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The podcast for high-level leaders carrying the invisible weight of the world.
If you’re a founder, executive, or high-ranking leader, you already know this truth: the higher you rise, the fewer people you can safely talk to.
Lonely at the Top is a sanctuary in the storm—a space where the emotional cost of leadership is named, and where relief, clarity, and grounded support are always on the table.
Hosted by Soul Medic and former psychotherapist Rachel Alexandria, this podcast dives into the unspoken realities of high-level decision-making: the pressure, the isolation, the doubt, and the fatigue. Each episode offers insight, emotional tools, and conversations with seasoned leaders who’ve learned to navigate the weight of responsibility without losing themselves.
Rachel: [00:00:00]
Welcome to Lonely at the Top, a podcast for high-level leaders carrying the invisible weight of the world on their shoulders because you know the higher you rise, the fewer people you can safely talk to. Here we welcome founders, executives, and decision-makers who feel the isolation and pressure that comes with power. Lonely at the Top is your sanctuary in the storm, and I'm your host, Soul Medic and former psychotherapist, Rachel Alexandria. Today on the podcast we have Dr. Pamela Lee, who is a colorectal surgeon, also chair of surgery at Sharp Memorial Hospital and chair of surgery for Sharp Reese Stealy Medical Group.
[00:01:00] She's a robotic surgeon as well as a mom, a wife, and the primary breadwinner in her family. I am so excited to have this conversation. Thanks for coming, Pamela.
Pamela: Thanks for having me.
Rachel: So when we start the pod, I always like to talk about how I know the person because sometimes they're a friend or a client and sometimes they are a new, a new acquaintance. we know each other through the very fancy San Diego group called The Reading Club.
Pamela: Yes. Are we allowed to say that out loud?
Rachel: I don't-- I, I think so. It's not
Pamela: yeah. It's on their website.
Rachel: Club. Yeah. You can find it online, yes. And we met actually on a bus doing a tour of an active battleship that was stationed in San Diego.
Pamela: Mm-hmm. Yeah. The USS Lincoln, I think, right? I think that's what it was.
Rachel: Good memory. Yeah, I don't remember. Yeah, it was, it was cool, and I think you [00:02:00] introduced yourself saying, "I'm a butt surgeon."
Pamela: what my kids call me, so it sounds better than proctologist. I hate saying proctologist. It's so, like, I don't know. I think it conjures up bad images for people.
Rachel: Well, you know, when I heard butt surgeon I didn't think this was the case, but I immediately thought plastic surgery. I thought you were doing Brazilian butt lifts for a second.
Pamela: You know, it's funny 'cause sometimes I make a joke in the OR that I am kind of a plastic surgeon because I beautify anuses. It's part of my job. but yeah. So in a way, I kind of am a plastic surgeon for the anus.
Rachel: Nice. That's cool. That's part of your job to beautify the anus. Can you say more about that? I know nothing about
this.
Pamela: I mean, colorectal is kind of a very broad specialty. So I did, a residency in general surgery, right? So that's like five years, and then I did an extra year of fellowship training. So colorectal surgery, proctology, that's all kind of used interchangeably, but we do a [00:03:00] ton of stuff. So, part of my practice is anal rectal stuff, so hemorrhoids, fistulas, you know, all the things that kind of can happen to your anus.
And then, but I also do, you know, abdominal surgery, mostly colon and rectal work. So we do like surgery for diverticulitis and colon cancer and rectal cancer and, many, proctologists or colorectal surgeons still do colonoscopies as part of their practice too. So, yeah, so it's a mix of, kind of office stuff, outpatient surgery, inpatient, you know, complex surgery.
and then I also take general surgery call at the hospital, so I cover emergency stuff too.
Rachel: is incredibly, busy and wide-ranging.
Pamela: Yeah, it is. A lot of colorectal surgeons don't take general surgery call. Like, one of the reasons you can go into colorectal surgery is you don't really-- I don't know. It's kind of like, in a lot of cities, you are not expected to take general surgery call as a colorectal surgeon.
Like, you would just cover colorectal emergencies, which don't happen very often. But, in San Diego, I would say most colorectal surgeons have to [00:04:00] cover general surgery call. It's just kind of the culture in this city, so
Rachel: Hmm. Interesting. How long have you been working in this field?
Pamela: So I graduated fellowship in 2011, so I've been in practice since 2011, and I started out in Santa Barbara. that's where I did residency, and I joined my old program director there for like four years, and then came down to, Sharp Rees-Stealy in 2015, so I've been here about 11 years
Rachel: Wow.
Pamela: I did undergrad at UCSD, though, so that's, you know.
San Diego was like one of the few places I've left, probably one of the only places I've ever left where I was like, "I'm really to be leaving," you know? I mean, the other places it was kind of like, "All right. We've d- we've done enough here. Like, it's time to move on," you know? But San-- When I graduated UCSD, I stayed a, a year.
