral people, you know, they tell the joke, Oh, if we want to stop the elevator doors from closing, I’m going to stick my hand between them.

But you, you’re a surgeon. You’re going to stick your head between them because, That’s not the most important thing. Your hands are the only thing that matter to you. So, but then, you know, as you [00:44:00] know, medicine got much more lucrative for people who have procedures and people wanting to do surgery. And then people started wanting to have good lifestyles.

And so like ophthalmology becomes popular dermatology. Um, I had the benefit of going to medical school and knowing a lot about different fields in medicine. And I, I think a lot of my classmates in med school thought they had to have a stethoscope around their neck to be a real doctor. I never felt that way.

I knew there were other fields that I could really enjoy and love, and I really wanted to be a surgeon, but I wanted to have a pretty, you know, a good life that would allow me to do other things like, you know, be a, raise my kids or write books. And so that, that’s, And great. So I, I look, I think that I’m sure he’s happy for me that I do these things.

I think he recognizes dads these days, unlike in his era, actually have to do stuff. Like the first diaper I saw him change was my kid’s diaper. So, you know, it’s a totally different era. Right. So he, I think he’s happy that I made a choice that was good for me. 

Kristin: That’s all you can ask for. That’s a good dad.

Yeah. [00:45:00] Yeah. 

Will: That’s good. And you’ve, I mean, you’ve practiced in so many different settings too. You did your internship in Hawaii, right? 

Dr. Andrew Lam: That was great. Best year of my life. If you look at my life and I have four kids. Uh, I’d still go back to Hawaii, just forget the kids, forget the books I’ve written since then, like, it’s, it was an awesome time.

Will: Was this pre kids, right? Your internship? Yes, after 

Dr. Andrew Lam: med school, transitional internship, uh, class of ten people every year at the University of Hawaii. Probably the hardest thing I’ve ever gotten into, frankly. 

Will: Kristen knows all about the transitional years. Poor residents, because I did one too. Poor residents these days don’t know the magic of a transitional year.

Usually they’re doing integrated internships where they’re actually working. 

Dr. Andrew Lam: It’s changed. Yeah. 

Kristin: I think you had maybe two rotations that year where you actually had like a real work schedule. A real 

Will: doctor’s schedule. Yeah. Was, uh, so, so, uh, um, Hawaii. Yeah, it was fantastic. Oh my God. Which, which Island were you on?

Dr. Andrew Lam: [00:46:00] Well, we were on Oahu, which is where Honolulu is. And I mean, for me, I’m Asian American. I grew up in a place where there were very few Asian Americans. It’s the first place I was ever in the majority. And to be honest, that was, that was just a totally different feeling. Like you don’t realize you walk around all your life with like this on your shoulders.

And then you realize, Oh my God, This is how other people feel, this is how white people feel basically, um, but at the same time there’s some things like, you know, there were Caucasian people who were discriminated against in Hawaii because they were the minority and I saw that happening and I realized people are the same everywhere, all over the world, all, in all times, so.

But in addition to that, you know, the training was, was good, they have a lot of really good People there, and it’s the only med school in Hawaii, and of course they get incredible visiting professors, as you can imagine, who get their free trip to Hawaii, um, and there were a lot of, a lot of great people, and there were some very unique situations, like, you know, I’d worked in an ER in Philadelphia in med school, but I worked in the ER in [00:47:00] Hawaii and had totally different problems, like sea urchin stings or going on an ambulance run to the beach to get a lot of the, uh, the calls were for elderly tourists who basically had chest pain on the beach.

And we’re taking, we’re trying to get these big wheelchairs or gurneys onto the sand. And you’re on this, you take a, you look around and you’re like, Oh my God, I’m like an incredible beach. It’s beautiful. And this poor guy’s having a chest pain and, or, or because Hawaii is the only major. Like medical trauma center in the Pacific, you’d get calls from like islands, far flung islands, 

Will: like, there’s 

Dr. Andrew Lam: this American island called Johnston Island, which is where we basically have studied and disposed of our chemical and nuclear weapons.

And there’s Americans there. And then some guy will be five hours away and, and they’ll be like, we’re bringing in a guy with chest pain. We’ll be there in five hours. We’re getting on the plane from Johnston, Johnston Atoll is the name of it. And, and it was just like bizarre because you’re used to normally like.

Chest pain coming in 15 minutes from a nearby neighborhood. So, but it was really great. How much ophthalmology did you learn? [00:48:00] Uh, so many of people who listening may not realize before you get to ophthalmology residency, you don’t actually know how to see the retina or look in the eye very well.

