Matt Sherrer, MD (Host 1): Welcome to another edition of the Fresh Flow Podcast. Mitch, I got to congratulate you, man. It looks like, despite the past few times, you seem to have some sort of malady. You've either been decerebrate from being post call, or you've had a cold and you look like Rudolph. You seem well in this episode, so I'm happy for you, and want to congratulate you on that.

Mitchell Tsai, MD (Host 2): You know, it was Saturday night and we worked all night in the operating rooms. It's fun being the hub of a network. I don't know about you guys. But no, I've been reading a little bit of the stuff you assigned me the other day, I think it was last week when--

Host 1: I assigned you?

Host 2: Yeah, you assigned me reading. I read Chan and can't say her last name, but Beyond Disruption.

Host 1: Yeah, Beyond Disruption. Cool book, man.

Host 2: How we really don't need to blow up stuff to make it better. I think that was the basic premise of the book, but good book.

Host 1: All right. Well, I continue to be just blown away at the level of guests that we get on this podcast. And uh, today is yet another one. So, you want to introduce Dr. Chu and we'll get going?

Mitchell Tsai, MD (Host 2): Oh yeah, absolutely. So pleasure, and thank you, Larry, for coming on this podcast. Dr. Larry Chu is a Professor of Anesthesiology, Perioperative Pain Medicine at Stanford. He directs the Anesthesia Informatics and Media Lab, and he's got his footprints everywhere in our specialty from education to clinic to research and now to advanced artificial intelligence.

So one day he's going to take over the world. I do have to start the podcast with the story though. I've actually never met Dr. Chu in person. So, the last time we were supposed to meet was a society education anesthesia meeting in Baltimore. And I got a text message at the last minute saying that Dr. Chu needed to speak with President Obama and that he wasn't going to be able to have coffee with me. So, so welcome aboard Larry. You've done a lot in your career. Just reflecting back on your career as a physician, researcher, and then leader in our specialty, what challenges do we have to address as academic anesthesiologists for future anesthesiologists and also for our specialty?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Well, first, Mitch and Matt, thank you so much for inviting me to Fresh Flow. Big fan of the podcast and I'm honored to be part of the lineup of amazing guests that you've had on the program. I can't believe I'm one of them. So first of all, thank you for inviting me. I'm really honored to be one of the academic anesthesiologists who are practicing these days.

I think that it is such an amazing specialty that we are in and like many different fields of academic medicine, we do face our own challenges. Probably one of the biggest challenges that we face, not unlike other specialties, is just balancing the increasing demands of clinical care with all the other things that we have to do. Research, education, administrative responsibilities, and our specialty is one where we're highly compensated individuals, so our time is really valuable. So finding that time to do those other really important aspects of academic anesthesiology and advancing our specialty and getting the resources for that time, that's a big challenge for us today as a specialty.

And especially when you look at funding and funding for specialties and anesthesiology compared to other specialties; that is a challenge that we have to face and look at. And think of as a priority. Keeping pace, I think, with the rapid advancement of technologies. That is happening constantly and, AI, machine learning is one of them, but, there are continually evolving technologies that are outside of computer science that we could apply to anesthesiology, but we have to think about do we have time and resources to look at those and apply them to perioperative care.

There's the challenge of continually demonstrating the value that anesthesiologists bring to the healthcare system within the operating room and outside of the operating room. And that footprint can constantly expand. Or sometimes maybe people are looking to shrink it. That's a challenge. And then as an academic anesthesiologist, I think growing importance for me as I get older, I get the graying hair; it's developing that next generation, I think of academic anesthesiologists, especially, I don't know if you're seeing it, but, this shortage, I think, of people in anesthesia. We see it. And mentoring and attracting that talent, I think, is crucial.

Matt Sherrer, MD (Host 1): So it's a perfect segue education. Uh, you've been heavily involved in resident fellow education throughout your years. And from reading your CV this morning, which by the way, I tried to print and it's so exhaustive that it literally destroyed my printer. It gave me the worst paper jam my printer's ever had.

