Podcasts about when victor

In this episode of Smart Energy Voices, host John Failla speaks with Victor Udo, Bucknell University's Director of Sustainability. Bucknell University recently announced a 7-acre solar array on the campus. Victor explains how the project came about, how it fits in with their overall sustainability strategy, and what was needed to overcome the sometimes contentious process to gain local ordinance to proceed. This episode is a must-listen for other large power users, especially in higher education. You will want to hear this episode if you are interested in... Victor's journey to and current role at Bucknell [03:22] The role of renewables in Bucknell's sustainability plan [08:07] The beginning of Bucknell's solar array project [12:57] What's next for Bucknell's sustainability journey? [16:25] How will the utility sector need to change? [18:51] Why is sustainability important to Victor? [22:27] The biggest influential person in Victor's life [26:19] Using your opportunity to help society [31:36] How does Nigeria move forward as a country? [34:03] Victor Udo's experience in renewables Victor is a Nigerian-born American. He started in a battery manufacturing plant in Nigeria through a company in Germany and is excited to see the industry go back to batteries, which he sees as the future of capturing renewable energy. Victor studied in the U.S. at a small school in Birmingham, Alabama. He went on to Howard University, where he worked in a lab with one of his professors. At that time, renewable energy was a thing of the future. After finishing his master's degree, he was given the opportunity to work for Atlantic City Electric, eventually purchased by Pepco. When Victor had worked for Pepco for several years, his governor in Nigeria asked him to go back and help with the power infrastructure there, serving about 6 million people. He spent seven years in Akwa Ibom State, Nigeria. After coming back to the U.S., Victor was offered a position with Bucknell University as the Director of Sustainability. He currently works with the students, faculty, staff, and administration to make sure Bucknell has a solid strategy. They're developing a ten-year plan to help the university become carbon neutral by 2030. They are also doing their part in restoring the ecology by planting trees. Bucknell's carbon-neutral goal Sustainability is something that Bucknell has been involved with for a long time. When Victor joined them, there was a lot that was already going on. In 2008, the university had already committed to becoming carbon neutral. His assignment was to create a sustainability plan focused on carbon neutrality, reducing waste, and encouraging biodiversity and natural habitats. They began by clearly defined terms and what they would do and decided what to do about carbon neutrality. Strategies they discussed were enhancing efficiency, powering the campus, and carbon pricing. Planning a trajectory with unknown factors Bucknell is creating a roadmap for their carbon neutral by 2030 goal, which should be completed in the next one or two years. They don't have all the answers yet. Technology isn't where it needs to be, and there will be financial implications. Also, they don't know yet what offsets might be acceptable or what their community will prefer. They're looking at all options that will help them to become both carbon neutral and budget neutral. As with many organizations who have made carbon reduction commitments, Bucknell is in the process of figuring things out as they go. Resources & People Mentioned PV - Bucknell University's new solar array receives approval Which Way Nigeria?: Structure, Leadership And Equitable Sustainable Development Sustainability Insights For Electric Power Sector Transformation: Looking at Nigeria James Knight - Director for Energy & Utilities - Bucknell University Connect with Victor Udo On LinkedIn Dr. Victor Udo is the Director of Sustainability at Bucknell University. Lewisburg, Pennsylvania where he Chairs the President's Sustainability Council (PSC) consisting of the President, Provost, CFO, senior faculty, students and staff.  He provides the PSC leadership to oversee a simultaneous planning and implementation process for the environmental sustainability objectives in the university strategic plan under four cross-disciplinary working groups - Zero Waste, Carbon Neutrality, Ecological Conservation/ Restoration, and Socially Responsible Investing. Dr. Udo works with students, faculty, and staff on Environmental, Social and Governance (ESG) impact investments for innovative sustainability results, including budget-neutral carbon neutrality and circularity enabled waste minimization and ecological vitality. Dr. Udo is a former CEO with international sustainability and utility processes leadership in academia, state and local governments, and Fortune 500 corporate energy companies. He has significant experience in identifying, analyzing, and incorporating global energy, economic, environmental, and educational trends into both public and private sector governance and infrastructure management.  He is passionate about the convergence of renewable energy resources and storage, electrification of transportation, AI, IoT, and Blockchain in the decarbonization, decentralization, and digitalization of business, academic, and public policy processes. Dr. Udo obtained his Ph.D. in Urban Affairs and Public Policy from the University of Delaware. He has a Master's degree in Energy and Environmental Policy from the University of Pennsylvania along with a Master's and BSEE from Howard University. Dr. Udo is an Author with several publications, including global, national, and local, sustainable development. Connect With Smart Energy Decisions https://smartenergydecisions.com Follow them on Facebook Follow them on Twitter Follow them on LinkedIn Subscribe to Smart Energy Voices If you're interested in participating in the next Smart Energy Decision Event, visit smartenergydecisions.com or email our Event Operations Director, Lisa Carroll at lisa@smartenergydecisions.com Audio Production and Show notes by PODCAST FAST TRACK https://www.podcastfasttrack.com

He was born in Asia Minor around the year 120, and was a disciple of Saint Polycarp, who was in turn a disciple of St John the Evangelist. He succeeded the martyred St Pothinus as Bishop of Lyons in Gaul (now France). He produced many writings contesting not only against paganism but against Gnostic heresies that were then troubling the Church. When Victor, Bishop of Rome, planned to excommunicate the Christians of Asia Minor for celebrating Pascha on a different date than the Church of Rome, Irenaeus persuaded him to stay his hand and maintain unity and peace in the Church. (This was before the date of Pascha had been set by the Ecumenical Councils). By his efforts Lyons became for centuries a center and bastion of Orthodoxy in the West.

Danielle from Lakewood has asked for help with her relationship with her boyfriend Victor. She says he and his best friend have been trying to become YouTube stars in the Jackass style for several years but they aren't very original or good at it and she thinks it's time Victor just got a real career. She says she understands there are people out there who are really successful at this but those people have good ideas and original material and a business plan and Victor and his buddy have none of those and Danielle thinks now that he's 28 years old, he needs to get a life. When Victor comes on, he comes straight after us "Boomers" for even having this conversation and not at all understanding what he's doing and who is he modelling himself after. After trying to drop a whole lotta jokes on us, Victor says believes in himself and is full of optimism for his career and wants no part of any negativity about his future. But...does he actually care at all about his future with Danielle?

Victor Stringer is 78-years-old and started playing golf 30 years ago. At one point he had a 3 handicap. When Victor incorporated yoga into his life, this helped him emotionally, mentally and physically on and off the golf course. He is the author of “Yogi on the Green,” a #1 international best-selling book. Customs broker and freight forwarder, he is the owner and president of the global company, VR Camelot, Inc.

