Intro

Dr. Cameron Chesnut 0:00

Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect.

The Case: A Full Facial Rejuvenation

Dr. Cameron Chesnut 0:12

My patient earlier this week was awesome. I got to meet her and her husband. She's in her late 50s, seeking a full facial rejuvenation. Her and her husband had been together since they were 15, which is an interesting side topic that I'm going to go into a little bit at the end because it actually kind of ties into this. But as part of her very appropriate full facial rejuvenation,

Addressing the Submandibular Glands

Dr. Cameron Chesnut 0:31

we knew that we needed to address her submandibular glands, the glands that gave her some fullness underneath her jawline. Now, this is not something that every surgeon addresses, but it is something that I address because in my world of achieving the highest levels of results, these 95, 97, 99% results, I find that I need to address them, and I do so in different ways, but to get those high-level results. You can leave them alone and still get very fine results, but they're not quite to the same level, in my opinion, to my eye, from a rejuvenating and restoring standpoint. And I tend to approach these in multiple ways. First, wanting to lift them back up into their position along the jawline. If I need to, I can sculpt or shape them in that process, but I tend to do that from an access in the midline. So not every surgeon does this. Like I said, it's a little bit more of a complex procedure to do it. It's very intricate, very detailed, takes quite a bit of time. And so not everybody does it. But those of us that do it tend to address it from this midline area, which is the sort of standard way that has emerged as we've done more and more of this.

A Lateral Approach Learned at UCLA

Dr. Cameron Chesnut 1:39

That being said, back in my fellowship training 15 years ago, when I was working with a lot of surgeons at UCLA, one of those surgeons that I worked with very regularly would approach them from a lateral approach, from the outside edge, which is very interesting. I got to work with that surgeon a lot. I got to do that approach with him a lot, and I understood everything about it. I understood the why, the what, the anatomy, all of the nuanced details of it, but it wasn't part of my practice that I adopted for myself. That was actually, I think, one of the big benefits of my fellowship training working with so many different surgeons that I got to pick all, I got to see a lot of different things and then pick. I like this, I like that, this works well for me, I like this concept, and I would see all kinds of different ways to do it. And I had a nice exposure spectrum of things to choose from. That exposure to that lateral approach, although it wasn't the one I adopted, will become very valuable to me down the road, which it did this week. Rolling along with the procedure, we get to this key element of the procedure, which is very much a focus

Aberrant Anatomy and a Decision Point

Dr. Cameron Chesnut 2:42

time for me. And the second that I get to where my normal access points is, I realize that she's got a little bit of an aberrant abnormal anatomy with the venous structures around her glands. And of all of the vascular anatomy that can maybe not read and obey the textbook, it's usually veins more than arteries that do that. Veins are lower pressure, lower consequence. But she had this sort of interesting spider web network of veins right in front of where I would want to normally access her gland. So it was this interesting decision point of do you just sacrifice the blood vessels? You can just clamp them off basically and go do your thing. And if you're doing like a really important cancer surgery where you just like, I gotta get all this out of there, like that's probably the suggestion. But I'm literally in surgery thinking to myself, that's not what I would want if this were my neck. I want those veins functional because they're there for a reason and they're important. And um, yes, maybe you can like do without them, but I don't want to do without them. I want them doing their thing.

Choosing the Harder Path

Dr. Cameron Chesnut 3:46

So that led me to this like, well, my other option is to do this lateral approach, which I have seen many times and done in a setting when I was a fellow, um, but it's not my regular approach. And so ultimately, that is what I did. I went through the rest of my procedure. And when I was at the lateral approach to do the rest of her neck, I accessed her glands and I did what I needed to do from there, which again, there's pros and cons to these different access points. I chose the one that I chose for a reason, but ultimately I, in this particular situation, I went and did this. And I haven't done that for probably 15 years since I was, you know, back early in my, you know, fellowship training time frames. The procedure took a little bit longer because I took this other approach. And so I was very careful to take my time. I'm never in a rush. I never pride myself with being fast. I pride myself with being good and thorough. And so I we stayed a little bit later, got done what I needed to get done, zero compromises. And I went home and my family was in bed,

Late Night at the Kitchen Table

Dr. Cameron Chesnut 4:45

everybody. Um, and so I had this moment and I needed to eat and things like that. And so I went home that night and I had this moment by myself at my kitchen table. I will never forget this. It's in true, this will, this is, this will be a forever memory. And I was just so curious, thinking through what was going on, what was that vascular anatomy? I had ideas, but I want to nail it down. So I literally am pulling out anatomy textbooks from when I was a fellow and going through old notes and old papers. And I like am sitting at my kitchen table at night in the dark by myself, family asleep, jacked and pumped up, and you know, norepinephrine and epinephrine flowing through my brain from surgery that day in this curious mindset state of like, I am going to figure this out. What's going on here? What did I see? I felt like a fellow

The White Belt Mentality

Dr. Cameron Chesnut 5:34

again. This is the white belt mentality. We call this in jujitsu of always staying curious. You never know everything. You're always going to have something thrown at you. So that night I'm sitting there in my kitchen by myself, digging in, and you know, it's uncomfortable to do that, but honestly, I kind of loved it. I I had that feeling again of like, you know, I'm an expert at what I do and approaching levels of mastery and virtuosity. And this is part of the game, is that you have to be at that level of expertise doesn't eliminate curiosity. You need to be protecting your curiosity, which is exactly what I found myself doing in a situation that, you know, I think many others would have just written off, or taken the blood vessels and been like, I just you don't need those, move through, which may be true, but it's not what I would have wanted for myself. Uh, and so because of that, I pushed myself and I did the more chose the more challenging option. And then I went afterwards and got really curious about what's the most I can suck out of this experience?