I had to pick it up, turn it upside down, and now it does not work. You have officially wrecked my printer. So, I will be sending Stanford a bill for that. Uh, no, looking at your CV, you have demonstrated the ability to evolve over time, as the residents evolve over time. We've talked about this being a different generation of learners and they learn differently, but you seem to be someone who has evolved with that.

I saw a lecture on that you had done recently on don't email me, text me. So how do we reach this, this newer generation of learners that are very different than prior generations?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Yeah, that's such a good question. Thank you. And it's, really important to think about education in that way about reaching people. Because for me, I started off in academic anesthesia thinking about education. Yes, I've done research. I've done lots of different things, but education's always been really important to me.

And it's always been centered around meeting people where they are. I think as an educator, that's got to be really important to success, I think. At least from my perspective. And for me, that's always meant doing your best to always be curious and understand the context of learning, where it happens for people, so that you can understand the new gaps that are happening, how we can help people meet those gaps, how we can understand where learners are in the context of their lives. The lives that they're living. And for instance, what I, I've learned about learners today, Gen Z. It used to be millennials, right? Now it's Gen Z. We keep going through different generations, but they have different contexts of their lives. Today, Gen Z are seeking more balanced work life. They want to make an impact in the world, in their communities. They want to have a sense of belonging and connection to each other. And so sometimes this is challenged, right, by the relatively solitary practice of anesthesiology, the busy clinical practice that residency training can have, and that leaves sometimes relatively limited time for didactics and study.

So we have to maybe adjust the methods that we use to engage. We have to acknowledge these gaps that exist if we want to engage our learners. So I kind of think about three words for today's learners. So I think about engage, connect, and transform. If we can think these three ways to reach today's learners.

We want to empower them because, they're a generation. And I don't want to, like, make generalizations, but I'm kind of making generalizations. Okay. But this is what I kind of see. The learners that I've worked with, they really do have a desire for autonomy and self efficacy. And, they're at a point in their professional lives where they really do want to make real decisions. They want to have an impact. And so what can we do? How might we empower our residents, our learners, in ways that their capabilities can be acknowledged? We can encourage their contribution to the residency and medical field. Maybe we can do that through technology. Maybe we can do that through blended learning.

Maybe we can do that through a flipped classroom. So, technology isn't always the answer, but I think of empower. How can I empower people? What are those ways? Connect. Connection, I think, is so important. And again, like, quickly jumping to digital, because they're digital natives, right? But that's not always a way to connect, because connection is about, like, building genuine relationships, creating a sense of community and belonging.

I think when you look at society and the things that are happening these days, I think about creating a safe space for people to really share what they're concerned about and embracing diversity and inclusivity. I think that's important for connection. And creating a place where people can feel valued for their interpersonal relationships.

Especially in the residency program, in the workplace. And the last one is transform or transformation. How can we, as a program, provide the tools, provide the people, provide the culture for people to transform, to create a way for them to become the healthcare providers, the learners, the educators that they want to be so that they can serve the communities, the healthcare systems in the ways that they want to.

Matt Sherrer, MD (Host 1): You guys can't see, but Mitch and I both took notes. I could tell you were doing it too. We both wrote down, I wrote down engage, connect, and transform. So,

Mitchell Tsai, MD (Host 2): Um, Matt, you can't copy off of my piece of paper, okay? Um, I mean, you know, I think, Larry, what you've said about what our specialty, what we need to do as academic anesthesiology, encapsulates and sort of scales down to what we do as anesthesiologists every day, right? I think we're the one specialty where we get five minutes to earn a patient and their family's trust, to show that we're going to get them safely through whatever they're going to get through.

In terms of the, the resources that you have at Stanford, I mean, when you talk about work life balance, I think of Pfeffer and Sutton, right? Over at the business school at Stanford. And then, when you think about technology connecting people, Stanford Design School, David Kelly, Don Norman, and you're absolutely right.

Right? The solutions don't exist just because we have the technology. The solutions are that intersection of a technology and the human element. And, I don't know if you were involved with this, but, Alex McCarty was one of our it was our first podcast interviewee. And, I still remember him telling me about how, you know, Stanford's got one of the largest academic training programs in this country, and most of them do preliminary spots elsewhere.