I guess the kids call it a gap year now, but it was basically like a year off, so I was here for five years and then before I went to med school. But I always miss San Diego, so...
Rachel: I get it. If I ever have to leave, I [00:05:00] will absolutely miss San Diego. It is, a balm for those of us who are drawn here.
Pamela: Yeah.
Rachel: So when I was talking to you about this show and about being lonely at the top, is this something that resonated for you? 'Cause y-you're chair of these two different surgery groups, which means you're in charge, and you were telling me a little bit about this over lunch.
Can you say more? Like, what's this experience like know, you're, you're sort of leading the OR, I would assume, and then you're also leading groups of a bunch of other surgeons.
Pamela: yeah, so I'm chair of the hospital department of surgery. So, at Sharp Memorial, I don't know, there's probably like 400 surgeons. I mean, it's basically I'm the chair for anybody who has privileges within, you know, the specialties that I cover. so I'm their chair. And then, as you mentioned, I'm also the chair of surgery for my medical group.
So that's kind of a different, you know, it's a different role. each one is challenging in its own [00:06:00] ways. so with the hospital side, most of my responsibilities have to do with ensuring quality of care, making sure that, you know, patients are safe. you know, we do what we call peer review, so if there's cases that have complications or fall out, you know, there's a number of things that we look for.
we have to look into those cases and, and sort of, send them, you know, for review, and then we discuss them, and decide if they're-- you know, we c- call it adjudicating, but basically decide if the case was fine or, you know, is there room for improvement. We send a letter to the surgeon, you know, "Hey, next time you should be thinking of this," and whatever, right?
So it just kind of depends on what the complication is or what happened. also on that side, I'm responsible for kind of behavior stuff. So when surgeons, you know, get a little bit uppity or angry in the operating room and maybe don't conduct themselves in the best way, which you can imagine sometimes happens in surgery because there's a lot of ego.
so I have to deal with that, as well. but on the, group side as the chair, it's much less of that. I don't deal with a [00:07:00] whole lot of quality very often or anything like that. It's mostly how are we building our department appropriately, hiring people and expanding and, you know, figuring out logistics of where we're gonna put them and, you know, things like that.
So it's, it's actually two-- They sound the same, but it's two totally different roles.
Rachel: yeah, I get that. One is kind of thinking more systemically and one is more personnel and HR, Yeah. Mm-hmm.
Okay. And what, made you decide to take on either of those roles and especially at the same time?
Pamela: So I've been chair at Sharp Memorial for longer than chair in my group. It's one of those things. I don't know. I mean, I started here 10 years ago, and obviously I was kind of the new kid on the block. So in that sense, I didn't really have any specific aspirations of, you know, being in leadership or anything like that.
but you know, probably about four years, three, four years into being here, some of the leaders that were already in these [00:08:00] positions kind of, tapped me on the shoulder and were like, "Hey, have you ever thought about running for this or doing that?" and yeah, so that's kind of how I got into it, and it probably wasn't until about five years ago that I really started getting into like some of these leadership roles.
Rachel: So you got tapped on the shoulder, but yeah, what, what in you, like, was there like a, "Oh, I think I can make things better"?
Pamela: Yeah, I think so. I mean, I think that like, there are plenty of leaders, and I've seen them, because they've been my leaders, you know, where I'm like, "Pfft, I would not do things that way." You know what I mean? Like,
Rachel: Mm-hmm.
Pamela: you know, it's kind of like parenting, right? Like, as a parent, there's so many things that my parents did that I'm like, "I'm not doing that."
You know what I mean? So,
Rachel: Yeah.
Pamela: you know, and most of my friends that have kids are like, "Oh yeah, I learned a lot what not to do from my parents," you know? So I think that, I've been subjected to bad leadership, you know, myself and, I just really did not want... It was kind of in a way like to kind of like get power out of like the wrong hands [00:09:00] almost.
Do you know what I mean? Like, and, be able to, you know, kind of take over those roles and, and do them in a, ethical and, and fair way, which I don't think some of those people were, were operating that way. And I think that, sometimes the most reluctant leaders are actually the best leaders 'cause there are definitely leaders out there who want the power and want, you know, the control and all of that stuff.
And then, they're not a selfless leader. You know what I mean? They're always gonna put their needs and wants above everyone else's, and then that's when the leadership really starts to go awry and you don't, you're not representing the people that you're supposed to represent anymore. So, yeah.
So I think that's probably why I got tapped on the shoulder just because I'm, I'm seen as a fair person. and my motivation really was to, to kind of topple some of the leadership that I didn't think was necessarily operating with the best intentions.
Rachel: what are the sacrifices that have come with that, and do you feel like it's worthwhile?
