Getting to Know Acute Care Surgery & Dr. Morad Hameed

In this episode of Scrubcast, host Rachel Baker interviews Dr. Morad Hameed, who recently joined Stanford as the chief of acute care surgery. They discuss Dr. Hameed's transition to Stanford, differences between Canadian and U.S. healthcare systems, and what drew Dr. Hameed to trauma surgery. Dr. Hameed shares an exciting trauma case and explains the nuances of trauma, emergency general surgery, and surgical critical care. The conversation also touches on Dr. Hameed's experiences in leadership roles, global surgery projects, and advice from mentors.

Rachel Baker: [00:00:00] Welcome to Scrubcast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today, we're speaking with Dr. Morad Hameed. Welcome to the show and indeed, welcome to Stanford.

Dr. Morad Hameed: Thank you for having me, Rachel. I'm a big fan of Scrubcast.

I've been listening to it and I'm thrilled to be here.

Rachel Baker: Wonderful. Well, so Dr. Hameed joined Stanford as our new chief of acute care surgery this past January. How are you enjoying the San Francisco Bay area so far?

Dr. Morad Hameed: We love it. It's so fun to be in California. I think just that sort of frontier spirit, you know, the spirit of adventure, of innovation that, you know, that you identify with California.

It's really cool to be part of that. The Bay Area has a big part in my family's history too, so that's fun to, to, to be part of it. And then being part of this group, like at Stanford Department of Surgery, like I already [00:01:00] have role models here and Drs. Han and Kabebu and Spain, who's like a giant in our field.

Just being around them is pretty amazing. And uh, my trauma acute care surgery group here has been so welcoming and I'm, I'm pretty starstruck honestly, just to be in this environment.

Rachel Baker: Wonderful. Have you taken up, uh, surfing yet?

Dr. Morad Hameed: Once I learned how to swim, that's like step one and then, oh

Rachel Baker: my gosh. Okay.

We'll work on this. Very important. Well, so you did your surgical residency in Alberta. Then you did your fellowship in Miami. Now you're coming to California from Vancouver General Hospital and the University of British Columbia. What are some of the biggest differences between the U S and Canadian health systems, but particularly where it comes to your area of expertise?

Dr. Morad Hameed: I spent the last almost 20 years, 19 plus years in Vancouver at Vancouver General Hospital. And that was, a beautiful experience. It's a phenomenal place. [00:02:00] VGH is a big quaternary hospital. It's got a catchment of like 4 million people. So it's busy and acute and complex. And my trauma and critical care groups came over the years, my family, my experience there was just wonderful.

And, uh, and I was kind of evolved to be in that environment and coming to Stanford has been in some ways a new period of discovery for me. Um, and I, I have been able to see some distinctions between. I would say like a big difference, I think, in Canadian healthcare is that Canadian healthcare is designed to provide high quality care to the population and not so much for innovation.

Um, it is innovative and I think innovation does fall to individual providers, but I would say it's not the top priority, whereas coming to an, you know, an academic medical center in the United States and particularly to Stanford, I noticed that contributing to knowledge, [00:03:00] innovating is expected, you know, and the system is sort of built for that purpose.

And I feel that here we are all expected to be at our best, to be our most creative and to keep pushing the boundaries of knowledge. It seems to be like that people are here in order to fulfill their potential, whatever that may be.

Rachel Baker: I think you may be getting a little more innovation than you would elsewhere since we are in Silicon Valley. We're definitely all about the innovation.

What was it about trauma surgery that drew you to it originally?

Dr. Morad Hameed: At the very beginning, the, the original draw, um, was the physiology. Like the, the physiology is so fascinating that people can be bleeding, feel can be in shock and the interventions that we have to reverse that physiology, to restore that physiology to normal, that's what really drew me, it's so fascinating.

And then in order to do that well, um, you, it's not an individual effort. It's very much a coordinated [00:04:00] team effort. So that coordinated. You know, that symphony of teamwork that's needed to reverse that physiology also fascinated me. And I love being part of a high functioning team. That was appealing to me.