Right. And so Alex was trying to figure out how he could connect all the interns that weren't on the Stanford campus. And they did that through like, I think it was like monthly tests or sort of like IT training exams and then like a group session to discuss the questions. And my hunch is that you probably built that thing for Alex.

I could be wrong. So, going back to technology, how do you see the future? We've mentioned it, we've talked about engage. You've talked about you're gonna have to help me with my

Matt Sherrer, MD (Host 1): handwriting here.

See, I told you, you can't even read your own

Mitchell Tsai, MD (Host 2): Yeah, yeah, yeah, I can't even read my own handwriting.

Matt Sherrer, MD (Host 1): Engage, connect, transform.

Mitchell Tsai, MD (Host 2): So, we've talked about it for education. And, you know, I can't remember which Cornell University president said that. But, if we're not at the front of research, we pretty much shouldn't be teaching. So how are you getting your residents interested in what you do? And then sort of helping them build their practice on top of that? I know it's a broad question.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Gosh. That is a broad question. Yeah, I don't know that I actively try to recruit people into what I'm doing, but I, think in general what I try to do is to create a culture of curiosity. And what I mean by that is, so we did a design thinking workshop a couple of, a long time ago with the ACGME. And one of the things, the questions that we were looking at is not only why does it take so long to implement best practices into clinical setting but why are people afraid of change? Why can't we get people to actually do the right thing?

And part of it is fear of change. And so then we got into the question of, well, what is the opposite of fear? And so, well, then it got into this conversation of it's courage, right? Isn't the opposite of fear, courage? And then, well, we kind of discovered that, no, it's not. It's not.

Because courage means that you actually are scared, like you're on the battlefield, you're frightened, but you're still gonna go out there, right? But actually, the opposite of fear is like, no fear. There's like cannons booming, there's gunshots, and you're still gonna go out there and like smell the flowers and you're gonna like, oh, what, there's daisies, there's like grasses, there's trees, I want to go take a look. That's curiosity. So, I guess what I like to do is to create a culture where residents are just curious. That they won't be judged of, hey, why aren't you, like, in the lab, like, putting drops of liquid in a tube, and just be curious. Oh, you're interested in OR efficiency. You're interested in this process safer.

You're, you don't necessarily have to fit in a box. But you're curious about X, Y, or Z. So I guess my answer is I don't actively recruit people to be interested in what I'm interested in, but I, want people to be curious about what's around them and find something that's important to them, that is interesting to them and help them ask questions about that and teach them about how to explore that. t

Mitchell Tsai, MD (Host 2): To you Larry, I've built this culture of Chu. So anytime somebody has something that I think you might be able to help them on, I introduce them and I send them to you at Stanford. So God bless you.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I love that. I love that.

Matt Sherrer, MD (Host 1): Mitch, I wish we could go back and do a word count on all of our podcasts on how many times our guests have mentioned curiosity. I would bet that it's come up every episode, this lifelong learning, this culture of curiosity as Larry said. So, to that end I feel kind of left out here. I mean, Mitch has a connection to Stanford.

Larry has a connection to Stanford. They're dropping a bunch of names at Stanford. I went to a school, one of my alma mater's called Samford here in Birmingham. And we have a slogan there, which is Sam, not Stan. So, I feel like the outsider here in this group, but uh, another Stanford alum is Jeremy Utley.

And he has written a cool book called Idea Flow. Mitch and I have talked about it a good bit and written on it. He is big these days in AI, ChatGPT, et cetera, and how to incorporate those into your teams. I noticed that you had done a talk recently on how to incorporate ChatGPT into your teams.

One of the things that he said in an HBR article recently was that if you don't do it right, you can actually just kind of generate average ideas faster. And he kind of gave some suggestions. From your perspective, how have you been able to incorporate ChatGPT, AI, et cetera into your practice?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): That is a very timely question.