He was born in Asia Minor around the year 120, and was a disciple of Saint Polycarp, who was in turn a disciple of St John the Evangelist. He succeeded the martyred St Pothinus as Bishop of Lyons in Gaul (now France). He produced many writings contesting not only against paganism but against Gnostic heresies that were then troubling the Church. When Victor, Bishop of Rome, planned to excommunicate the Christians of Asia Minor for celebrating Pascha on a different date than the Church of Rome, Irenaeus persuaded him to stay his hand and maintain unity and peace in the Church. (This was before the date of Pascha had been set by the Ecumenical Councils). By his efforts Lyons became for centuries a center and bastion of Orthodoxy in the West.

Today we celebrate the man who invented the cottonseed huller. We'll learn about a Canadian legal eagle who loved gardening and one of Oregon's pioneer botanists. We'll celebrate the work of a female biochemist who made some remarkable discoveries about bloom color by studying snapdragons. Today's Unearthed Words feature words about March. We Grow That Garden Library™ with a book that was released 11 years ago today. And then we'll wrap things up with the fascinating story of a garden activist who was teaching gardening on this day in NYC two years ago. But first, let's catch up on some Greetings from Gardeners around the world and today's curated news.   Subscribe Apple | Google | Spotify | Stitcher | iHeart   Gardener Greetings To participate in the Gardener Greetings segment, send your garden pics, stories, birthday wishes and so forth to Jennifer@theDailyGardener.org And, to listen to the show while you're at home, just ask Alexa or Google to play The Daily Gardener Podcast. It's that easy. Curated News Starting Seeds: Use What You Have - Lewis Ginter Botanical Garden | Jonah Holland  "If you have seeds that are less than three years old, at least some of them should be viable. You could also use avocado seeds, citrus seeds, seeds from dates. You could try anything you happen to have — peppers, squash, beans, or maybe even pineapple! Mail ordering seeds is another option. We asked our horticulturist some of their favorite seed sources, and here are a few of our favorites: Johnny's Select Seeds, White Flower Farm, Peace Tree Farm and Prairie Moon Nursery. You might even have a really fun time exploring the Seed Saver Exchange."   My COVID-19 Renee's Garden Seed Order for the Cabin I share the seeds I ordered after planning to ride out the first wave of the COVID-19 pandemic at the cabin.   Alright, that's it for today's gardening news. Now, if you'd like to check out my curated news articles and blog posts for yourself, you're in luck, because I share all of it with the Listener Community in the Free Facebook Group - The Daily Gardener Community. There's no need to take notes or search for links - the next time you're on Facebook, search for Daily Gardener Community and request to join. I'd love to meet you in the group.   Important Events 1814  Today the inventor and agricultural pioneer John Lineback received a patent for the first cottonseed hulling machine. He was based in Salem, North Carolina. Today, cottonseed hullers are known as disc hullers, and they not only dehull oilseed shells like cottonseed and peanuts, but they also crush oilseeds such as soybeans. Cotton is neither a fruit or a vegetable. The fibers of the cotton plant are made of cellulose. The seed of the cotton plant attaches to the fibers after emerging from the fruit. After maturing and left to its own devices, the cotton plant seed would simply blow off the plant in the wind - which is how the plant would get distributed. Cotton seeds are exactly what you might deduce: the seeds of the cotton plant. They are egg-shaped and are 3.5-10 mm long. The Latin name for the Cotton Plant is Gossypium ("Gah-SIP-EE-UM), and the seeds are richly covered with white or rusty-colored, long, woolly hairs, called lint. It is actually the lint on the outer part of the seed that is the main product used to make cotton textiles. Lineback's machine dehulled the seeds. The hulls are the outer coverings of cotton seeds. Dehulling makes it possible to extract cottonseed oil from the seeds. The process of dehulling is pretty straight forward: after removing the lint, the hull is removed from the kernel by screening. Cottonseed hulls are fibrous, and they also get used and incorporated into food for livestock like cattle and sheep. There's one final note about whole cottonseed worth mentioning: Cottonseed is toxic to humans and most animals.   1840  Today is the birthday of William Ralph Meredith. Meredith was a Chief Justice in Ontario, and he's remembered as the founding father of workers' compensation in Ontario. His work helped shape worker's compensation for the rest of Canada and the United States. his principals regarding workers' compensation became known as the Meredith principles. The Meredith Principles allowed that workers would give up their right to sue employers in exchange for income security if they were injured at work. In turn, employers would receive business loss protection while paying for the system. Meredith came from a large family in Westminster Township in Upper Canada with eight sons and four daughters. William was the oldest boy, and all the men in the family became quite successful in the legal community. The Meredith brothers were known as 'The Eight London Merediths' - a reference to the family's London Ontario homeplace. London is just north of Lake Erie and the U.S. border. As Chief Justice, Meredith was known among his legal colleagues simply as "The Chief." And, on more than one occasion, Meredith found himself presiding over cases where the lawyers for the accused and the defense were two of his own brothers - Richard and Edmund, who was regarded as the area's top criminal attorney. All of the Meredith brothers enjoyed gardening, and Meredith was no exception. Meredith gardened on his large estate in Rosedale, Ontario, at 41 Binscarth Rd. In 1913, a Toronto newspaper ran a delightful story about Meredith, and it ended with his love of gardening, writing: "Despite his seventy-three years, Sir William is still a fine and handsome man. His favorite pastime is gardening and on his beautiful grounds in Rosedale, he spends much of his spare time. Donning a straw hat and gloves, he delights in moving about among his plants and bushes, weeding and clipping, or else to dig out dandelion roots from his lawn."   1867  Today is the birthday of an important pioneering Oregon botanist Elmer Ivan Applegate. Elmer was born near Ashland. His grandfather, Lindsey Applegate, was a wagon train leader, and he led many settlers to Oregon during the "Great Migration" of 1843. Elmer was the oldest in his family of six children. He grew up on a 5,000-acre ranch where he mastered the demands of ranch life, and it was on the ranch that Elmer discovered his love for botany. In 1895, Elmer graduated from Stanford, and after graduating, he spent time with the USDA's Frederick Colville - the botanist who, along with Elizabeth Coleman White, helped tame the wild blueberry. As one of the most prominent Oregon botanists of the 20th century, Elmer's signature work focused on trout lilies (Erythronium) "AIR-ah-THROW-KNEE-um." The trout lily is a native plant featuring nodding, freckled, yellow flowers that bloom in early spring in woodlands and on north-facing slopes. Trout lilies bloom in spring from March to May. As a spring ephemeral, they often bloom before the trees leaf out, and once the forest canopy fluffs out, the trout lily bloom disappears. At the base of the trout, lily are these mottled brown and green leaves, which inspired the name of the plant because they look like the markings on brook trout. Those spots have also inspired the name fawn lily. Trout lily is also known by common names like the dogtooth violet or the adder's tongue. The dogtooth name refers to the tuber of the trout lily which is underground. The tuber looks like a smooth, white fang. The adder's tongue refers to