Pamela: I do. I mean, I think [00:10:00] some people have a calling for this. Because selfishly, I do get satisfaction out of this too, right? It's not just like I'm, doing it-- I mean, I'm doing it because, I wanna do it well, but I also get satisfaction out of making sure that, we're achieving the goals that we set out to achieve, right?
it does require sacrifice, certainly time. you know, I have two kids, as you mentioned. They're, you know, they're a little bit older now. They're 10 and 12, so they're a little bit, you know, they're more self-sufficient for sure. I have an incredibly supportive husband who, you know, as you mentioned, I'm the primary breadwinner, so, things were, I think, a lot... It, it was a lot tougher to be in leadership when they were younger, right? Because, you know, there's just so much stuff going on, and the emotional, toll of being a parent, which is significant.
You know, I would sometimes come home and my husband would point out to me that, like, I didn't have a lot of bandwidth left over for, like, the kids and the family. You know what I mean? So not only was it a time thing, but it was also like, you know, an emotional [00:11:00] exhaustion thing that I think my family has kind of had to deal with.
and you know, like, even in the beginning, I mean, when I first started out in practice, I mean, I was just like so anxious all the time too, you know? So my husband's seen me go through-- I mean, we've been together since residency, so, and he's not in the medical field, right? So he's seen me go through all of these, like, phases of my life, and definitely, like, a big learning curve is, like, coming out of, training and having your first job as, like, an attending, you know, it's so different when you see your name on the chart, you know? 'Cause as a resident, there's always kind of like a safety net a little bit, right? Like, it's like, "Oh, this is my attending. I'm just, you know, and so he saw me through that. That was obviously a very stressful time. I would say, you know, I always feel whenever I meet new surgeons, I'm like, "Ugh, I, like, feel for you." You know what I mean?
Because it's gnarly the first two years. You finally, after I think five years, I would say, like, kind of, you're like, "Okay, I got [00:12:00] this." But it takes five years after training to really feel comfortable that you can deal with the stuff that's coming in through the door, especially with like taking call and things, right?
'Cause it's like, you know, it can very much be like, you know, a, a crapshoot as to what comes in. and then I got through that, and then I got into the leadership, right? And so now that's a different time, you know, and kind of like emotional suck, you know? so I think that that has been probably the biggest sacrifice is, to my family is, that, the time and the emotion.
you know, I'm at the kids' baseball games, like, doing meetings, you know what I mean? And I'm there, but sometimes I'm, you know, Mom has to be on a meeting. Sorry, I'm, like, watching you, but I'm, thank God for Teams.
Rachel: Yeah.
Pamela: You know what I mean? Because before pandemic, I mean, everything was, like, pretty much in person, so, you know, if there's one good thing that came out of pandemic, it's that most stuff is on Zoom, so I can do it while I'm, making dinner or, going to the game, so.
but they're kind of used to seeing me with my headset on.
Rachel: Mm. Yeah. it's so helpful to [00:13:00] hear about, I don't know if, if you experience this sort of post-feminism thing of like, I think we've seen lots of women in power, talking about trying to hold family time and trying to hold work at the same time.
But it also seems like we, can't get enough of these stories. even still, even, you know, 30 years into this post-feminism, like, I don't think I'm even using the right term because I don't think we've ever left feminism, but not a, a student of that part of sociology.
it still feels like it's hard to talk about and it's a thing that guys don't talk about, about being in leadership, you know, having a really powerful career and m- you know, just sort of the, the heart-wrenchingness Of knowing that you're, trying to be there for your kids, but you're still not there.
You're still not as present as you wanna be.
Mm-hmm.
So [00:14:00] I appreciate you bringing that in because
I think there's a way that we tell women they should have it all, and it's not true. we have to make our choices.
Pamela: Yeah.
Rachel: So how is that for you in the field? Are there a lot of other female surgeons who are making these same choices? Do you have, like, a camaraderie around this?
Pamela: Yes. I mean, so women in medicine is like, you know, I think over 50% of the med students in the US now are women. It's over 50%, you know? But within my specialty and within surgery, it's not as much, right? So, which I understand. I mean, When I went through med school, I was not interested in, you know, you do all these rotations like through, you know, medicine and pedes and, you know, everything like that, and I just, didn't-- Those things didn't call to me, you know?
people always ask me, like, "Why'd you choose surgery?"
But it's just, like,
Rachel: Is peds pediatrician?
Pamela: Yeah, ped- yeah, pediatrics, yeah. So there's, like, more... Sorry. [00:15:00] So with surgery, there's less women because it's more demanding. I think that that is changing somewhat. Like, when I was in residency, I didn't have kids, right?
