***********SENSITIVE CONTENT WARNING**************************

This episode discusses suicidal ideation. Please listen carefully.

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Jeremy Heffner is a trauma and acute care surgeon fifteen years into practice. He ran the COVID response at his institution. Somewhere in there, his compartmentalization strategy stopped working. He would find himself in situations where he couldn't contain his emotions and couldn't locate where any of it was coming from: which part of the past, which patient, which year. He had hypercompartmentalized to the point that he could no longer find the source. He saw therapists. He did EMDR. Eventually he admitted himself to a residential program for a month. Frontline workers, he says, are given almost nothing to process the day-to-day, so they don't.

In surgery we keep running until we hit a wall. He describes a room full of surgeons nudging each other about who is earning more and taking the harder cases, and nobody ever asking the only question that matters: did you ever figure out the work-life balance thing? His own verdict is unsparing: you have to run the race yourself and reach your limits before you'll believe they exist.

After admission to the residential facility, things got worse. Without the normal stressors he felt empty, and there was one night he came very close to dying by suicide. He couldn't work out what defined him anymore. He knew he couldn't go back to being who he had been, because that version hadn't worked. If he wasn't producing ridiculous RVUs, had he failed? For the first time in his life, he didn't know what the path forward looked like. Two realizations moved him. The first was that every single moment of the day is his choice — that the excuses, starting with “if I don't see these patients, then…,” were his own. The second arrived as a willingness to be fired: once he understood he didn't have to prove himself, the rest of the stress fell away. Recognizing your own intrinsic value, he says, is the muscle. And he's blunt about his own part in it; he had been blaming the system for hiding what he was keeping from them.

He also turned to AI during that stretch, in a state of high vulnerability and shame. It helped him, he says, by forcing his mind onto a new problem. But it also showed him what the models actually do. He argues the models can induce psychosis in vulnerable people, and he lays out three places this could land — we believe we're steering when we aren't; too many destabilizing ideas arrive at once; or we learn to work alongside these systems as neither boss nor slave, which he calls the real threading of the needle. His warning for medicine is sharp: whatever efficiency AI creates does not entitle administrators to more of a physician's time.

What got him through PTSD was his wife, and a life rebalanced around something other than output. He is worried about the surgeons being trained right now on a model that no longer matches the world, sent out like deer to the slaughter by leaders who haven't noticed the game changed, World War One generals all over again. His closing thought is about leverage: once you genuinely believe in your own worth, you simply stop accepting the terms. You are not an easily replaced part.

Follow Jeremy on LinkedIn here.

Join SurgeON here.

Get his book, Proof of the Impossible here.

If you're struggling: the Physician Support Line (1-888-409-0141) is free, confidential, and staffed by volunteer psychiatrists for U.S. physicians, residents, and medical students, 8am–1am ET every day and nothing is recorded. The 988 Suicide & Crisis Lifeline is available any time by call or text.

Empowered Surgeons Group is going to Cabo January 6th-10th, 2027 for a mindset coaching intensive. Learn more about the retreat here. Interview for a spot at the retreat here.

You know that old adage: when life gives you lemons, make lemonade? What that means is solving for a result we want as opposed to indulging in our own mind drama. That's what this episode is all about. When you learn how to process through mind drama, you reach your goals faster and raise your self-concept to someone who can solve any problem.

Easier said than done. This is where a coaching relationship helps: to pick you up in your failures. If you are ready to jumpstart your personal development, the Women Surgeons' Retreat is the ideal place to do that.

Get on my calendar today to interview for a spot.

And join Empowered Surgeons Group to get started on this process right away.

My TEDx journey started while I was pooping on a very fancy toilet in NYC. But before I say more about that...

First things first, get Cesar's book, Great Speech, here.

Then book a call with him here.

And finally, join us for the Women Surgeons' Retreat in Cabo Jan 6-10, 2027. Calling all women surgeons who want to uplevel their lives and mastermind with colleagues. Get on my calendar here to interview for a spot in this mindset coaching intensive.