the curled, serpent-like, pointed leaf-tips, and the six stamens with anthers that look like fangs. Here are some fun facts about the trout lily: Trout lilies are short; they grow 6 to 8 inches tall. Young plants have only one leaf, but mature plants sport two leaves. In fact, until that second leaf appears, the plant cannot flower. Trout lily colonies are very long-lived, and some are 200 to 300 years old. Trout lily leaves and bulbs have been used for medicinal purposes, such as contraception. Mary Oliver wrote a poem called Trout Lilies: It happened I couldn't find in all my books more than a picture and a few words concerning the trout lily, so I shut my eyes, And let the darkness come in and roll me back. The old creek began to sing in my ears as it rolled along, like the hair of spring, and the young girl I used to be heard it also, as she came swinging into the woods, truant from everything as usual except for the clear globe of the day, and its beautiful details. Then she stopped, where the first trout lilies of the year had sprung from the ground with their spotted bodies and their six-antlered bright faces, and their many red tongues. If she spoke to them, I don't remember what she said, and if they kindly answered, it's a gift that can't be broken by giving it away. All I know is, there was a light that lingered, for hours, under her eyelids - that made a difference when she went back to a difficult house, at the end of the day.   1880  Today is the birthday of the biochemist Muriel Wheldale Onslow who researched flower color inheritance and pigment molecule biochemistry. Muriel was born in England and ended up marrying a fellow biochemist named Victor Onslow. Victor was actually the son of royalty - his dad was the fourth Earl of Onslow. Muriel and Victor's story is special. When Victor was a student at Cambridge, he became paralyzed from the waist down after diving off a cliff into a lake. The accident also left him with limited use of his arms and hands. Even though Victor and Muriel were married for only a little over three years before Victor's untimely death, their love was a story of mutual admiration and respect. When Muriel recorded her memoir of Victor, she wrote that he was a man of amazing courage and mental vitality; and that he was an inspiration to their peers in biochemistry. Early in her career, in 1903, Muriel became part of its genetics group working at Cambridge University, and it was here that she began studying flower petal color. Much of her research specifically focused on snapdragons which come in a range of flower colors including green, red, orange, yellow, white, purple, and pink - and now even bicolor and speckled. Muriel's work on coloration gained her worldwide recognition by 1910 she had published a whopping four papers on color inheritance in snapdragons. Snapdragons or Antirrhinum majus ("ant-er-EYE-num MAY-jus") are a beloved cottage garden flower. It's a cousin to the foxglove. Snapdragons are happiest when planted early, in cool weather. They will bloom their hearts out all summer long. Then, if you cut them back in August, you will get a second flush of color in the fall. And here are a few final notes about Muriel Whelan Onslow. Muriel was multi-talented. In addition to her scientific work, she was also an artist. Her Botanical illustrations are actually quite good, and she was often regarded as a top botanical artist among her scientific colleagues. As one of the few female scientists of her time, there are just a handful of fantastic online images of Muriel working in her laboratory. They are a must-see if you get the chance. And you might recall that a decade ago in 2010, the Royal Institution in England put on a play called blooming snapdragons. The play was about for female biochemist of the early 20th century. Naturally, one of them was Muriel Onslow.   Unearthed Words Here are some poignant words about this time of year. This first poem was shared on this day in 1859. Come to the woods, where flowers bloom,  The violet peeps beneath each tree,  And on the wintry slope bestirs  The silver-leafed Anemone. The yellow Cowslip decks the pool,  And early Crowfoot lifts its shining head, The star-eyed Liverleaf looks forth  From out its green and mossy bed. Lichnidia tall and Draba pure  And Erythronium appear,  Claytonia comes with penciled brow,  The first of all the pleasant year. Wake-robin nods its snowy crest,  The Blue-Bells pale, Collinsia rare,  The tiny Ground Nut, Squirrel Corn,  All the joyous welcome give and share. I then to nature's palace grand,  All purple, yellow, green, and gold;  Leaf-music, bird-songs, fill the air,  The summer days, their revel hold. — Lydia A Tompkins, Come to the Woods   "Indoors or out, no one relaxes in March, that month of wind and taxes; the wind will presently disappear, the taxes last us all the year." — Ogden Nash, American poet March! March! March! They are coming In troops to the tune of the wind. Redheaded woodpeckers drumming, Gold - crested thrushes behind; Sparrows in brown jackets, hopping Past every gateway and door; Finches, with crimson caps, stopping Just where they stopped before. March! March! March! They are slipping Into their places at last. . . Little white lily buds, dripping Under the showers that fall fast; Buttercups, violets, roses; Snowdrop and bluebell and pink, Throng upon throng of sweet posies Bending the dewdrops to drink. March! March! March! They will hurry Forth at the wild bugle sound, Blossoms and birds in a flurry, Fluttering all over the ground. Shake out your flags, birch, and willow! Shake out your red tassels, larch! Grass blades, up from your earth - pillow. Hear who is calling you. . . March. — Lucy Larcom, American teacher, poet, and author, March   Grow That Garden Library Life List by Olivia Gentile It's hard to believe that this book was published on this day already eleven years ago in 2009. The subtitle to this book is "A Woman's Quest for the World's Most Amazing Birds." This book is a loving and beautiful biography of bird enthusiasts Phoebe Snetsinger. Phoebe was a 1950's housewife, married with four children, and an avid bird-watcher. When she got diagnosed in her 40's with incurable cancer and given less than a year to live, she started traveling the world, birding, and she never looked back. Phoebe ended up living, after her diagnosis, for another 18 years. Oliva begins this book by explaining the concept of a life list: "Bird-watching, the way most people do it, is a lot like hunting, which is why some practitioners prefer the more active sounding term "birding": you have to know where and when to look for Birds, you have to chase them down, and, when you find them, you have to figure out what species they are— often in just a second or two, before they fly away. Tate, like most birders, kept a "life list" of all the species he'd seen and identified, and he was always looking to add new ones, or "life birds." Olivia continues: "I decided to write some sort of essay on bird watching, and I called a few bird clubs near my home in Manhattan to see what they had going on. One man misunderstood and thought I was interested in joining his Club. He tried to encourage me. "Who knows?" he said. "Maybe you'll be the next Phoebe Snetsinger." the man had never met Phoebe, but he knew all about her— as most birdwatchers do, it turned out— and he told me a little. That was back in 2001, two years after her death, and I've been piecing together her life ever since." You can get a used copy of Life List by Olivia Gentile and support the show, using the Amazon Link in today's Show Notes for under $3.   Today's Botanic Spark On this day in 2018, garden activist Karen Washington was giving a talk in New York City to help spur on the community garden movement. The theme was peace and justice. Washington has done so much for the Bronx as an Urban Gardener. She's an award-winning gardener, farmer, and co-owner of her business called Rise and Shoot Farm. It was Karen Washington who said, "If you come into the garden feeling sad, you will leave feeling happy."