Like, 'cause I was just like, "I'm not gonna do that. It's too stressful," and I'm not, like... You know what I mean? Like, I'm not, There's very much this, like, onus as surgeons that you don't wanna put your work on other, other, you know, on anyone else, right? Like, I'm not gonna, pass my patient on.
I'm not gonna sign my patient out. Like, and it's kind of an old school way of thinking. I think that, there's more women in surgery, as we're more, like, You know, the younger generations are obviously a lot more concerned about lifestyle and things like that.
You know what I mean? So I think the needle is moving, But I was kind of brought up in that transition point where you really didn't wanna sign things out. You round on your own patients. You, you know what I mean? You know, if something happens, you're the first one there, you know, to your patient, you know?
So, I still think there's value in that, but I think it has, also has to be a balance, right? so I think that there-- As things have moved on, there, there are more women in surgery. probably, I think maybe, like, [00:16:00] 40% of general surgery residents now are, are female. but it's definitely when you look at, like, my department that I run, there's not many, there's not many women.
And I think that there are plenty of women in leadership. certainly, you know, if you were to do, like, a nationwide kind of, like, poll, there's not a lot of, women in leadership, like, academically, right? Like, chairs of departments for, like, you know, for, in the medical schools. There's not a lot of women that way.
I think I'm probably the first female chair at Sharp Memorial. I don't think there's been one before me. so I think there is camaraderie in some of the leadership, but at the same time, being a female surgeon leader is kind of like a, more of a unique, I think, thing than, being, like, a pediatric, you know, or an internal medicine leader.
It's just not as, it's probably not as common, I would think, just 'cause there's less of us, you know?
Rachel: Yeah, makes sense. So do you experience that as lonely ever?
Pamela: you know, I don't [00:17:00] really feel like I'm lonely in this often. I mean, I have so many good people that have tapped me on the shoulder and kind of, you know, brought me up through this process, and they're-- most of them are men. there are some females. there's one or two females that, that, you know, we collaborate and, you know, and we're very much on the same page, so that's nice.
I have a lot of support, in both of my roles, I would say. And I'm kind of, like, not the very tippy top, right? I'm, like, in leadership, but I have people above me, and I have people below me, so I'm kind of sandwiched in between people. And so depending on what the issue is, I always have people to kind of, you know, support me and, run things by and things like that.
So I'm very, I'm very fortunate in that.
Rachel: Yeah, that is really helpful. yeah, sometimes on the show, I get people who are like, "Ugh, I'm the only one, you know, in here making decisions," but it's nice to hear of people who don't have that isolating experience. Do you think in the OR, [00:18:00] like you said, the first five years or the first two years are some of the hardest, where you're the one where the buck stops?
Pamela: Oh, yeah, that can be lonely. that feeling like sometimes where, like if you get in like a car accident or something like that, it's like this in- intent-- You have actually this like lonely feeling like you're by yourself, right? Like you're like scared and you're lonely and like, and then, you know, it's that initial like I think like fight or flight response.
you know, your s- your stomach drops. You know what I mean? I guess that's how people kind of describe it, definitely in the OR, especially in the beginning, like it's very, it is very lonely. you know, we're expected to be decision-makers. We're expected to be confident but it's a balance too, right?
And it takes a while to gain that confidence. Like I said, you know, two to five years. First two years are rough, really rough, but then after that, you kind of plane out. But at five years, like I said, is kind of where you really start to hit your stride. but there are times in the OR even now where I'm like, "Oh my God," like, you know?
And that's, that's like the worst feeling in the world, is how am I gonna get out of this? [00:19:00] You know what I mean? Like the patient is incredibly complex or, the anatomy is not what you expected or... You know what I mean? 'Cause I think like when I go into a surgery and I see a patient, let's say, in the office, I kind of have an idea in my mind about like what level of difficulty this case is gonna be, right?
Like this is a standard colon resection, you know, for diverticulitis, or this one's gonna be rough because of all of these other factors that are, whether it be, other surgeries or, you know, they're a really sick patient at baseline and they have all these other things going on. so in my mind, I already have a certain level of anxiety about a case.
And so where the anxiety sometimes gets out of control, or not out of control, but, elevated in the operating room, I would say, is when I'm caught off guard. So, if I'm mentally prepared that it's a bad case, like or it's gonna be a difficult case, like I know it's gonna be difficult and I'm mentally prepared for that, right?
I tell my nurse, "Hey, this isn't a standard case. Don't book it for two. I'm gonna need four hours for this." Or you know what I mean? So in a way, I've kind of mitigated that [00:20:00] because part of the anxiety is, "Oh my God, I have another case to do," you know what I mean? And I'm, you know, I don't wanna have to rush and, and I wanna take my time.
So, when I tell my nurse, "This is gonna be double time," like in a way that's me responding to the level of difficulty that I think the case is gonna be. Now, sometimes I'll go get in there and, you know, I'll think it's an easy case and it's really not an easy case, and it's, it's a lot more difficult.