Matt Sherrer, MD (Host 1): Oh, wow.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I think that large learning models like Claude, ChatGPT. These are things that are like, entering the popular culture, people are talking about it both in good ways and bad ways. I think in the popular press, hear about people using it for homework assignments. I think in the medical literature, we see papers about how large learning models have passed the USMLE.

Matt Sherrer, MD (Host 1): Yeah.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Now, I think it leads to the impression, incorrectly that somehow large learning models are able to practice medicine or that somehow they have clinical judgment, which is incorrect. And I'm not even sure, I don't believe that the paper authors are even trying to make that connection.

I think large learning models like ChatGPT do have some benefit for academic anesthesiologists, for practicing clinical anesthesiologists, but we, have to understand how to use them. It's a tool like any other tool. It's developing, the technology is emerging. I'll tell you and there's so many unique affordances.

I, we could talk for hours about them, but I think in terms of the context that you mentioned, I'll comment that I think one good use for it is almost like a partner to challenge you a bit on your thinking. So, like a cognitive aid for your thought process. Let's put it that way.

What do I mean? So, there are scientific studies that talk about conflict in teams. They talk about different types of conflict and they talk about how task conflict is actually kind of good because having someone disagree with you on task conflict on a task can actually improve the quality of output of a team, right?

If somebody challenges you on what you're doing, that maybe will help you question a little bit, on what you're doing. Maybe you would reconsider something and that would maybe improve your thinking. And we don't always have that person in our life who's going to tell us truthfully, right? That maybe we should question or rethink something that we're doing.

So that's, I think, something where LLM can be helpful. So what do I mean by that? I'll give you an example. I recently wrote a review article. What did I do? I uploaded it to ChatGPT. And I said, ChatGPT, give me a grade from F to A plus on this review article and give me five suggestions for improving it. I mean, I would never ask ChatGPT to research any information for me because it hallucinates and it's kind of like terrible at actually reviewing the primary literature, but like if I wrote an article and I would ask it to read the article, right, and give me feedback and tell me, like, do I have any flaws in my thinking?

Did I miss something? What do I not know that I've missed here? It's been very helpful. It has helped me as a cognitive aid for my thinking processes, it has helped me improve things, find things that I've missed. So, from that point of view and then it helps you iteratively improve your work that way.

So from that perspective, where the technology exists today, I think it can help people improve their work as kind of that feedback tool. Some people also say that it can help them in terms of not starting from a blank page, giving you some starting point of a project.

Matt Sherrer, MD (Host 1): So that's what Utley talks about is treating it as a conversation partner, not an Oracle, meaning don't go to it looking for the answer. Treat it as a conversation partner, exactly as you have said, what am I missing? So,

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I love that. I think that's quite true.

Matt Sherrer, MD (Host 1): I got to know what grade did you get? What, how did it score you?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I'll tell you, I usually get, when I start, I usually get a B plus and then I iteratively work my way up to the A minus. And I'm just like, okay, I'll take it. It's fine.

A minus to where I am today. I'm an A minus guy all day, so.

Mitchell Tsai, MD (Host 2): A minus satisfies us, right?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): That's good enough. Good enough.

Mitchell Tsai, MD (Host 2): So, you know, we're going to take a brief intermission here and just thank our sponsors ChatGBT. Dr. Chu did not suggest all the anesthesia residents that before you call your attendings about the cases before that you ask ChatGBT to come up with an anesthetic plan for your patients.

No, we're not doing that. Um, but, you know, I agree with you, Larry, what you've said that as clinicians, right? And you know, one of the benefits or one of the advantages about staying on in an academic department, especially if the one that you grew up in is that, you know, you do have this network of people that you can always ask when you're stuck in those hard clinical decisions about what somebody else would do, right? And I've had it all along my entire career. And I'm going to shout out for my office mate, who's not here, but Kevin Abnett was a surgeon at Harvard Medical School, general surgeon, surgical residency, and then went to the Indian Health Service and came back to train as an anesthesiologist.