Monday, September 21 | 51 days until the conference | 273 registrationsOn Monday, Bea Goffer gave Pooky his final vitamin C shot. The power food for guinea pigs was doing its job well, and if Victor continued to feed him that, he wouldn’t need to come back. When Victor arrived at the office and quickly checked their social media channels, he noticed Casper had already posted a message about speaker Li Zhou-Wei, who would be talking about ‘feng shui for the rodent cage’ at the conference. Li had a pretty impressive fan base, who responded eagerly to the post. Only one message was negative. Animal Revolution wrote: No cage is good for any animal Hmm, thought Victor, Animal Revolution, the activist group that would be taking part in the confrontation panel at the conference. The fans ignored the message, posting only happy responses to the announcement of Li Zhou-Wei’s attendance, and sharing tips among themselves about cage organization. Victor noted a confirmation of Ronald’s theory: if you have a lot of fans, the risk of criticism growing into a riot is not so big. ....----Written by Gerrit Heijkoop & Paula Vos Narrated by Kevin Stillwell

Victor receives a letter from his father telling him to return home immediately. William, the youngest in the family, has been killed When Victor arrives at the city gates, they are closed, so he must remain outside the city in Secheron until the gates are reopened at dawn. It is at this time that he realizes that he had been gone six years from home and that two years have passed since the creation of his monster. --- Support this podcast: https://anchor.fm/hmphaudiobooks/support

For more FREE Wealthy Contractor resources go to www.TheWealthyContractor.com. On this episode of The Wealthy Contractor Podcast is Victor Smolyanov, owner of Victor's Roofing in southeast Michigan. When Victor climbed onto his first roof at age 13, he was instantly hooked. His father, Vladimir, was a roofer and put Victor to work to encourage him to take school more seriously and pursue a college degree instead of following in his footsteps. But that plan backfired because Victor loved every minute of it. He went on to build a business that focuses on residential roofing, gutters, and attic insulation and employs more than 50 people. After making a number of poor hiring choices, he shares the things he's learned about employing the right people and having proper systems in place. Listen carefully as we follow his interesting journey to success and what he's learned along the way that got him off the roof.

Victor receives a letter from his father telling him to return home immediately. William, the youngest in the family, has been killed When Victor arrives at the city gates, they are closed, so he must remain outside the city in Secheron until the gates are reopened at dawn. It is at this time that he realizes that he had been gone six years from home and that two years have passed since the creation of his monster. While near Secheron, on Mont Blanc, Victor catches a glimpse of the monster between flashes of lightning. Having a nagging feeling that the murder of his little brother could be the handiwork of his monster, Victor questions, "Could he be (I shuddered at the conception) the murderer of my brother?" The monster disappears when he realizes that he has been seen by his creator. Now fully believing that his creation murdered William, Victor knows that he cannot reveal the source of the crime without some serious inquiry about his creation. Thus, Victor is torn between revealing the monster and risking inquisition on his past or letting the criminal justice system free the accused. Finally at home, Victor engages in a conversation with his family. He learns that Justine is accused with circumstantial evidence. He relays his assertion of Justine's innocence and states that she will be found not guilty. His words reassure Elizabeth in a time of great need. --- Support this podcast: https://anchor.fm/hmphaudiobooks/support

What a day... When Victor woke up at 4am this morning for his gig on the Fox TV show, "Empire", he had no idea what to expect. After a 16-hour work day, he and Rix chat about the excitement on set, his role on the web series, "Southland Bounty Hunters" and the unpredictable rewards that manifest from hustling. When the director yells "it's a wrap!", you can't help but smile. Join us on our next step of the journey that is Life.

Session 12 Dr. Chung is a solo private practice Facial Plastic Surgeon. He discusses his path through ENT residency and what he likes and dislikes about his job. Today's guest on Specialty Stories is a solo private practice facial plastic surgeon. It's a great specialty, super sub-specialized specialty of ear, nose, and throat surgeons, or otolaryngology. And Victor, or Dr. Chung, is going to join us and tell us all about it. [02:15] A Personal Choice to Be in Private Practice Dr. Chung practices facial plastics and reconstructive surgery as a subspecialty of otolaryngology; ear, nose and throat surgery. He considers himself as one of the rare breed of private practice, truly private practice solo by himself, the only physician in the office which is an interesting kind of hybrid situation. As a specialist, he is affiliated with a number of the hospitals in the San Diego area, however, he’s not officially on staff who who has to be in the hospital all the time. Nevertheless, he does consultation and coverage for call and operate at those sites. Out of all the fellows who graduated in his year, only two of them went into true private practice and are opening practices. The majority are either joining multi-specialty practice groups. He thinks even looking for academic jobs was a tradition that's fallen by the wayside. As to why he chose private practice, Dr. Chung had his personal reasons. He had phenomenal training and wanted to practice medicine the way he was trained to do. “When you become part of a bigger group or even as small as a partnership,  there's a level of compromise. Otherwise, there's no way for you to be successful.” He further explains that what he likes in private practice is having that freedom to practice without restriction in the sense of delivering care to the best of his ability that gets to order the more expensive supplies and equipment or employ a technique he knows well. So his choice was natural for him and he sees being in a personal situation that he could do it is a luxury. Although joining a bigger group or academics is not a complete compromise, Dr. Chung says that oftentimes, you find that your patient population or the group you're in will dictate your niche and your future. Then you may start doing things that don't make you necessarily happy anymore in medicine. You start doing fewer of the cases that you like to do or take care of the patients that you like. You can find that ideal situation in academics in larger groups, but it's just more challenging. Victor has been out in his own practice just over twelve months. It actually took him a number of months just to get his place set up which involved a lot of logistics as well as a lot of things they don't teach you in medical school, or residency, or fellowship about applying for business licenses, insurance, and all the other type of regulations that are necessary to own and run a successful and safe business. [05:36] His Interest in Facial Plastic Surgery Victor always knew he was going to do surgery when he was in medical school. He enjoyed the aspect of thinking, being hands-on, its culture, and the lifestyle. But honing into a particular specialty was tough. He was looking at a number of sub-specialties that operate in the areas of ophthalmology, neurosurgery, plastic surgery craniomaxillofacial, and the ENT subspecialty, which he found very appealing. “Even within a single focus of the human body, it was challenging. And although facial plastics is a sub-sub-specialty within it, it's still an integrated part.” You will go out in the community and meet physicians who are ENT-trained, but not fellowship-trained, but they are still practicing as facial plastic surgeons. This is actually encouraged by the overall academy. The types of procedures can be reconstructing cancer that may have been excised on just the skin level, but others are doing larger reconstructions or rhinoplasty and face lift based on their skillset and their comfort level. Victor adds that the specialty overall gives you all the skillsets you need, As an individual, you get to pick the things that you are comfortable with  or you really enjoy doing and focus on those. Additionally, you'll meet other physicians in your community who like doing the other procedures that you may feel less comfortable with or ones you don't like as much. Victor points out the good camaraderie that goes on there and you're a lot happier treating the disease states and doing the surgeries that you like to do. [07:50] Traits of a Good Facial Plastic Surgeon Victor explains that you need to be both left brain and right brain. On one hand, you need to be analytical, be very objective, and be able to understand proportions and direct measures and changes. On the other hand, you have to be someone who has an artistic component in how you think about things and how you view them. When Victor performs a rhinoplasty surgery, he is not only looking at this overall picture. So it's just not