Will: Absolutely. So my 

Dr. Andrew Lam: goal doing a one, one month rotation was just to be able to use the indirect ophthalmoscope 

[Music]: to 

Dr. Andrew Lam: see the back of the eye. And I was able to do that, which put me a huge step ahead when I got to residency. I’ve 

Will: got to say that was a huge step ahead because I couldn’t even do that. That was, nor did I really make that concerted of an effort to be able to do that during my intern year.

But that’s, that’s the thing with, uh, the trainees now, you know, they, they’re so far ahead of the game. Once they get to that first year of, Uh, basically their second year of ophthalmology, uh, they can already do so much with, you know, being able to operate a slit lamp and 

Kristin: I’m sorry. What are you 

Will: laughing at?

Kristin: Between 

Will: What are you laughing at? 

Kristin: We’re probably going to have to cut this, but between all the eyeball talk and Milo’s farting Oh 

Will: yeah, our dog 

Dr. Andrew Lam: just ripped one. Oh, nice. 

Kristin: It’s so bad. 

Dr. Andrew Lam: I thought we were doing a new fan, we’re talking about [00:49:00] Hawaii now, that’s not gross. No, and then he had to ruin I can’t control your pets on your side of the screen.

Kristin: Oh boy. He knows what he did. 

Dr. Andrew Lam: Are you, are 

Will: you gonna be alright? I’m just really struggling. You’re struggling today? It’s a tough one. I’m, 

Kristin: like, it’s a little, a little, uh, not seeing stars exactly, but a little far 

Will: to see. We’re, we’re, we’re almost there. 

Kristin: Woo! Alright. 

Will: Um, are you ready? Are you, are you okay? 

Kristin: Yep.

Will: All right, do you want to, which direction do you want to go? Do you want another gross eyeball thing? Or maybe we can talk about his new book. 

Kristin: Let’s do that. You wanna do 

Will: that? All right. 

Dr. Andrew Lam: That sounds safe. Let’s do that. 

Kristin: It’s really, it’s just eyeballs. I feel about eyeballs like he feels and a lot of people feel about teeth.

Like it’s just a really squeamish area that I have. That’s common. I can talk about other parts of the body a lot better than eyeballs. 

Will: Let’s talk about your new book, uh, The Masters of Medicine. Uh, so it sounds like you, you’ve, you branched out into other areas of medicine [00:50:00] with this? And yeah, is that right?

Dr. Andrew Lam: Yeah, after I wrote my book, Saving Sight, about the heroes of ophthalmology and all the incredible stories of perseverance, grit, and serendipity and lucky mistakes, Uh, that book was pretty successful and people said, you should do that for all of medicine. And I was a kind of an arrogant ophthalmologist.

I thought all the best stories of discovery were in our field, but I started reading about, you know, during the pandemic, I had more time. I was kind of like one of these docs self quarantining in my, in a guest bedroom because we were seeing patients as, as you all know, and many of your listeners, I’m sure are familiar with.

So I had time. Yeah, I would binge, binge watch TV and watch all The Walking Dead. And I mades. I was in the middle of . Yes. I made, I made tiktoks. Yeah. You actually contributed to the world. Yeah, I think I was in the middle. That’s questionable. That’s, 

Will: that’s, but yeah, thank you, . 

Dr. Andrew Lam: I was in the middle of Tiger King and I thought, oh my God, I think I could do something more valuable with my time.

[Music]: So I started 

Dr. Andrew Lam: reading and my dad was a cardiologist, so I started reading about cardiac history and I was blown away. I’m like, oh my God, these are, oh, yeah. Even better than the stories in ophthalmology. Like the guy who, uh. [00:51:00] Wanted to show as possible to catheterize your heart through an arm vessel Werner Forsman in the 1920s a German intern And he just did it to himself and risked his own life or the people who invented basically open heart surgery to operate on beating hearts during World War two because they had soldiers whose chest had been blown apart with shrapnel or bomb blasts and they were able to like Operate on them because there were pieces of metal embedded in the heart walls and lodged there so they weren’t dying instantly Yeah, but they said we got to do something to save their lives and that’s how they started doing open heart beating heart surgery And then they showed that the they had success and it showed that the heart was a viable surgical target And then that led to the advent of the heart lung machine and other inventions that made cardiac surgery an actual field And I was just blown away And I, and then I said, I read about the discovery of insulin and how these Canadians, they invented this, they discovered insulin, but they hated each other so much.