He was my chief resident and, my entire career here, I've been lucky because he's always been the guy that I can ask him, Hey, am I crazy here or? Right. And having that objective, hard truth always helps people. So, we've talked about technology. We've talked about education. Do you think that our specialty is about to go through an existential crisis with everything that's going on with the workforce imbalance, inability to keep up with the clinical demands of a burdening baby boomer population?

I mean, you know, and then you throw in physician wellness in there, and then with Gen Z, where are we headed as a specialty?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I do not think that we are in a crisis. Mainly because as anesthesiologists, we always have a plan A. We always have a plan B. We always have a plan C. I think that we are in times of change. I do think so. I think how we manage that change defines us as a specialty. I think we have to make some decisions about how we manage time and resources that will define our future and the direction of anesthesiology as a specialty. I think we have really good people thinking about that. I'm working with one of those groups, the Anesthesia Research Council, who has a whole group of really smart people looking at data, looking at where we as a specialty are and where we should direct some resources to help with the future of, like, right now the problem that they're looking at is medical education in anesthesia.

So, I think we can't be afraid. Again, it goes back to fear, right? don't think anyone's ever made any good decisions out of fear. I just don't. And I think we have to embrace change. Yeah, I don't look at things like a crisis. I look at them as an opportunity for growth and learning, not as a crisis.

Matt Sherrer, MD (Host 1): The obstacle is the way, right? What lies in the path becomes the path. Yep. So we would be remiss if we didn't bring up your Everyone Included project on this podcast. It's something that I totally geeked out on this morning and I went way down the rabbit hole. So this is from my perspective, one thing stood out here, and I'm gonna read this sentence from your website.

It was how you are amplifying the patient voice in academic medicine further, including the patient voice has moved providers beyond knowing how to treat a disease to learning what it is to live with a disease. That is something that when we talk about delivering value in the perioperative space that you mentioned before, you are somebody I would say who is on the forefront of going beyond the traditional role, finding ways to define value. And that is one that's in, it's really kind of near and dear to my heart. It's something that I have a nerdy interest in as well. So as I was reading all this, it became apparent to me that this is a passion project for you. And where there is a passion project, there is often a story.

And that's the kind of stuff we love here on the Fresh Flow Podcast. So can you give us the story behind the Everyone Included project?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Ooh, that's a good story.

Matt Sherrer, MD (Host 1): All right. I love good stories, man.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Okay. This is a good story. So, more than 10 years ago, I was invited to host the World Congress on Social Media and Medicine. And I was very excited to do this. It was a great opportunity and I was very curious on how to organize an international conference and, how might I really do this well? So one of the things that I did is I researched the leaders in the field of social media, which was actually kind of new and burgeoning in 2010.

I don't know when Twitter came out, I think, but it was still very early then. I mean the iPhone came out, what was it 2008, 2007. Okay. Anyhow

Matt Sherrer, MD (Host 1): Yeah, Mitch still has the first iPhone, too, by the way.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I remember standing in line for the first iPhone. So Susanna Fox was one of the thought leaders at the time in the space and I called her up. And one of the things that she said is, Larry I was at this conference who had the foresight to invite the end users of healthcare, patients themselves. You might want to think about doing that because, you know, that would be important if you're going to have a conference about healthcare. And that sounded a little crazy to me but I thought, this is Susanna Fox. She's a thought leader expert. This, I'm going to do it. I am going to do this.

Matt Sherrer, MD (Host 1): No fear.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): I put on the website, I put on Twitter, this conference is going to have patients. We're going to invite patients to this conference. I put it on Twitter and then I get a reply on Twitter. So it's all public and something to the effect of and I'm paraphrasing now and I probably need to find this tweet, but it said something like, I see that you are inviting patients to your conference, but are any speaking?

I don't see any actually speaking or something like this. I, I'm paraphrasing. And so this patient was Hugo Campos and he and I now are actually very good friends and collaborators because Hugo says that I pulled the Jedi Knight move because this is what I tweeted back on Twitter. I said to Hugo, Hugo, you're right.