Back to that fancy toilet in NYC…

I was with my family on spring break, and an email from Cesar somehow showed up in my inbox. Next thing I knew, I had the thought, "I can do a TEDx talk." I booked a call with Cesar, and that same year I landed my first talk. Then I landed a second talk, which was selected for the coveted Editor's Pick (an honor reserved for less than 0.1% of TEDx talks). You can watch my first talk, How to save lives with two minutes of listening here and my second talk, Can we end fear-driven healthcare? here.

Cesar Cervantes was the kind of child whose parents concluded early that he was going to need a stage: theater camps, commercials, and a father he first learned to be funny with. He started doing stand-up and was touring by nineteen, work that eventually took him into war zones, performing at lunchtime on forward operating bases to service members. He calls it the worst possible setup for comedy and the most fulfilling work he has ever done.

What he ran into was the limit of the medium. He wanted to create transformation, not just laughter, so he went to graduate school and began teaching comedy inside a theater department. The keynote he built out of those classes drew a different question from other speakers: how do I get on a stage like that? And Top Talks grew out of answering it.

His case for humor is more serious than you might expect. Humor is catharsis. Pain and joy are both part of being a person, and comedy is where we metabolize the overlap; it is a celebration of the flawed human state. Pain plus time equals comedy, which also means a story told too soon is not ready for a stage. We also get into how badly a story suffers when the teller makes themselves the hero of it, a habit that feels like confidence and lands like distance, and one accomplished people fall into without noticing.

On TEDx, Cesar talks about how the stage is for ideas and how ideas change things, rather than motivational speaking or a personal story of overcoming. Ten to twelve minutes is the sweet spot, and the goal is a talk your audience can leave holding in one sentence. Getting there takes laser focus on your throughline, a clear sense of where the audience starts and where you intend to move them, a refusal to get precious about everything you write, and what he calls an "Oh My Gift" moment.

The structure runs in eight beats: an attention getter, an unequivocal reveal of the problem, the throughline, the solution stated plainly, then building the problem out, revealing the solution, the Oh My Gift moment, and a call to action. TED, he notes, loves reason-based thinking that arrives somewhere.

His advice on getting selected is unglamorous and correct. Land the idea, learn to communicate it, submit to events you would genuinely travel to, and separate the outcome from the process. Once selected, get a coach. TED is its own form. As a two-time TEDx speaker, I can vouch for this.

Join us inside Empowered Surgeons Group here.

Follow Cesar on LinkedIn here.

*************SENSITIVE CONTENT WARNING*******************

This episode discusses a recent suicide. Please listen carefully, or if this is particularly triggering for you, forgo listening completely.

On July 23, 2025, Vaibhav Duggal turned 24. He spent the morning of his birthday in a women's health clinic in El Paso, on his OB/GYN rotation as a third-year medical student at Texas Tech University Health Sciences Center. Six days later he was dead.

In this episode, I share more details that have come to light about this case, including the processes the institution followed to address the complaint against Vaibhav, what the culture was like inside the institution, and the conversation between the Dean of the school and Vaibhav's parents.

Please go back and listen to the first episode #111, Vaibhav's Story, before listening to this one.

If you or someone you know is struggling, the 988 Suicide & Crisis Lifeline is available 24/7 by call or text in the U.S. Medical students and physicians can also reach the Physician Support Line at 1-888-409-0141, staffed by volunteer psychiatrists.

Join us inside Empowered Surgeons Group here.

Join us inside Empowered Surgeons Group here.

Interested in the Women Surgeons' Cabo retreat Jan 6-10, 2027? Get on my calendar here.

Dr. Erik Pearson grew up the son of an X-ray tech, trained in Dublin, and matched in Utah, where watching the pediatric surgeons at work made the decision for him. It wasn't only the operations. It was the weight of being trusted with someone's child.

After fetal intervention research at Children's Hospital of Philadelphia and pediatric surgery training at Emory, he found a growing practice in Las Vegas looking to build out its ECMO program. Ten years later, he joins us to talk about what that work actually asks of a person.

We get into the parts of pediatric surgery that don't make it into the training curriculum: the driveway moments after a hard case and learning to compartmentalize without going numb. Erik describes the mental shift that let him keep doing this work: I get to be there to help. Not so much be the hero.