And if it's done well, you can not only save life, but you can restore good long term outcomes just from that strong coordinated intervention in the moment. But, but I'm also from a, from a family of social scientists. And one thing I love about, uh, yeah, about trauma and acute care surgery is that It really does focus on societal problems, like trauma, injury control.

It focuses on populations that have been historically marginalized or underrepresented. So I really love that part as well. So right from the physiology to the societal implications, I think trauma and acute care surgery really covers that whole spectrum of things in itself. That's why it's such an amazing area to work in.

Rachel Baker: That's such a great response. I love that. Carla Pugh, uh, [00:05:00] one of your colleagues, this question is coming from her. She asks, what was your most memorable, unusual, or exciting trauma case? particularly successful penetrating cardiac cases? I feel like she's asking a very pointed question here.

Dr. Morad Hameed: That's a very specific question.

I have many stories, it's hard to choose, but um, the one that's kind of stands out, it was a regular morning doing rounds and we were activated for a patient who had been shot in the chest. in Yale town, which is sort of a very upscale area of Vancouver, downtown Vancouver. And he was sitting at a Starbucks and was shot.

The trajectory of the bullet was through and through the right chest. We didn't actually know what it was. So I sent my fellow down while I just finished up rounds. And a few minutes later I joined and by then it was a full on resuscitation. We had to, um, open that patient's chest in the emergency department.

He ended up not having a cardiac injury. He had a [00:06:00] bad lung injury, which was actively bleeding, and he had arrested from that. And, uh, they actually had done CPR in the field. And so as soon as he arrived in the trauma bay, he was met with a big coordinated response, like I talked about.

He opened his chest, the operating room was standing by, the ICU was standing by.

It was a massive response. And, uh, we ended up doing what's called a clamshell thoracotomy, which gives full access to the chest left and right. And we identified the injury to be in the right lower lobe of the lung, which we cross clamped and we brought him up to the operating room and he ended up needing a lung resection.

But he survived and we closed him and he had a big incision, like complete side to side incision. But he bounced back, he recovered. He had a wife and I think a 10 year old son who got him back. He went back to his job as an owner of one of the iconic bicycle shops in Yaletown. The story was in the news, so that's why I'm able to talk about it, but that was an interesting [00:07:00] example of how a coordinated effort, like, you know, when you see the timelines of the response, where you see when the police responded within four minutes and EMS responded within five minutes.

The patient was transported to the trauma center within 10 minutes. These are all predefined processes. And we received them and the whole coordination with the OR and the ICU, I think it sort of exemplifies how much coordination is needed, but how great the rewards are for that coordination.

Rachel Baker: I'm totally understanding how you called it a symphony before.

That makes so much sense. What a great analogy. Uh, during my, uh, online stalking of you, I saw that you actually completed two fellowships during your training. Uh, one was in trauma surgery and one was in surgical critical care. And. This is something that I've always wanted to know and I've worked at Stanford Surgery for almost seven years now And I still don't know the answer.

What is the difference and where does [00:08:00] acute care surgery come in?

Dr. Morad Hameed: Yeah, that's a great question. Rachel. Thank you for asking that Because acute care surgery is kind of a rebranding. It's sort of a newish concept in North American surgery So I'm not doing acute care surgery is the umbrella acute care surgery describes any surgical emergency Anything In surgery that is highly time dependent, imagine like hemorrhagic shock or sepsis.

These things, we know that when you intervene on them quickly and definitively, that patients do well. And you, you even see survival change with minutes of delay. It's all about, I think, acuity, complexity, and time dependence. That's the umbrella. And under that umbrella, you have three areas. One is trauma, which is, Um, you know, traumatic injuries, energy transfer that causes bodily injury or tissue disruption or hemorrhage.

Rachel Baker: Okay.

Dr. Morad Hameed: That's trauma.

Rachel Baker: Your gunshot wounds, your car crashes.

Dr. Morad Hameed: Exactly. And then, a second thing under that umbrella is emergency [00:09:00] general surgery. This is acute, Surgical conditions like appendicitis, or Ligaticularitis, valve obstructions, these are usually problems that are associated with sepsis.

Rachel Baker: Okay.

Dr. Morad Hameed: So those also require often life saving surgery that's on a fast timeline.

Rachel Baker: Mm hmm.