just a nose and a good-shaped nose, but he has the entire face prepped in the field exposed. He looks at the relationship of the nose to the chin, the forehead, proportions to how wide the eyes are, and that overall aesthetic. Moreover, as a confirmatory measure, he does all these different measurements as to how far the nose projects out, the angles, and those that are within accepted values. So you need to be able to mind both sides and not be locked into either one. It's right in the middle of your face, it's very obvious, so the stakes are a little bit higher. [09:28] Other Specialties in Mind Victor had not picked his residency specialty until very late in the process. He had gone through most of the clinical clerkships of my third year thinking that he was leaning toward orthopedic surgery as just a specialty within surgery. He didn't think he was going to do general surgery, but he knew it was some sort of surgical hands-on one. At that time too, interventional procedures were getting big. Interventional radiologists and cardiologists have very hands-on and very three-dimensional stereotactic type specialties as well. But thinking about which one to hone in on, Victor wasn’t exposed to it until the last quarter of the third year clinical clerkships. And it did turn around having interacted with some very stimulating cases as well as with nice residents and attending physicians who were open to sharing what they were doing and allowing him to participate. If you’re considering ENT, Victor recommends that you see if you're okay with boogers and earwax and all those bodily fluids. If you have no problem with them then you'll be okay. He explains how people have aversions to different things. So you have to pick what you’re comfortable with seeing everyday. You can't just base that purely on a good experience. You need to figure out what is the day-to-day kind of drudgery. “Pick what you are comfortable with seeing day to day, because if you don't like your day to day, you're not going to enjoy the highlights any more.” Victor tells students all the time check out the really dizzy patient that is struggling and you can't get a good exam on, but you still try to figure out how to treat them. It’s really, really tough sometimes to figure out if they're surgical or non-surgical, and yet they can take up more than a full appointment visit. So regardless of your specialty, be sure to examine, find those highlights, but also find what are the low points and if you're okay with those. [12:20] Patient Types and Typical Day in the Life of a Facial Plastic Surgeon Victor sees all kinds of patients, which is something that keeps him captivated and stimulated in his specialty. His patients range from very minor, very cosmetic to no medical emergency about it whatsoever, there's no urgency, it's purely elective, the changes are super subtle, super small, there's no life threatening thing that you're changing. Nevertheless, people gain quite a bit of benefit from them. Their attitudes change and their self-esteems improve with the subtle thing that bothered them that maybe no one else noticed. Moreover, Victor still participates in general ENT call. He does tracheostomies for people who have lost their airway or reconstructions for people who have lost major tissue from skin cancers or other disease or trauma. These are very drastic changes to improve someone's function and there's very little cosmetic aspect of that. So Victor likes that spectrum and he doesn’t see himself giving up on doing all those things. Overall, he likes the full gamut of complexity and simplicity because you can gain benefit for your patient on both ends. Being new in his practice, every day for him is pretty variable at this point in time. The idea is a clinic, a private-based practice, and so the majority of his patients would be seen in the office setting in a combination of consultations, follow-up visits, minor procedures, injections- injectables. Those types of visits are all in the office. “As the trends go, more and more surgeons are doing things in the office.“ Typically, a surgeon in his specialty will have block time or days set aside where they would be operating, maybe two days a week being in the operating room doing a number of cases. But the majority of them would be on the outpatient setting so most of those patients are going home. A select amount would be seen in the hospital as an inpatient and seen on multiple visits in the hospital before they're released. Moreover, Victor stresses how a lot of students and doctors don’t realize the business side of it. You can fill an entire day with administrative tasks, but it is about prioritizing and compartmentalizing. In his case, he picks one night a week where he does it until late of night and he doesn’t go home until everything on the administrative side is done then for the rest of the week, he sets up tasks and completes as many as he can. But when those tasks pile up, they will get all done on that one day. Otherwise, you can get pretty overwhelmed going from task to task to task so it's nice to have some structure in your day. [15:35] Taking Calls As a plastic surgeon, you don't have to take a lot of calls. It actually depends on where you are geographically located. Some hospitals require you to take a certain amount of call depending on the size of the call pool and how busy the hospitals are. But Victor is not required to take any call whatsoever, but it also depends. He explains that there are some financial compensation at some sites while others don’t so it's just part of requirement-maintaining privileges. Although there is no requirement in the San Diego area where he is practicing, Victor is participating. In terms of the percentage of patients he sees ending up in the operating room, his goal is close to 100%. He has seen surgeons who are well-established and basically they are turning patients away. “You want to get to that point in your career where you are selecting patients who they're the most appropriate, that you can exercise and perform the best surgeries for the best results.” Victor has patients who are not good candidates and he tells them that they are not appropriately going to be surgical patients. But he enjoys the fact that he gets to educate a lot of the patients coming in. He spends over an hour in his consultations with patients giving them all the facts including the raw details and the scary things that can happen in surgery in order for them to make an informed decision. At this point, he doesn’t feel that half of them are going to the operating room because they're just still in that information gathering stage. But as careers progress and you become very well known for particular surgeries or techniques, a lot of patients coming in have already done their homework and research. Especially with the availability of resources on the Internet, they've done their background on you. They know where you trained, they know what technique you do, and they've come specifically for that technique or procedure, and that ratio of conversion is much higher. [18:10] Work-Life Balance Victor describes having a good work-life balance whenever he chooses to have a good work- life balance. And that is very different from a lot of other physicians who are at the beck and call of their pager or their schedule, and therefore they don't have the same freedoms as he does. He can choose to work incredibly long hours or he can also choose not to be working those hours based on his specialty. There are still emergencies and so he won't operate for weeks before he goes out of town and out of the country on vacation, but that's the only limitation. Nevertheless, he can choose within his personal setting to take time off to tend to himself and his health. However, he is also participating in community volunteering and spends time with his wife which he thinks are two very important things. “When you start sacrificing your own personal health, your interpersonal relationships, then you're not going to be as healthy of an individual and therefore not a good doctor over the long run.” You're just going to get burned out, and that's an increasingly common phenomenon. Victor adds that good diet, nutrition, exercise, health maintenance, time with family, downtime are all things that should be scheduled and be consciously part of your day-to-day instead of things that are added on if you have time. [20:35] Residency and Fellowship Before you graduate to an otolaryngology head and neck surgery residency, it used to be an early match, and for many years now it's on time with everyone else's. It’s basically a five-year program which has an intern year but it's considered an integrated intern year. Typically at the same institution that you're doing residency, it does have general surgery components and rotations, however, increasingly more focused toward an ENT residency. The elective months would be Anesthesiology. You'll be in the ER and you'll be doing surgical ICU, all geared toward skillsets that will be beneficial for your residency versus a standalone general surgery or where you are on rotations that are purely dictated by the general surgery department. This is commonly seen in orthopedics and other surgical subspecialties. After which, there will be four years of ENT training. This may involve time at a children's hospital, at a VA institution, maybe