And I mean, I can remember this one time where, you know, I do da Vinci surgery and, I was in this awful case. I mean, I think I knew it was gonna be bad, but it was like, way worse than I thought it was gonna be. And,
Rachel: Wait, hang on a second. Did you say Da Vinci surgery?
Pamela: Yeah, the robot, robotic, yeah. 'Cause the da Vinci robot, yeah, so Intuitive makes the da Vinci robot, so that's basically how I do all my cases.
Like I, you know, I'm like 98%, da Vinci or robotic surgery. So I-- and you know, when, when you do, surgery on, on the da Vinci, the patient has, you know, you have a scrub tech by the patient, right? So they're doing the instrument exchanges. I put the ports in, so I'm scrubbed in. I put the ports in to, to allow for the [00:21:00] instrument exchanges.
Once the ports are in, then I move over to a console that looks like basically like a 3D video game console, right? And I control the robotic arms. I'm still in the room, but I'm unscrubbed. Now I'm on, now I'm not sterile. So now I am controlling the robotic arms that are being, moving around in the patient, eight to 10 feet away from me.
and I have a microphone so everyone can hear me say like, "Hey, I want this instrument exchange," and then the scrub tech is doing, you know, the stuff at the bedside. But, that's just the setup, how the room setup is. But I remember like I was in this really awful case, and I just like almost started to like cry, like in the, in the console, you know?
'Cause I was just like so overwhelmed, like, "How am I gonna get out of this?" You know what I mean? And I remember thinking to myself like, and I tell this story sometimes to people, I'm like, "There's no, there's no crying. There's no crying in surgery, Pam." You know what I mean? Like it's like that line from, you know, Tom Hanks in, uh, "League of Their
Own," "There's no crying in baseball.
Were you crying? There's no crying in baseball," you know? [00:22:00] And I was like, "Pam, there is no crying in surgery." Like, because if I lose it, everybody around me loses it. You know what I mean? And I'm like, I am I set the tone in the operating room, and if I lose my shit,
everything falls apart, you know?
So I remember I just like kind of like took some deep breaths. I kind of gathered myself, and I was just like, "I'm just gonna get through it. I just have to get through this case. Like I'm getting this patient off the table however the safest way that I can, and we're just gonna handle it." And, afterwards, the anesthesiologist who I'm friends with was like, "Oh man, that was a terrible case."
And I was like, "It was. It was awful." He goes, "I've never really seen you struggle before like that." And I just started laughing 'cause I was just like, "Thanks. Thanks, Gary." He's like, "Yeah, I mean, I just have never seen you struggle like that before. That was like... But you did a really good job. I'm just telling you, you did not lose it.
Like, you did a really good job." And I was like, "Thanks." You know what I mean? But that was one moment where-- And that doesn't happen very often, and as you get on in your career, it happens less and less, thank God. but you know, yeah, I mean, those [00:23:00] moments are incredibly lonely in the operating room. I do have partners that I can like ask for help and stuff like that, but you know, we're, we're very busy surgeons, you know?
My partners are operating. They're doing other stuff, you know. I have to pull them into the operating room to get help. you know, one thing that is really-- So we use this new, robot called the DV5, the da Vinci 5. One thing that is amazing about it, and I'm gonna tell you is like one of the best features, is I can phone a friend on it.
Rachel: Oh
Pamela: So you can like show an image, you can like call and be like, "See what, this
Yeah, so I can send a link to my friend and, I've helped people in the operating room. Like one of my, you know, one of my partners was like, "Hey, do you think that I need to do this?" He was doing a colon resection and, and I was in the office seeing patients, and I just put in the link and he could hear me, and I was watching him on the conf-- I was seeing exactly what he was seeing.
And I was like, "Yeah, I'd go here, I'd go there," you know what I mean? "I think you're good." And then I was typing up notes. I mean, this is like kind of exciting stuff about surgery now is the technology that's being... Yeah, I mean, to be able to phone a friend, I mean, think about if you're in this like
Rachel: If you're in the middle of
nowhere, Illinois or something,[00:24:00]
Pamela: you're the only surgeon doing that surgery, and you're like, "Man, I just could really use some help right now." You can remote in proctor. I've proctored one of my old residents in Seattle, in like, in Washington, and I just logged on from my computer, and he was there, and I was watching him operate, and I didn't even have to travel to Washington and I could be there for the whole case.
So, the connectivity between all of us is, I think, like one of the most exciting things that's gonna happen in surgery in the next like-- It's happening now, but it's only gonna get better.
Rachel: Wow. That's incredible. What a cool ... Yeah, thank you for sharing that . People who tune into the show never know what they're gonna hear about, you know? That's part of why I like doing the show and I like doing what I do, because I get these windows into other people's amazing professions and their worlds and what's happening there.