Dr. Morad Hameed: And then the third thing under the umbrella is critical care. And that's patients who require multi system life support. So these could be trauma patients. They could be emergency general surgery patients, but they could also be liver transplant or vascular thoracic patients. And so these are surgical illnesses that again require this attention to physiology and anatomy and oxygen delivery and optimization of blood flow and hemodynamics.

It's, it's this multi system support of critical illness, very much from a surgical perspective. So those are the three. things that we've kind of captured under this umbrella. And that's become a new discipline in North America called acute care surgery. They're different, but There's a lot of parallels and [00:10:00] crossovers

Rachel Baker: Awesome. Thank you. Thank you so much for explaining that. That's very helpful. So you've been a program director of residency programs, fellowship programs. You've been a chief of general surgery. You were president of the Canadian Association of General Surgeons. Why hold an administrative position?

Doesn't that like take you away from your OR time? Yeah. Thank you.

Dr. Morad Hameed: Yeah, this is another very important and insightful question. Rachel and I have to reflect on that a little bit.

Rachel Baker: Okay.

Dr. Morad Hameed: I mean, these things happen by accident, like you never know, like, what opportunities you might get in your career and they're very unpredictable.

And so it wasn't by design to do these administrative roles. It was just kind of a fortuitous thing, but you know, I found my experience in administration or leadership to be. Very inspiring. Like, as I mentioned, I came to surgery a lot because of the physiology and anatomy and societal implications, but also because of the teamwork.

And it's just such a [00:11:00] privilege to work on a team with brilliant people who have similar values and who are all fighting for the same thing. And then to be able to somehow coordinate that work, you know, so that it's bigger than the sum of its parts, it's, it's an enormously inspiring thing. And to be a program director or section chief or division chief or really any, any surgeon has a role as a leader to lead a team to do something big and difficult and to fulfill potential is enormously rewarding and it's creative.

And with surgeons, I find, I guess I'm biased, but whatever ideas are out there, they're open to it. Like there's so much openness to. To momentum, to movement and to progress in surgery, that it's a fun part of the job.

Rachel Baker: I see that. I feel like, um, your take on leadership roles, administrative roles is very similar to how some people talk about research and [00:12:00] innovation and that you can do more by changing systems and, you know, helping the teams work.

You can help more patients than just one on one during that time when you're in the operating room. Very interesting. Well, so the next question is coming from Dr. Lisa Knowlton, another one of your colleagues. She says I should ask you about global surgery, which is a phrase that I've come to learn can mean all sorts of different things.

How do you fit global surgery into your practice?

Dr. Morad Hameed: Yeah, it's very interesting to see the evolution of the term global surgery. There is a little bit of a distinction. So, I have a master's in public health and I've always been inspired by the idea that we're working toward the health of populations, like what we do at a micro or patient level also has implications and importance for population health.

And I think that public health concerns itself with the health of populations, but often those populations are within a healthcare system [00:13:00] or within a, within a region or within a country. And I think a broader concept is global health, which is. Health of populations that doesn't see boundaries. It doesn't see political boundaries.

So now, now we're thinking about not only the health of populations within our own geographic areas, but on a global scale. And there's lots of lessons that can be learned like in global health, we can learn from other people. Regions of the world, how they're doing things, how they're solving problems, how they're innovating, and we can share knowledge that we have.

So that's the, that's the attractive thing about this global health paradigm is there's a big world out there to learn from and to contribute to. My work has been on a very small scale, but been sort of a collaboration with the University of Cape Town in South Africa to build data architectures, to measure trauma care, to measure the performance of trauma systems and to analyze the.

population effects of injury. At the root of that is data. How [00:14:00] can we get good data about injured patients that will help us to care for those patients? But also help us to prevent injury, to reduce inequities and injury risk. And I think that type of work is important and has big public health and global health implications.

Rachel Baker: Well, so we are at that point on each episode of Scrubcast where we ask our guests the same two questions. The first one is, who is a surgeon you admire and why?

Dr. Morad Hameed: Yeah. So I have many, many phenomenal mentors who've changed my life. It's hard to

Rachel Baker: choose just one, isn't it?