a research block, but you'll be rotating through different sites and every year you're increasing your skillset. You're learning about all the systems, the ear, the nose, the throat, the different types of surgeries, seeing patients in clinic, and operating as well. But as you go through each year, your level of responsibility, and then as a Chief, you'll be running the service teaching and mentoring junior residents, and before you graduate you'll apply to a fellowship. This is typically within your fourth year. There are a number of fellowships you can pursue such as pediatrics, neuroethology, head and neck cancer, microvascular reconstruction, facial plastic reconstruction, and sleep medicine even. So the fourth year is an application that goes in around January through March and you interview between March and end of May, and then you'll match to a one-year fellowship program that would go after your graduation from your ENT residency. [23:37] An Alternative Route to Facial Plastic Surgery Outside of ENT Victor explains that if you wanted to just do plastics in the face area, you could definitely reach that goal through an alternative route, which is through plastic surgery. There are two pathways through plastic surgery. The first one is to complete general surgery and then apply to a plastic surgery program. The second one is an integrated plastic surgery program that you match right out of medical school knowing you're doing plastic surgery and that has a general surgery component to it. These programs are typically longer with research years as well. Victor believes it can last as long as seven years to finish those residencies. And then most individuals who want to operate in the face area will go ahead and do an additional fellowship on top of that. “You can reach the same goal in a sense, the same practicing setting, but you'll just have other skillsets bringing to that job as well.” [25:00] Competitiveness in Matching Victor describes matching in ENT has gotten to be one of the more competitive subspecialties to match. “I think all of the surgical sub-specialties have gotten difficult because it's just a pure numbers game, just from any type of academic application.” Kids are applying to more colleges. College students are applying to more medical schools. Medical students are applying to more residencies. Even when he was applying, he met people who applied to every single ENT residency in the country just to play the numbers. And so it's more applications on the Residency Director's table to leaf through and make a selection. In Victor’s case, they had a pretty small program. Only two residents are accepted per year, and maybe thirty people were applying per spot. Some programs only have one resident while big programs have four to five residents. And although some may say thirty people may not be a lot, but each one of those individuals have published research, phenomenal USMLE Step 1 score, letters of recommendation from the Chairman, have done research rotations, have really stacked their binder full of accolades. There’s now an ENT student interest group that starts guiding students from the first day they get to medical school. And so it has gotten increasingly competitive to apply to any of these residencies. Victor feels ENT has a popular swing recently. It had a big swing before he applied, but it's always been up there along with the other types of subspecialties that are maybe competitive to get into. [27:32] How to Be a Competitive Applicant Victor outlines that in order to be competitive goes down to all the basic things that everyone is always striving for. This means maintaining good grades regardless if you're a pass or fail system. Getting into AOA as another marker on your application showing that you stand higher in your class than other students. Then the USMLE Step 1 score. Before it was just about generally trying to get in some research but if you can get on a research project that is related to the residency that you want to apply to, that can only help more. Publications, participation, posters, presentations, attending meetings, getting involved in the department, attending conferences because there's always academic conferences every week within that department. Just make a personal connection with the attendings in that department. All of those things can make you more visible and create a level of investment, not necessarily to get you accepted into your home school's department, but also, they may be invested in getting you into their alma mater, or another program that they're aware of that would be a good match for you, or a geography that you're interested in. “It is a time investment because you're spending so much time already studying and trying to do all those basic things. But by investing yourself personally, that will give you an additional edge.” But there's also a gamble. Victors knows of people who've done that and then decided they wanted to actually do a different specialty too so you're not locked into it. But if you know early on, that will behoove you to create those. Create that rapport, create that link to those individuals early so they can really get to know your medical school career. [30:12] Osteopaths and Subspecialty Opportunities Victor says there are only very few osteopathic ENT physicians out there. He has interacted with some and they're all great, but within the world of facial plastic surgery, it is still a very small community. He thinks the majority are going down the MD path. However, the individuals operating in the head and neck facial area is growing. There are oral surgeons who perform cosmetic facial plastic procedures. There are general plastic surgeons who do those and there are those in the field of oculoplastic surgery who want to do face lifts and rhinoplasty. There are dermatologists who want to do more surgical procedures in the face. Then there are general surgeons, other surgeons who take cosmetic courses and get boarded under the Board of Cosmetic Surgery and perform those. “There is an increasing number of individuals out there who have not gone down a traditional path of training and are performing those procedures.” In terms of subspecialties available after ENT, there is a phenomenal opportunity to sub-specialize, not only by pursuing a fellowship but also many departments are strong in all fields within otolaryngology. It's not a necessity to have a fellowship training because it's not as formal. There isn't a required board certification for all the subspecialties, not all of them are ACGME certified either. You can pursue a fellowship in facial plastic and reconstructive surgery, head and neck cancer with or without microvascular reconstruction, pediatric otolaryngology, otology or neuroethology that involves an ear surgery, sinus rhinology, laryngology professional voice. If an individual has graduated and they've had strong training, they can go out and they can become a sub-specialist. They can focus their practice doing laryngology professional voice in an area that needs it and provide that care at that subspecialty level without fellowship as long as they're adequately trained and have a desire to pursue those patients. But Victor says this is rare. Most times, even those who are really focused, even nationally known for a particular field, those guys are always interested in doing other aspects of ENT as well. Some are doing more trauma, some may be doing head and neck cancer or they may be doing endocrine surgery but they're known for voice. They may be filling other roles within their group practice. Most of the otolaryngologists that Victor has met often miss doing other aspects, but find that, there’s no one else who's stronger in ear surgery so a lot of the ear cases go to that surgeon within the practice. Or someone else really enjoys sinus surgery, is savvy with it, is up with the latest techniques, and so that practitioner in that group will see more of those patients. But each and every one of the ENT doctors in that group is less likely to solely focus on a subspecialty and only, only do that. Most of the times it will be a little bit more well-rounded and be doing multiple aspects of ENT, but not necessarily all of them. Victor concludes it's getting tougher and tougher to be in overall general unless you're in a more remote area where there's fewer practitioners around. [35:06] Board Exams, Certifications, and Pass Rates Victor illustrates the board exam as consisting of a written and an oral exam component. The current format are separate examinations. At one point in time, they were done on the same setting, but currently you will take the written exam. I, it is a computer-based test that is administered in September following your June/July graduation from residency, and that is a multiple choice format test that tests all the aspects of ENT medicine and surgery. There is a pass/fail threshold for that test, and those who pass may go on to the April exam which is currently administered in Chicago. There are five rooms with a number of three or four modules in each one, and it's basically a mock simulation clinical case. They're integrating some technology CT scans. They used to give you photographs but now you can get a computer screen and you can flip through a couple slides of a CT scan, or lab tests, or histopathology, and you went through a case from, say, the