The second half of the conversation turns to October 1, 2017. Erik was on call at Sunrise Hospital when victims of the Las Vegas mass shooting began arriving. He walks us through the organized chaos of the ER, the improvised triage bay in the ambulance parking lot, the color category the team invented on the spot because the standard system didn't fit, and the five hours he spent with a single gunshot patient alongside a scrub tech he had never met. He also describes the leadership he saw that night: a CEO in a purple polo whose entire job became removing barriers so clinicians could work.

It's a conversation about competence, grief, transparency with families, and what every hospital and every physician should be asking themselves before the worst night of their career arrives.

• 124 patients with gunshot wounds requiring treatment
• 129 patients admitted that night
• 16 mortalities, 14 of them dead on arrival
• 58 surgeries in the first 24 hours
• 516 blood products used

A model first identified in the response to the Boston Marathon bombing (observed in flocking birds) that Erik saw play out in real time:

1. Unity of mission
2. Generosity of spirit in action
3. Staying in your lane
4. No ego, no blame
5. Trust-based relationships

Dr. Erik Pearson is a pediatric surgeon in Las Vegas, where he has practiced for the past ten years as part of a physician-owned group. He is known as Citizen Surgeon on Instagram. Follow him here. Check out his website here.

Interested in the Cabo retreat? Click here to schedule a 15-min interview.

Learn more about the powerful coaching community & mindset course, Empowered Surgeons Group, here.

Decades of research point to the same conclusion: social support is one of the strongest protective factors in the face of trauma. But what happens when the way we've learned to relate to others gets in the way of that connection, especially in a profession where repeated trauma exposure is routine?

In this episode, Dr. Sacha McBain joins me to talk about the intersection of attachment, community, and trauma-informed care in medical settings. We start with the research: Australian psychologist Richard Bryant's work following the Black Saturday bushfires showed that it wasn't just individual relationships that predicted recovery; it was the shape of a person's whole social network. People who were diversely connected, and whose connections were also connected to each other, fared better. The overlapping network itself served as a buffer.

From there we turn to what happens inside hospitals. Sacha describes sitting in on resident onboarding and hearing the scare tactics used to keep new physicians in line: it's not if you'll be sued, it's when. Patients will find you in parking garages. Never admit you were wrong. The message underneath is essentially "be perfect, or a patient could destroy you.” And it makes co-regulation almost impossible with the very person you've been taught to fear.

What shifts when you see a distressed patient as a frightened, vulnerable human rather than a threat to your livelihood? What do you do when you can't find any empathy left and you're already overwhelmed? Sacha shares a piece of advice from a mentor that reframes curiosity as the thing you reach for when compassion isn't available. And we close on trauma-informed care as something fundamentally pragmatic, not a soft add-on, but a working set of practices around safety, transparency, power, collaboration, and cultural humility.

Sacha McBain, PhD, is a clinical psychologist and associate professor at Rush University System for Health in Chicago. A national leader in medical traumatic stress, she has published peer-reviewed research on the conceptualization and treatment of medical trauma, led national clinical trainings, and helped shape best practices for mental health screening and intervention after traumatic injury.

Previously at the University of Arkansas for Medical Sciences, she developed and led the Trauma Surgery Psychology Consult Service at Arkansas's only Level 1 Trauma Center and served as associate director of the Center for Trauma Prevention, Recovery, and Innovation. She contributed to the American College of Surgeons Mental Health and Substance Use Disorder Best Practice Guidelines Work Group and is an active member of the International Society for Traumatic Stress Studies.

Learn more about Sacha here.

Interested in the ESG Cabo Women Surgeons' Retreat in January 2027? Get on my calendar here.

Join us inside Empowered Surgeons Group here.

In today's episode, you will learn the three success tenets to create success and sustainability in surgery:

1. Protect the asset
2. Serve the patient
3. Diversify your professional identity

When we master these three things, life as a surgeon becomes easy and fulfilling. Even in the face of moral injury, decreasing reimbursement, litigation fear, complication fear, and the public's mistrust of the medical profession in general. I know because I'm living proof.