Dr. Morad Hameed: And I won't choose just one. I think, uh, ultimately I think the surgeons that inspire me most are our trainees in particular our residents.

Um, and they inspire me like across the span of their training. So if you can imagine like a first year resident or an intern on the service. In them, you see like this incredible talent, like they've chosen to bring their [00:15:00] ideas, their knowledge, their experience, their, their ability, their potential.

They're bringing it to your specialty. And that's kind of awe inspiring to see a young person come to surgery. You just have this feeling that the future of this work is in good hands when you see our first and second years come through like this world of idealism and intelligence and creativity and, and, uh, and then right through to being a chief, uh, resident.

I don't know. I'm sure actually seen the, the chief graduation celebrations. And when you, when you're at those celebrations, you know, you see a chief. Who like seemingly like a few weeks or months ago, you think they were just a first year and now they're like a full time surgeon and that metamorphosis is just breathtaking.

And so that that's very inspiring to see all those little steps that took to train a fully trained surgeon who's going to go out in the world and, you know, represent you and represent the specialty and care for patients and [00:16:00] teams and populations like that. That is like, yeah, that's breathtaking. Those are the surgeons that inspire me.

Rachel Baker: I absolutely agree. The surgeons, the chiefs who will be graduating this year started the same year as I did as interns and I will probably just be in tears the entire graduation.

Dr. Morad Hameed: I have seen this many times in Vancouver and I've had a chance to meet the chiefs here at Stanford and wow, like they're just brilliant.

They're exceptional. Just to see what they're is, you know, you just can't wait to see it.

Rachel Baker: Very exciting. Well, so our second question is, uh, the best advice you have received in 10 words or less.

Dr. Morad Hameed: I have two for you, Rachel.

Rachel Baker: Ooh, yay!

Dr. Morad Hameed: Okay, you can pick which one, but this one was from Nick Namias, who was my mentor when I was a fellow.

He's now the chief of acute care surgery at the University of Miami. And [00:17:00] these are, these are, uh, these are, this is advice in trauma surgery, but I think they apply to life as well. Okay. So, so Dr. Namias said that. If you're ever faced with a dilemma in the middle of the night where you you just can't decide what to do between two options He said, always pick the option that's most personally inconvenient for you.

And I use that almost every night on call. It's never failed me that advice. Um, and, uh, always picking the thing that's most inconvenient kind of overcomes the inertia of, uh, not doing something because it's the right thing to do. So that, that was great advice. The second one comes from another mentor who, um, Richard Simons, who is trauma medical director at the Vancouver General Hospital.

And he said that a wrong decision is better than no decision. Uh, and so in trauma often, you know, we're trying to make decisions with incomplete information. Um, and sometimes you just have to make a [00:18:00] move. And I asked him, what does it mean that a wrong decision is better than no decision? And the idea is that if you make a wrong decision, if you're sensitive to the results of that decision, you can learn from it and you can change direction.

But no decision doesn't give you that movement or that information. So I think that does apply when sometimes it's important to just make a decision, to learn from it, and then to adjust course.

Rachel Baker: That is fantastic advice. I'm going to add that to my wall. I also already have Dumbledore do what is right, not what is easy, but which is very similar to that first quote from your mentor at Miami.

Uh, well, so it has been just absolutely a pleasure talking to you, but before we go, I want to ask what is next for Dr. Hameed, what big plans do you have in store for Stanford Med?

Dr. Morad Hameed: Thank you, Rachel. I'm just kind of soaking it all in. Like I said, I'm still pretty wide eyed. I'm pretty, still pretty starstruck being [00:19:00] here and I'm just learning from the people around me and, uh, I'm not sure what's next, but it's going to be a great journey, whatever it is.

I think we, our group, um, Section of Acute Care Surgery has. Some big plans and, uh, we're just deciding how to move forward with them, but I, whatever it is, I think the adventure is going to be great.

Rachel Baker: Awesome. I cannot wait to see what you do. Thank you again for coming on the show.

Dr. Morad Hameed: My pleasure. Thank you so much for having me.

Rachel Baker: And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker. The music is by Midnight Rounds.

And our chair is Dr. Mary Hawn.