That's really cool.
Pamela: Well, eventually you'd wanna be able to do surgery in Africa from New York City or something, you know what I mean? You put a robot there and then you have like a cable and you can actually like, you know. So yeah, it's a really exciting time for robotic [00:25:00] surgery. It's gonna be pretty amazing, so.
Rachel: Yeah, that is amazing. wow. It makes me think of, we've seen Project Hail Mary a couple times
in the theater. Part of what happens in this, in this realm in the book is, they have to devote the entire planet's resources to sending these three people off to another, solar system to find the answer for something that's killing our sun.
And, our sun as in the solar star that supports life on Earth. Yeah. And one of the things they have to resolve is how to take care of the people when there's g- not gonna be any medical personnel present. And so they have like nanny robots that have to be able to do ... It, it's not really a major plot point, but it's in there .
So yeah, I guess we're not that far
off.
Wow. That's crazy. Well, I love hearing that, you know, it sounds like in your career like, everyone who works in surgery has figured out [00:26:00] that isolationism is bad for the
work. So it seems like a career where, like, unlike a lot of other things, they, they're really seeing, like, we have to figure out how to support each other to have better outcomes.
Pamela: 100%. I mean, I think that that is like, just not being on an island. You know what I mean? Like, there's so much that we can learn from each other as surgeons and, you know, like I said, most of us, we're busy. We're-- I'm, I rarely operate with my partners. If anything, I'm operating with other surgeons that are, of a different specialty and we're doing like a co-case, right?
So I'm like operating with like a gyn onc or something, a gynecologic oncologist, and he's doing the uterus and the ovaries, and I'm doing the rectum or something. Do you know what I mean? So, so in those cases, we're together. But, I don't operate with my colorectal partners like ever, right?
Because they have a full schedule. They're doing their own thing. And so, surgery can be incredibly isolating in that sense where, you're just kind of the, you know, you're the one in the OR, and you're the expert, and everyone's looking to you. And so for me, I think you're right in [00:27:00] terms of outcomes and quality.
You know, there's so many times as a surgeon you just think like, "If I could just get someone else's eyes on this to just look and just make sure that I'm in the right plane or that I'm doing," you know what I mean? "That I'm doing the right thing." you know, it's incredibly valuable, because we have so much that we can learn from each other, and that's what I think the connectivity and the community that's being created with this new da Vinci system is, you know, that's one of the biggest advantages, I think, is that ability to connect surgeons.
Rachel: Wow. It just makes me think about-- 'cause when you were first talking about, kind of getting into the weeds, like being in there with a, with a patient and being like, "Oh, boy," I mean, that happens with therapy too. one of my trainers, when I was in therapy school, she was addressing a question somebody had about being intimidated to do the work, and she said, "Yeah, the first time I sat in with a, client, they, they started talking about all their problems, and I thought to myself, 'Oh boy, this person needs a therapist.'"
And then I went, "Oh no, that's me." [00:28:00] I loved that she shared that, you know? And I think early on, therapists tend to have the same issue of like, "How do I help?" Especially because we don't have immediate results the same way that something very physical like surgery does. But, That same thing can happen, and I think it happens less over time.
But I've definitely sat in with a client from time to time, and they come in and I'm just going in my head like, "I don't, I,
Pamela: How do
Rachel: know how to make..." Yeah, I mean, I guess the benefit that I have with my clients is I get to say, because this is just how I practice, I get to make that transparent. Like, " Wow, yeah, this is, this is a really rough one.
There's not a lot of getting out of this. Here are some things we can do. What feels appealing?" You know, so I can kind of collaborate on the treatment with them, which obviously you so cannot do in your profession. So that is one way that I un-isolate myself as [00:29:00] a practitioner. But yeah, there's some part of it that I really feel a kinship with.
Like sometimes you're just like, " Ooh, this is more complicated than I thought it was, and I thought I could help and now I'm doubting
Pamela: I think like, you know, from the perspective of somebody who, I can't collaborate with the, with the patient on the table obviously, but I think that that vulnerability to be able to say that I don't have all the answers is incredibly, powerful as a surgeon because surgery is, interesting, right?
Like, you want your surgeon to be confident, and let's be honest, most surgeons have some sort of ego. My husband will tell you that as well. and there's a healthy amount of ego, right? Because you don't want your surgeon to be paralyzed in the operating room when something comes up, right?
You want them to be very like, um You want them to take charge, exactly. And there's a certain level of ego that has to come with that, right? but I think the best surgeons are the ones who have that, but they balance it with [00:30:00] humility and curiosity to learn and learn from their mistakes, right?