The Edges of Your Capacity

Dr. Cameron Chesnut 6:29

Uh, because when you reach these levels of mastery, um, you start to view things differently. The edges of your capacity uh become something that you need to focus on to grow more, not to be stagnant in the well, I'm already an expert, I'm already a master of this. You know, be careful of the person who's seen it all. I've seen it all. That's not true. Um, you've seen a lot more, but you've never seen it all, right? And I hear that all the time. Oh, I've seen it all at this point. Well, be careful because that should never ever at least be your mindset. That's a that's a you know, rolling against the black belt in my jujitsu world who's like, I've done everything, I know everything. And then they meet this like very curious white belt who's asking questions all the time and throws something at them they've never seen. And you don't want to be stuck in that spot, basically. And this is one of the things that I love about surgery is that experience changes what you're capable of learning. Uh, with this lateral approach to the gland, I've seen it before, I'd done it before, I understood the what, I even understood the why. But it was something that was sitting dormant there that I had not had to access for 15 years. And then when it came out, I was ready.

Intrinsic Learning and Self-Taught Golf

Dr. Cameron Chesnut 7:38

I knew what to do. Um, and that really gives credit to this idea of intrinsic learning, which is something when I really reflect back, that I learned in athletics as a kid. Intrinsic learning is this idea of being able to see something and apply it without having to do it a million times necessarily, like seeing it, understanding deeply what, why, how, all the things that you need to know, and then being able to mechanically do it. And people describe this in tennis. And for me, it was golf that taught me this. I was self-taught at golf. I was reading through golf digest magazines when I was a kid, and I was like reading articles on how to swing, and then I would go do it, basically, uh, which is a lot of that ended up being a wild asset for me as a surgeon later on, the ability to get a lot more out of the reading and reps that I was getting. I did a lot of them and I got a lot more out of them because I had this intrinsic learning capacity that I had developed as a kid. And I felt it. I felt it come out in the operating room when I was doing this other approach. It's like, oh, I know exactly what to do here. I've done it before. I know, I understand the mechanics of it, I understand why, I know the anatomy. Um, it was very, very much back into that, again, back into that white belt, feeling like a fellow mentality.

Why Mastery Means Better Questions

Dr. Cameron Chesnut 8:52

And I actually love that feeling, that white belt mentality, that feeling like a fellow, not because it's comfortable, but because it reminds me that there is another level to go to. And I think it almost doesn't matter the field, but people assume that expertise means that you have all the answers. Virtuosity means you have all the answers. But those that are there, if you really examine, I think it's quite the opposite. Being at that level of mastery and virtuosity means that you understand the perimeters. You ask better, more detailed, finer, and ultimately more important questions, maintaining that curiosity that we're working so hard to protect. And this is a cycle that I've seen in myself over and over again with this intrinsic

The Anatomy as Teacher

Dr. Cameron Chesnut 9:33

learning. Nobody made an assignment to me. Nobody made me go home and read about this. Um, nobody told me I had to, but I was curious. I went and learned. I examined. There wasn't a test. The anatomy that I was with became the teacher that I was at. And this is how children learn. This is how athletes grow and develop. I really resonate with that as a surgeon because that's also how I grow and develop. It's a beautiful pattern. You see something, you become curious, you study it, you apply it, and then the next patient teaches you something else. So I'm super grateful for that patient today teaching me that. It's this idea of compounding experience.

Couples Together Since Fifteen

Dr. Cameron Chesnut 10:07

And that actually plays into the other part that I mentioned about her, um, and that her and her husband had been together since they were 15 years old. And I mentioned 15 because this number, this pattern, I've it's sticking in my head. And maybe it's my reticular activating system, but I've had many patients with these remarkable caretakers. It's usually a wife and her husband. Um, and they have this husband's an incredible caretaker, super attuned with what's happening. These like cool guys that I would definitely be friends with, their wives are awesome, but they've been together since they were 15. And I don't know if there's actually an answer to this, but it's an observation that I've at least been curious enough to pay attention to. It's an unusually high amount of my couples that are the happiest, the healthiest, the most successful, um, that have known each other for a long time, that 15, high school, college. Again, this is just an observation. This is not a study, uh, but it definitely leads me to ask why. My personal observation with this, also being married to my high school sweetheart, where our first date was over 26 years ago, is that it's this idea of growing together instead of growing up and then meeting and coming together. And I this gets nuanced, but it gets into this idea of we you quite literally grow up together. You share victories, you share failures, you share grief, you share success, you share milestones, children. All of these things happen with both of you. There's no, there's a very few experiences prior to that that you didn't have together. And it's this idea of compounding experiences.

Compounding: Marriage and Surgery

Dr. Cameron Chesnut 11:50

And here's where things tie in again a little bit for me, because this compounding is a lot like mastery in surgery. You don't just become a great surgeon automatically or because of one difficult surgery, just like you don't build a great marriage because of one romantic vacation. Both of these are built through thousands of small moments, small adjustments, small conversations, small lessons, learning all compounded together over years and years and years. And I think that's why I pulled out these 15-year-old relationships, because that reminds me, those relationships remind me a lot of expertise in surgery. Nobody in either of those situations thinks they have everything figured out. They're still adapting, they're still learning, they're still curious, they're still growing, they're still asking questions, and nobody thinks they're a master and that they've got it all figured out because if they do, things tend to go the wrong

Staying Teachable / Closing

Dr. Cameron Chesnut 12:42

direction. And so in closing and tying these together, it's this idea of how does one become exceptional at something? And I don't think there's one answer. I think exceptional people stay teachable for longer, whether that's in surgery, in marriage, as a parent, playing golf, doing jujitsu, as an athlete, or even in business. The white belt never actually goes away. And if you keep that mindset, time will reward you greatly in your marriage or in your practice. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here, and I will see you on the next episode.