And I think I need your help to get patient speakers. And so we'll work together, we'll work together on this. So, and I still remember, Hugo came to Stanford because he lives in Oakland, and we worked together, and we put together a patient panel at the conference, which again, like, at the time, it was really unheard of to have a panel of patients and physicians speaking about the use of social media, to bring patient voices to talk about healthcare. And it was by far electric. You could hear a pin drop. The most, like, engaging session of the entire Congress. And that really I think ignited my belief and interest that patients do have ex, do have a lot of real knowledge and expertise about their condition that can bring real value to conversations about health care.

And that a lot of what we do in health care could benefit from real co production. And, the example that I often use, or Hugo and I use, or that we talk about is that we forget healthcare is co produced. It always has been co produced. Right? We just forget that. So, the patient comes to the doctor, the doctor makes a diagnosis and writes a prescription, but it's the patient, that has to go and fill the prescription.

It's the patient that has to take the medicine. It's the patient that has to monitor their body for any side effects. It's the patient that has to monitor themselves for resolution of the symptoms. It's the patient that has to return to the physician. Healthcare's always been co produced. We're just under this illusion that the physician takes all the credit for the healing because the healthcare system pays and supports the physician part of co production through payment systems, right? The healthcare system doesn't actually pay the patient to go to the pharmacy, doesn't pay the patient to take the medicine.

The doctor gets all the payment. So the doctor gets all the credit for the healing and we forget that. So when we think about creating new systems of care, when we have Congresses that talk about innovation in healthcare, we go to the expert, which is the physician, because we forget that there's a lot of expertise on the other side of co production that comes from the patient, because that side isn't supported. So that's Everyone Included.

Matt Sherrer, MD (Host 1): That's cool.

Mitchell Tsai, MD (Host 2): No, I mean, Larry, I just wanted to echo what you said about the physician patient relationship and I'll get you a copy, but you know, Francis Peabody, 1927, I think wrote a piece in the New England Journal of Medicine, The Care of the Patient. And, back then when physicians wrote, they were storytellers, right?

And we've mentioned this before in the podcast series is that, what you're talking about with design thinking, innovation, leadership, education, it all shares the same sort of root, empathy, right? The willingness just to listen to these patients. And I a hundred percent agree with you that, if we actually, listen to the patients, the healthcare systems that we have today wouldn't look like they do now, because right now they're optimized to make sure that the physician can do as much as they possibly can, which isn't necessarily the best for the patient.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Yeah, well, it's a fascinating topic. We could talk for hours about it, but what I think why it's a passion project is because when we think of Everyone Included, and it's not just patients, by the way, like end users of healthcare, so we think about caretakers. also a part of that.

But um, it's working on problems that actually matter to people because oftentimes in Medicine X, which was this conference that I ran on healthcare technology, you have a lot of these technologies that solve problems that don't like really matter to end users, that they solve problems that honestly, it's not helping the co production of health care, but it's a technology that's interesting.

And I think what Everyone Included is about is don't forget what is at the end of the day, the real problem that's going to be meaningful for people.

Matt Sherrer, MD (Host 1): Wow.

Mitchell Tsai, MD (Host 2): You know, and I think for our listeners, just this idea, and I always try to encourage my residents and my young faculty is that, you know, you and Hugo built the network if you believe Robin Wright from Princeton with the book Non Zero about, the basis of human civilizations, the efficiency of information transfer, you know, you reached out to Hugo, Hugo reached out to you, and then now you've grown this network that you probably would have never known if you hadn't reached out, right.

And the cost of reaching out is getting cheaper and cheaper. I wanted to ask you, and I know you didn't want us to, but you know, many, many decades ago, and we won't let the listers know how many decades ago, you were the recipient of the Congressional Commendation from the U.S. Committee on Science, Space, and Technology.

You were also a semifinalist of the Westinghouse Science Talent Search Competition. You're shaking your head. We don't

Larry Chu, MD, MS, BCHM, MS EPI (Guest): This is too long ago in my past.

Mitchell Tsai, MD (Host 2): Too long ago? Well, so my real question is, one question, one part of this is how is it that you didn't end up with NASA trying to figure out how to send astronauts to Mars?