A dangerous surgeon is somebody who doesn't think that they have anything more to learn. and so it's about finding that, balance and, the best surgeons are the ones that can balance those things. They can have an ego, and they can be confident in what they know, but they can also understand that they have a lot to learn and they're still learning as they go, right?
but, you know, if you have one side or too much of one or the other, that's when you get, imbalance, and you can get surgeons that are either have behavior issues or, you know what I mean? Or have quality issues, when they have too much of one of those things, or they're really paralyzed by decision-making.
I mean, you don't wanna have a surgeon that's like that either because that's also not safe. So it's about, you know, finding that balance, which, can be difficult.
Rachel: I watch a lot of "Scrubs" with my husband, so it's interesting because I've seen all of these issues represented in the show, so that I just keep going [00:31:00] back to like, oh yeah, Turk and his ego, and the times where he's been too vulnerable with a patient, and then a patient comes off of his service, for example, because he wasn't cocky enough.
He
didn't convince the patient that he had a handle on it. we literally just watched that episode last night. I actually think a lot of people in leadership could learn a lot from what surgery is doing. I mean, I understand that there's a lot of sensitivity in the business world and in lots of other places where you, don't wanna give away too much because people might take advantage of you, I guess.
But wouldn't it be nice if you know, in the, the chief chairs, you know, CEO, CFO, COO, if you could just like send a link and have someone remote in and be like, "Mm, we're looking at this here, and what do you," you know? "Which... Does it make sense to cut over here?" And like, I [00:32:00] just think that we don't do enough of that, so it's interesting 'cause it sort of sounds like robotic-based surgery is leading the way in being more collaborative and therefore more successful.
Pamela: Yeah. No, absolutely. I think that it is probably going to be one of the most interesting times for surgery right now, because this robot just came out, like, two years ago. but, it's slowly-- I mean, it-- I think-- I, I just came back from a conference. I think we've done over, like, 100,000 procedures on the DV5.
but it's only using right now about 8% of its computing power. So we get over-the-air updates, kind of like your Tesla, and as the company is making improvements to the technology, you get on-air updates. So, you know, think about it, like 90% of the, computing power is not even being utilized, and, so what, what does the future hold for this, And this is, on average, they come out with one about every 10 years, so, you know, probably 2034 there'll be another iteration of it. But this is our robot probably for the next eight years or [00:33:00] so, and, it's just amazing. I can't I can't wait to see what's gonna come down the pipeline, 'cause It's an, a pretty amazing company.
Rachel: That's incredible. Okay, so I don't know if we've Talked about this much yet, but can you share with us a leadership decision or season that really tested you?
Pamela: I think that probably the, thing that is the toughest for me is
probably more on my, on the hospital side
with the chair of surgery. Because, you know, the, with the department, for my group, it's like I said, it's mostly, like, program building and stuff like that, so. but you know, I think that there's an incredible responsibility that comes with being the chair of the department on the hospital side, just because, like I said, we deal with a lot of quality.
We deal with a lot of, like, stuff, you know, that, can be very impactful to somebody's career.
Rachel: Mm-hmm.
Pamela: Um, you know, there are certain actions that we take sometimes that will report someone to the medical board, for [00:34:00] example, right? And that is, like, a permanent mark on their record, and so it doesn't, thank God, happen very often, but it does happen, and I, think that that's probably one of the most difficult things, that we do, that's the most trying thing, is, And a lot of it is done by consensus, so it's not like just me making that decision, right?
Like there's definitely, you know, legally like a whole process that we have to go through and, so it's never just on me to make that decision. But, I think that anybody who's on that committee has to take it very seriously and, you know, I think we actually have a really good committee, at our hospital that, does take it very seriously.
But, you know, there's a lot of opinions sometimes in the room, right? And if it's somebody who's a surgeon, you know, you have other people that aren't necessarily in that, specialty that are, voicing their opinion. And so I think for me, it's my job in those situations to, you know, mitigate those things, try to, advocate in some respects for the surgeon, and give my objective opinion about it just because I, do think it's incredibly important for [00:35:00] us to be good stewards of the people that we're representing.
so it's a balance for sure. but I think that in terms of the difficult things, you know, the trying things, thank God it doesn't happen very often. But when it does, it does take a toll on you just because it can be very impactful, like I said, for somebody's career,
Rachel: Yeah. Yeah, that makes sense. Oh, yeah, changing the trajectory of what happens to somebody's career. Although, you know, I also make the argument with my clients that if people don't want negative results, they also should change their behavior.
Pamela: Yeah. No, and it can be difficult, right? You're dealing with like, you know, personalities that have been entrenched for like, you know, 40, 50, 60 years, you know? and, and surgery's a different, now, you know what I mean? Like back in the day you it was, you know, very, they got away with whatever kind of behavior stuff they wanted, and now we're just like, "Dude, that doesn't fly."