patient presents as a child or an adult who had a car accident, or someone who's lost their voice, and then you ask questions, you proceed through the case, and you gain points based on your questions and responses. Then hey tally those up and then once you've passed both of those components then you're board certified for ten years. Through that ten years, you're doing maintenance certification through online modules every year, and then at the tenth year, you're re-certified again. So that is the board certification process for otolaryngology. You can also get board certified in neuroethology sleep and facial plastic surgery, and those consist of both of a written exam, an oral exam, and in some cases collecting case reports of patients that you've operated on in the first couple years of practice. The pass rates are pretty high for both exams. Although Victor doesn’t know the exact number, he thinks it’s less than 10% fail because there's quite a bit of preparation for these exams. [38:10] Working with Primary Care and Other Physicians Victor still gets to work with primary care physicians whenever he sees more of the general ENT type patients. He used to give a lecture to family medicine residents about HIV manifestations in the head and neck, and it's shockingly common, and this is from sores on the lip, to frequent sinus infections, to ear infections, skin lesions, lots of different changes in the head and neck area, and a primary care can pick them up if they're looking for them, and make the appropriate referral for both HIV specialists, infectious disease specialists, as well as an ENT doctor to get involved. So that's one of the things Victors thinks that can be missed, and it frequently is missed, but then can be detected and really initiate early care at that primary level. Other specialties he gets to work closely with depends on Victor personally. There could be dermatologists if they're removing skin cancers. This is the closest in his personal practice. However, there are a lot of ENT specialist surgeons who work with the head and neck cancer doctors that will interact with medical and radiation oncologists, the ear doctors. The neuroethology training will interact with neurosurgery for skull-based surgery. In the Intensive Care Unit where you're doing larger surgeries, the head and neck cancer surgeons will see patients again, admitted to the ICU for laryngectomy or tracheostomy management. “A fair number of patients are generally on the healthier side, and a number of procedures we’re doing are for improved quality of life, for better breathing, better functioning.” Victor adds that there is a close connection with ENT doctors in general with primary care doctors for sure. Absolutely, and oftentimes there's an unfair and sort of inverse ratio. There's tons of primary care doctors and you get a lot of their patients into ENT specialists and there are just very few ENT doctors available. And even with jam-packed schedules, there may be months' long wait lists. But all the time, he’d talk to primary care doctors who really need to get someone in urgently they will always make their best effort to get those in and not have them on the waitlist. [41:35] Special Opportunities Outside of Clinical Medicine Victor says there's always lots of research going on with the basic science level looking at wound care, tissue healing, in addition to the types of different injectable products, hyaluronic acids, botulism toxins. There's a lot of these things called PRP, Platelet Rich Plasma, and other types of different materials that are being injected for stability, safety, efficacy, improving them. There is a number of possibilities to pursue research and development of these types of products. Those who are more interested in the business side can become Chief Medical Officers for healthcare related corporations. There's actually a very small and probably should be more encouraged politically active doctors. “There's always lots of different opportunities that you can springboard from your specialty.” There are a lot of different opportunities based on what you're interested in. But there is always that idea of you're giving up that patient interaction and that normal typical doctor schedule, but maybe it's for more regular hours when you're becoming an executive in a corporation. [43:55] What He Wishes He Knew Then “One of the major deficiencies in a doctor's education is the business side.” Victor attended Tufts Medical School and they had a great health professional MBA integrated program that didn't really hold you back from graduating under four years. Although he didn't participate in it, he still thinks it should be part of more the regular curriculum. There are great doctors that can no longer practice because their practices get shut down and closed. Other individuals who have some phenomenal skillset and need to get out there, if there's this barrier that they can't set up their business and they don't think it's possible, or even you don't necessarily have to be a small business owner, but as a component within even an academic group or a multi-specialty group, if you don't understand the metrics of and the financial side of it, you can't practice effective medicine if you're running at a loss, and you're going to get shut down, and then what happens to all your patients? Hence, Victor thinks the economic side of medicine really needs to be a core component in addition to biochemistry, genetics, anatomy, and physiology because it's inevitable. Medicine has become more and more business. It may not be desired to be that way, but it's a reality and physicians really need to understand how to run it effectively and how to protect their business so they can continue to give great care to their patients. [46:05] The Best and Least Liked Part of Being a Facial Plastic Surgeon Victor loves the fact that he has the ability to look at something that a lot of people think they understand well, and bring just another level of understanding, another level of treatment to it. For example, when people talk about breathing through their nose, some may attribute it to allergy while others to structural issue like a deviated septum. Victor stresses that alone takes a higher level of understanding of nasal physiology, and the anatomy, and diseases that affect it. But a lot of really well trained people will stop at that point and they may treat the allergy, they may fix the deviated septum, and the patient still has a breathing problem going on. This is where Victor comes in and he loves understanding the true nuances of the facial structure. He says having that ENT background gives him the understanding of all the functionality, all the moving parts, all the components that need to work day-to-day being normal. “The additional training in facial plastics gives me the side of the aesthetics but also the skillset to create that structure, to improve the functionality while maintaining overall looks.“ Victor claims his best results are noses that have just gone away. The patient no longer notices that it's stuffy or they have difficulty breathing through it when they exercise, and they no longer stare in the mirror and look at their nose that they feel is so prominent, and some people feel like it makes them ugly. And so the greatest success for him is to see patients to have their nose essentially disappear and just be in harmony with the rest of their face. It's still their nose, it's not a beautiful or fantastic looking nose, it's just their nose. He loves the fact that they don't even have to think anymore about picking up a spray bottle, or an allergy pill because their nasal passageways are nice and open, and so they just go about and they do normal tests every day without a thought in their mind. Victor describes it as one of the pure joys of doing it that he notices and that the patient no longer has to worry about anything anymore. On the flip side, Victor thinks trauma is tough but there's a great opportunity to really make a major improvement. Someone breaks their jaw, or shatters their eye socket, but there is a limit of what the end result can be because of the nature of the original trauma. You can always make improvements but you can't really get them to a truly better place. “There’s a major psychological component related to trauma, so even with an improved physical state, mentally there's still a deficiency. There's still a pathology going on.” Victor thinks maybe a multi-specialty kind of care type of thing can get someone who's come back from major trauma to really get them healthy again, because mentally or physically there are just limitations from just those initial insults that they can't really get back to their baseline. If he had to do it all over again, Victor would still choose to do facial plastics. He loves what he does and he says he’s excited to get up every day to go and see what comes through the door and he thinks this will stimulate him for years and years. At the same time, he would look for other additional skillsets such as check out a neuroethology fellowship as well as other things that would complement what he already does. Or he may get into facial nerve reconstruction therapies and then advance outside of that. Victor feels blessed to be able to do this. He could have gone a lot of other ways and would have been fine, but if given the opportunity