That's, one question. But you talked about it, right? You're the, co founder or co editor of the Manual on Clinical Anesthesiology. Hopefully I didn't botch that. But you know, what's plan B, C, D for Dr. Chu?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Well, I mean, you can't do everything, Mitch. You have to, make some choices in your life. So I happen to choose anesthesiology. I would love to go to space. Don't get me wrong but, see, this is an anti aging filter that you see on your screen right now. So, I'm actually 99 years old, so I would age, I've aged too far now in my career to go into space.

I had to make some choices in my career. I chose anesthesiology, and I'm happy with my choice. But yeah, I think we all have to make choices about what we want to do in our careers. Actually another side story is that as an intern, I actually had my own startup and that's where I learned you have to make choices.

You cannot do it all and do it well. So, you know, one of the things that you have to do is you've got to make choices. I love anesthesiology. I love the practice of anesthesiology. I'm at a great place in my life where I have the AIM Lab. We have this ability to, as you said, Mitch build networks and collaborate with people, and I find meaning in that. I find meaning in meeting new people, hearing about the challenges that they have, and maybe bringing some of the ideas and some of the tools that we have to help elevate what they're already doing to create new solutions that can help them and other people.

That is kind of where I am in the world that makes me happy, and I like that. So that, my plan A, B, and C, and that's all I need.

Matt Sherrer, MD (Host 1): Well there's a lot of wisdom in your words. So, I got a last question for you and we've asked this one before to other guests and it's an easy one and a hard one all at one time, which is Larry Chu, when you're retired from the specialty and you're off doing whatever you want to do, what do you most want to be remembered for?

Larry Chu, MD, MS, BCHM, MS EPI (Guest): Oh my gosh that is easy and hard. But I think said at the beginning of this podcast, which is, I'm at the stage of my career where I'm just really enjoying mentoring people. And my greatest satisfaction is when my mentees are successful. I am so proud when people that I mentor go on to success.

So I started about seven years ago now a program for high school students to inspire compassionate careers in science, technology, medicine. And the idea is they don't actually even need to go into healthcare careers. Whatever career that they go into, I just want them to incorporate compassion in that career.

So they get to actually work with real patients and over the course of this two week program that I run, they will learn design thinking, they will learn with this patient and solve a real problem that the patient's facing. So I'm at this point where what I want to be remembered for is that person that they met way back when when they were a high school student, that maybe taught them how to listen to people, how to be empathetic and compassionate, and that's informing what they're doing today in whatever they're doing. Like, if they can remember that, and I think they are, because actually, we have people now in the program who are nurses, who are doctors, who are applying to anesthesia, actually.

Ha ha! That's what I want to be remembered for.

Matt Sherrer, MD (Host 1): This is no joke, this is a true story. On my mirror, when I brush my teeth every morning, I have a sign taped up on there that says, it's not about you. And it's because we're at our best when we serve others. And that's kind of exactly what you said. And I keep coming, you know, do these podcasts and we keep hearing themes over and over again. Compassion being one of them and empathy being another one. So this has been great, man. I have enjoyed the heck out of it. I wish we could keep talking for another two hours, but Mitch, any final words?

Mitchell Tsai, MD (Host 2): Just to echo the compassion, the empathy, but just to remember that what we get to do every day is a privilege, right? Whether it's in the academic setting, teaching people or taking care of our patients that, you know, we in medicine it's a privilege to take care.

Matt Sherrer, MD (Host 1): I don't have to go to work every day. I get to go to work every day.

Mitchell Tsai, MD (Host 2): Exactly.

Matt Sherrer, MD (Host 1): Larry. Thanks, man.

Larry Chu, MD, MS, BCHM, MS EPI (Guest): It's been a privilege to be your on Fresh

Flow too kind. You're too kind. Thank you so much for doing this. It's been awesome.

Absolutely. Thank you so much.

Matt Sherrer, MD (Host 1): All right. Thanks guys. Thank you for tuning in to this episode of the Fresh Flow podcast. We will catch you next time.