That one of them almost refused his Nobel prize just because he was so incensed that his partner was going to get one because he thought his [00:52:00] contribution so outshined this other guy’s and I, and I realized like these stories are basically human stories full of like fallibility and envy and jealousy and I was hooked and I said, Oh my God, we got to, we got to write these stories of these medical heroes and the book is separate into like different important chapters of that are diseases like heart disease, cancer, diabetes.

Trauma, and there’s lots of incredible stories like how penicillin was discovered and how we actually credit the wrong person for discovering that. We credit Alexander Fleming who discovered a lucky observation where there was like a wayward mole that had fallen on his petri dish and he saw that the bacteria around it were dead, but he didn’t do anything with that.

He just wrote a paper in the 20s and it wasn’t until 10 years later. That these British doctors from Oxford actually developed penicillin, did all the work for it, Howard Florey, Ernst Chain, Norman Heatley, and they were the ones who got the medicine penicillin, which was the wonder drug in World War II, [00:53:00] and what happened was, journalists who went to interview Fleming and Florey, They found Flory to be very, very cool to them because Flory was very ethical.

He’s like, doctors should not do anything that would be self aggrandizing or for publicity, so he wouldn’t talk to them. Meanwhile, uh, Fleming loved the attention. He would’ve hated me. Yeah, he fit the picture of like this gray haired genius old British doctor and the, the, the Journalists started just going to him and giving him all the credit and getting it wrong.

And so every school kid knows Alexander Fleming, but he didn’t really invent penicillin. So there’s incredible stories like that. There’s rivalry between like Jonas Salk and Albert Saban for the penicillin, I’m sorry, for the polio vaccine. There’s just a lot of drama, so. I love the beefs. 

Kristin: Yeah. 

Will: Yeah. Well, that’s great.

Very nerdy beef. Yeah, 

Kristin: exactly. 

Will: What a great, that’s just, it’s just a great idea for a book though. And I, I’ve so like, what a lesson this is in, in [00:54:00] combining two passions, right? That’s something that I’m talking about. I talk about a lot with comedy and medicine. Well, you know, you’re saying that you really had this, this thing for history and so being able to, you know, To work that into your career, I think is something that probably help, would help a lot of people to recognize that you can do in medicine and it’s something that’s, that thought gets kind of beaten out of us, right?

That we can’t, we don’t, you know, medicine has to be your life with nothing else around it. And, um, so I think it’s cool that you kind of combine two passions. 

Dr. Andrew Lam: Yeah, well, so are you. Both of you are doing the same thing and helping a lot of people. So 

Will: yeah, some bring a lot of mirth. Some people do, you know, uh, valuable things during a pandemic and some people watch Tiger King or make TikToks, you know, it’s, it’s, uh, 

Kristin: Takes all kinds.

It 

Will: does. Um, so people can find Masters of Medicine out now is that it’s, yeah, it’s everywhere 

Dr. Andrew Lam: where books are sold. Masters of Medicine. Yeah. 

Will: And, uh, [00:55:00] you also have an Instagram. People can find you on Instagram at Andrew Lam MD. Anything else? My 

Dr. Andrew Lam: website’s andrewlammd. com, um, I’m on Facebook as well, so. 

Will: And, uh, uh, how, just how’s, uh, how, how is your, your mental state with ophthalmology?

Are you, are you, uh, enthusiastic about the future? Are you, Are you, uh, yeah, how are you doing? I mean, 

Dr. Andrew Lam: especially in our field, retina has so much research going into diabetic macular edema, macular generation, dry macular generation in particular. Obviously, there’s a lot of companies that just want to get super rich with the next.

Uh, big thing, obviously, and in my practice, we’re very involved with a lot of national clinical trials as well, um, and that’s how a lot of, a lot of, uh, developments occur, but obviously you also have to kind of check your conflicts of interest and make sure, you know, a lot of this is being profit driven, obviously, yeah, but it’s an exciting time to be in ophthalmology and You [00:56:00] know, a lot of people like doing research on ophthalmology conditions because it’s easy to see the result, like you can examine the eye, the inside of the eye, and see what the drugs are doing.

Gene therapy, stem cells, those are all great kinds of place, the eye is a great place to test these kinds of things and get results. Um, to see if you can get a good result, essentially. 

Will: That’s awesome. Yeah. A lot of cool stuff in retina world. I, I hear about a little bit from our retina specialists that work with us.

And, um, you guys are really at the forefront of, um, of a lot of stuff that’s going on just because it, you know, you’ve got a lot of diseases that we, we have good treatments, but. Still, you know, yeah, it’s a pain to get injected 

Dr. Andrew Lam: every month, a ways to go. We’re trying to make it better, make it last longer, you know, yeah, they’ve tried a lot of different things.