to go about this again, he would still pick the same residency, the same fellowship, and focus on the same things. Maybe small little tweaks here and there, but overall, that same path has been really beneficial for him. It has really played to his strengths and it has given him the skillset to be a successful practitioner. [52:15] The Future of Facial Plastic Surgery Victor isn’t sure if any major changes are coming to facial plastics whether in the technologies or just fundamental shifts in the way things are practiced. He admits though of being on social media, a lot of people are becoming aware of new products and technologies at a much faster rate. The initiation of that first treatment is getting younger and younger. There are twenty-year-olds getting Botox to prevent wrinkles and people getting surgery at a younger age. But the largest kind of shift going on around a lot of focus on non-invasive therapies such as energy devices, like injections to dissolve fat. “There’s a little bit of oversell on those stuff that get marketed as quick and easy, and when they add on cheap, quick, and easy, those results don't ever really match the promises of the outcome that they get.” They're often short-lived and have unforeseen complications. They affect your ability to do things later. They burn bridges in treatment pathway. One of the things is injection rhinoplasty. People are putting fillers in their nose, but fillers in the nose in that skin area don't behave as well or in the same way as it does in the other soft tissues of the face. Victor has even seen disastrous things like blood vessels being blocked off, and whole areas of the skin and tissue on the nose enclosing. And that can happen in other areas of the face. It will heal and leave with some scarring, but if it happens on the nose or near the eye, then you've lost more function. Victor thinks it’s revving up toward these office procedures, and some are great, but then they're being expanded to use in replacement of tried and true therapies, and he thinks it'll surge but then people will see so many issues with it and then it will come back. There will be better technologies, there will be better equipment, there will be safer mechanisms out there, and all for the good. Victor adds that's how medicine has always been. There's always been sort of a pioneering technology, or thought, or philosophy, and then new techniques come out, and then they kind of push the threshold of risk and complication, and they back off, and then there's a new push as new developments come on the horizon. But that's how you progress, and improve, and come up with new therapies for diseases that previously never had any treatment. So it has to be done but just in a careful way and more informed way. [55:30] Final Words of Wisdom from Dr. Chung Victor’s advice to patients is to take some art classes. It's one thing to understand the anatomy, but if you can translate that anatomy and the structures from your brain to your hands, and using your hands, those are all good basic skills that can translate into being a better surgeon, and choosing when not to upgrade. Everyone will study hard and everyone will get a high score on the test, and everyone will strive to get that letter, but you need to find one or two things like sculpting, or drawing, or it might be music, or something to really keep yourself active and in a unique sense to keep yourself motivated. You may bond with some big name doctor one day who's going to write you a letter based on that unique activity that you do that not everyone else is doing. [56:55] Final Thoughts If you are interested in ENT, or otolaryngology, or even the specialty or subspecialty of facial plastic surgery, I hope this episode was interesting to you. I love these conversations, I learn so much from them even as a physician, so I know that you as a premed or a medical student are going to get a ton of great information from these conversations to help steer you in the right direction for your career. Links: www.TheShortCoat.com

This week on StoryWeb: Sherman Alexie’s film Smoke Signals. Smoke Signals is the first – and as far as I know, only – feature-length, commercially distributed film written and directed by Native Americans with a fully Native American cast. Written by Sherman Alexie and directed by Chris Eyre, the 1998 film is loosely based on Alexie’s first collection of short stories, The Lone Ranger and Tonto Fistfight in Heaven, published in 1993. The film also includes characters who recur throughout Alexie’s other literary works. Is it a comedy? Is it a drama? I suppose it is predominantly a drama, as Victor Joseph and his friend Thomas Builds-the-Fire travel from the Coeur d’Alene reservation in Washington to Phoenix, Arizona, to pick up his father’s remains. In that sense, it is a coming-of-age story of sorts – or perhaps more accurately, a coming-to-terms story. But there are also many comic elements to the film, and the wry humor emerges in part because Smoke Signals is also a classic buddy road trip movie. Victor and Thomas, as mismatched as they ever were as children, spar and play off each other – Victor the cool, stoic Indian, Thomas the geeky, ever-chatty storyteller who smiles too much. As they ride the bus to Arizona, Victor tutors Thomas in how to present himself as a “real Indian.” He needs to let his hair flow freely as a symbol of his warrior status, and he needs to wipe the goofy grin off his face. Thomas returns wearing a Fry Bread Power T-shirt, his braids unfurled, his gaze serious, and his walk a swagger. While this scene is funny, it is also searing, as Alexie deftly skewers the stereotypes white Americans have of Indian people. Alexie pulls off this double-edged humor again and again in the film. One of my favorite scenes is the one in which Victor and Thomas ask two young women on the reservation for a ride. The women say they’ll consider the request but first need to hear a story. Ever one to spin a yarn, Thomas launches into an account of Victor’s father, Arnold Joseph, being arrested for protesting against the Vietnam War. He plea bargained, and his ultimate charge was “being an Indian in the twentieth century.” When Victor asks the women what they think and whether this story is good enough to catch them a ride, one of the women says, “I think it is a fine example of the oral tradition.” Academics who teach Native American storytelling and literature are caught up short – they’re forever celebrating the Native American oral tradition – but those in the audience can’t help but laugh. The scene ends with Victor and Thomas climbing into the backseat and with the car taking off in reverse – the only direction in which it goes. But the film is much more than jokes, funny thought they may be. No, the film is much more a drama. Called to retrieve his dead father’s ashes, Victor goes on a quest to find his father, to make peace – if he can – with the legacy of an alcoholic, sometimes violent father who abandoned Victor and his mother. At the end of the film, Victor calls to his father, Arnold, from the bridge over a river, and we feel his release as he lets his father’s ashes go. Like all of Alexie’s writing, Smoke Signals is self-aware, self-conscious, self-referential, perhaps one could say postmodern and not go too far. In Smoke Signals, there is a strong, clear story. But there are also “meta” references, where it’s clear that Alexie, as screenwriter, and Eyre, as director, are very well aware of the tropes they are using and overturning. Buddy film? Check. Road film? Check. Coming-of-age story? You got it. Western? You just might have something there. Developed at Sundance Labs, Smoke Signals won the Filmmaker’s Trophy at Sundance. Provocative insights into the film can be found in Filmmaker Magazine’s interview with Alexie and Eyre – and background on the making of the film and its impact on other Native American filmmakers can be found in an interview with Eyre. As the New York Times says, it is also more than a “first” in Native American film: “it is a step by a new generation of Indian artists toward finding an idiom for exploring their individual and cultural identities without resorting to self-pity, political correctness or Hollywood cliches.” For those of you who are teachers, check out the University of Michigan Press’s curriculum guide to Smoke Signals as well as the Teach with Movies supplemental lesson materials. If you haven’t seen Smoke Signals, you owe it to yourself to get a copy and take a look. And when you get hooked on Alexie’s work (as I know you will), you’ll want to delve into his print writing as well. Alexie is absolutely one of the best American Indian writers today (along with N. Scott Momaday, among others). His first novel, Reservation Blues, was published in 1996. His young adult novel, The Absolutely True Diary of a Part-Time Indian, won the 2007 National Book Award for Young People’s Literature. War Dances, a collection of Alexie’s short stories and poems, won the 2010 PEN/Faulkner Award for Fiction. This year, he published a picture book for children, Thunder Boy Jr. In addition to his fiction, poetry, screenplays, and books for young adults and children, you’ll also want to check out his poem “How to Write the Great American Indian Novel.” Visit thestoryweb.com/alexie for links to all these resources and to watch a short clip from Smoke Signals.