Will: Yeah. Um, well, thank you so much for joining us, uh, Andrew, and it’s just awesome to get to talk to you and keep, keep writing. Uh, yeah, I’m looking forward to, what’s the next book going to be? Or is that, is that just too painful [00:57:00] to think about right now? Writing another 

Dr. Andrew Lam: book. Yeah, I’m in a bit of a break now.

So I learned also, uh, not to divulge projects that you think you can do because sometimes it takes a long time. I, after my first novel, I wrote another novel and I, and I actually started talking about it in my book talks, but it took a long time to get a publisher, which is humbling. So it was many years later before my next novel came out.

And so, yeah, but thanks for asking. Maybe there’ll be something down the pike. 

Will: Yeah, don’t, don’t, don’t put the cart before the horse, I think is what people talk about with that. Um, all right. Well, thanks again. It was awesome talking to you. 

Dr. Andrew Lam: Appreciate it. Thanks.

Will: Hey, Kristen. What? You know what mites do when they get excited? They dance! They dance! They dance all over your face. 

Kristin: Ugh. 

Will: You got these on your eyelids. You know that, right? I do not. Well, some people do. Okay. They’re demodex mites. 

Kristin: Yes. 

Will: They cause blepharitis. [00:58:00] which is like red, itchy, irritated eyelids, like flakiness, you want to scratch your eyes, and don’t do that by the way.

But yeah, sometimes that’s from a disease. Demodex 

Kristin: dance. 

Will: It’s the demodex dance on the eyelids, except it’s not that fun because it gives you all those symptoms. All right, so yeah, but they’re cute, right? They’re not, they’re not gross. 

Kristin: These ones are, these, these stuffy. 

Will: Oh, the real ones, not so much. 

Kristin: Are the real ones gross in the microscope?

Will: Um, they’re still, I think they’re still cute, but again, I’m an ophthalmologist. 

Kristin: Yeah. 

Will: But don’t get freaked out by this. Okay. Get checked out. All right. All right. You can find out more, go to eyelidcheck. com. Again, that’s E Y E L I D CHECK. COM to get more information about Demodex and Demodex Plus.

Blepharitis.

I am so glad we did a dentistry episode and an ophthalmology centric episode [00:59:00] relatively close together. 

Kristin: Yeah, we’re recording those in the same day and, uh, it’s, it’s been a, it’s been a day. It’s been a rough day. One for each of us. 

Will: Yeah. I mean, we, we got through it though. Like you said, um, you know, during the dentistry episodes, like exposure therapy.

[Music]: Yeah. 

Will: I, it was so funny, like, as he was describing, like using a magnet to pull a metal out of an eyeball. I looked at you and you looked like you were almost gone. Like you were, like you were, you were, you’re, your brain was hanging on by a thread. You were trying to pass out, but you didn’t. 

Kristin: I was starting to, I don’t, what do you call it?

It’s not like stars, but kind of like black and white. Yeah, maybe tunnel vision. It was 

Will: closing in? Yeah. Things 

Kristin: were happening. Yeah. 

Will: You were struggling. It was 

Kristin: hard. Also, because I was in grad school, I did, um, fMRI research, as you know, which is a gigantic magnet, an MRI machine. Yeah. And you get, it just gets like.

Pound it [01:00:00] into you. 

[Music]: No metal, no metal, no metal, no metal, 

Kristin: right? Because it’s a gigantic magnet and if you have any metal on your body, it will just pull it out. So you were imagining. So yes, like that’s just like my baseline for, for magnets on the body. 

Will: That’s like third line therapy is just putting someone into a, into an MRI and just letting it pull.

No, we don’t do that. We don’t 

Kristin: do 

Will: that. 

Kristin: It was rough. 

Will: I like hearing him talk about it. He’s, he’s really, he’s good at talking. And telling stories. I like listening to him. 

Kristin: Yeah, I could tell that you were very much enjoying yourself. I was really into 

Will: it. I was super into it. You love eyeballs. Oh man, I gotta, we gotta have him come back for Knock Knock Eye.

Kristin: Yeah. 

Will: Um, alright. Let us know, guys, what you think. We want to hear from you. Uh, give us your, your, also give us your guest ideas. Who have we not? What’s, what specialties in medicine have we not talked to yet? 

Kristin: I mean, there’s so [01:01:00] many of them. There’s gotta be some that we haven’t gotten to. 

Will: Uh, and so you can, uh, lots of ways to hit us up.

You can email us at knackknackhigh at human content. com. You can also hang out with us on all our social media platforms. Our human content podcast family is on Instagram and TikTok. At Human Content Pod. See all the offerings? Uh, I got some great stuff. Great stuff. Thanks to all the listeners leaving wonderful feedback and reviews.

We love those reviews. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out. Like on our YouTube channel, at Glaucomfleckens. We have at the Magnolia Witch. Uh, about um, our episode, 100th episode, where we talked about old person smell. Remember that? 

Kristin: I do.

Will: Said, what an episode. To have post on my 40th birthday. Happy 100th, y’all. Uh, I appreciate it. I 

Kristin: feel your pain. 

Will: Yeah. I don’t know if we, if we decided what age it is that the chemical starts to secrete. I don’t think we did. 

Kristin: No, hopefully not 40. Do I have old person smoke? No, um, not [01:02:00] usually. Not usually. 

Will: But we also have a Patreon, lots of 

Kristin: cool 

Will: perks.

On our, on our Patreon. Oh, uh, full video episodes up every week on our YouTube channel, by the way, at Glaucomfleckens, Patreon. Lots of cool perks. God damn Milo. 

Kristin: Oh man. 

Will: Oh, it’s been a day, two days of this. You know what you did. Look at me. Look at me. God. It’s, oh, that was really 

Kristin: You have no idea. No idea. Oh, we have a Patreon, 

Will: lots of cool perks, bonus episodes to react to medical shows and movies.

Kristin: Our dog 

Will: Oh, you can hang out with other members of the community. We have early ad free episode access, interactive Q& A livestream events. We have a lot more. We have dogs that are smelly. Patreon. com slash Glaucomflecken. Oh, we got a Glaucomflecken. com. Speaking of Patreon community perks. New member shout out.

Cassandra C, Evan C, Denise Z My eyes are watering. [01:03:00] Nicole G. Thank you all so much for being part of our None of you 

Kristin: deserve what’s happening right now. Shout out to the Jonathans, 

Will: as usual. Patrick, Lucie, Sharon S, Edward K, Steven G, Marion W, Mr. Green Daddy, Caitlin C, Brianna L, Mary H, it’s dissipating, K L, Keith G, Jeremiah H, Parker, Mohamed L, David H times 2, Kaylee A, Gabe, Gary M, Eric B, Marlene S, we don’t have a lot of inhalation in this room, Scott M, Kelsey M, Dr.

Hoover, Bubbly Salt and, you know, Virtual R. I. P. to Pink Macho, of course. Patreon Roulette, random shout out to Amy! Amy, thank you for being a patron, and thank you all for listening. We are your hosts, Will and Kristen Flannery, also known as the Glaucomfleckens. Special thanks to our guest, Dr. Andrew Lamb, and to our horribly smelly dog, Will.

Milo. Our executive producers are Will Flanner, Kirsten Flanner, Aron Korney, Rob Goldman, Shahnti Brooke, editor engineer Jason Portizo, our music is by Omer Ben Zvi. To learn about Knock Knock High’s program, disclaimer, ethics, policy, submission, verification, and licensing terms, [01:04:00] and HIPAA release terms, you can go to, I got a headache now, you can go to Glaucomflecken.

com or reach out to us, knockknockhigh at human content. com with any questions, concerns, or fun medical puns. Knock Knock High. is a human content production. 

Kristin: Why don’t you crack a window?

[Music]: Goodbye.

Will: Hey, Kristen. Yeah. What do you think about clinical documentation? 

Kristin: Boo. 

Will: You feel that strongly about it? 

Kristin: I do. 

Will: Why? 

Kristin: Because your doctor ends up spending all their time typing little notes on their little computer instead of like, listening to you or looking at you in the eyeballs. 

Will: Well, it sounds like your doctors could use DAX Copilot.

Kristin: I bet they could. 

Will: Yeah. This is like a little Jonathan in your pocket. It’s, it’s, it’s, it’s an AI assistant that helps, uh, decrease the administrative burden [01:05:00] that leads to burnout and leads to like your doctor’s not being able to look at you while they’re talking to you. 

Kristin: Yeah. It helps them do their little typing and take their little notes without having to do it themselves.

Will: 93 percent of patients say their physician is more personable and conversational with Dax Copilot. You love conversation. 

Kristin: I do. And I want them to be a person. 

Will: And that, that’s, and that we need that because today’s physicians are overwhelmed and burdened and they feel like work life balance is unattainable.

That’s 

Kristin: right. And 

Will: we know that work life balance makes you a better physician. 

Kristin: That’s right. 

Will: To learn about how DAX Copilot can help you reduce burnout and restore the joy of practicing medicine, visit aka. ms slash knock knock hi. Again, that’s aka. ms slash knock knock hi.