Like, "You can't be doing that." You know what I mean? "This isn't the '60s anymore." You know what I mean? Like this isn't even the '70s. Like you can't be doing that, you know? anyways.
Rachel: [00:36:00] Hmm. Well, when you're at the top, no one sees your balance sheet of burdens. But here on the show, we always like to ask the guests to open their private ledger. So can you share with us, and I think we talked about one thing, but maybe there's something else, or we can just, hit the same note.
What is one cost you've paid for being in leadership? We talked about the cost of family.
Pamela: I don't think I've necessarily lost any friends But sometimes I do have to regulate people that I know personally through all my relationships. You know what I mean? So,
Rachel: When you say regulate, what do you mean?
Pamela: well, a lot of the people that I lead are like part, you know, I know them on a personal level 'cause we're friends. Do you know what I mean?
So because they're my colleagues too, you know. So sometimes I have to put on like the leadership hat,
Rachel: Gotcha. Like you have to still-- You can't, like, let your hair down even though you're friends because you're also the leader.
Pamela: Yeah. Or if they're doing something that is like not okay, you know, I have to tell them that. And so, you [00:37:00] know, it's sometimes that can be, that can probably take a toll on some of my personal relationships just because, you know, now I'm the person that's coming down on them, so I mean, I...
Rachel: Yeah, Yeah, I can see that. That is a lot. It, it seems like you're pretty comfortable with being in charge and at the same time, yeah, there is a, a price that you pay.
Pamela: Yeah.
Rachel: Uh, the little therapist in me is like, it's like, "Oh, I can get in there."
Pamela: yeah.
Rachel: All right. So what is one invisible asset you didn't realize you had at the time?
Pamela: I think that I... Like, in terms of me, like, and what I, realized about myself was that I have buy-in from a lot of the people that I lead that I didn't necessarily think that I would have. just being a female and being like, you know what I mean, like probably the first female chair, at the hospital.
But, I think I had a lot more respect from those people than I anticipated, honestly. Like, I kind of was like, "Well, I don't know. I mean, I'm in the [00:38:00] position, we'll just go with it." But, you know, I'm asked to have a lot of difficult conversations and, I do think that the people that I'm having those conversations with, they do listen to me.
They're not just, kind of like pretending to listen to me and, they listen to me because they respect me, which I guess I have, I guess I wasn't expecting that I would be able to, have that kind of impact on people who, like we said, are egotistical a lot of the times. They've been doing something the same way for 20, 30 years, and here's this like, 45-year-old Asian female that's like coming at them and being like, "Hey, you can't do that."
You know what I mean? And like they're like, "Okay, fine, Pam." You know what I mean? And I'm like, "Oh, wow," like that, you know. Let's see if it actually works. but I think I've gotten that way just because I've, earned their respect, just by being in the trenches with them. Like I definitely think that there's something to be said about leaders that are doing what they're saying other people should do, and I do that, right?
Like people see me in the hospital, I work hard. I'm not shirking my duty. I'm a good surgeon. I take good care of my patients, you know. And so when I come at them and say, "Hey, you can't do [00:39:00] that," they know I'm not doing that. You know what I mean? and I'm in the same position that they are essentially.
You know what I mean? And so, you know, I think that if you, don't come from a place of authenticity from that standpoint, you're not gonna get people to, listen to you or, even consider what you're saying.
Rachel: Yeah, I think that's very wise. I'm gonna ask you two more questions. If anybody hears this episode and would love to, in some way, be in touch with you or, be inspired further by your leadership and your example, is there a way that you're letting people get ahold of you?
Pamela: yeah, I mean, I think they can, find me on LinkedIn
on my profile, yeah.
Rachel: Okay, we can add your LinkedIn in the show notes. And last question then the time machine question. We're gonna open the time machine. If you could go back to any point in your career, what would you say to yourself?
Pamela: I would say to myself that, you know, I think one thing that I, didn't do well was, take the time to self-analyze
Rachel: Hmm.
Pamela: when I was coming up through this process. I think that I was very much like [00:40:00] keep my head down, traditional surgeon, like, work, work, work, work, work.
And, you know, I didn't do a lot of self-reflection, about myself and my relationships, you know, with my husband and my children and things like that. And so I think that I've come into that later on. but I wish that I had, done that sooner to just kind of, create more balance in my life, I think.
Rachel: That's pretty typical from high performers. you gotta focus on one thing and make it a priority. Well, thank you so much for coming and having this conversation with us.
Pamela: Thank you for
having me.
Rachel: Yeah.
Pamela: Thank you so much.
Rachel: Thanks for listening to Lonely at the Top. If today's conversation resonated, I hope you'll give yourself a moment to check in with yourself and see what you might be carrying silently. You don't have to hold it all alone. If you're ready for support that goes deeper than just strategy or listening, you can learn more about working with me at rachealexandria.com.
And if you know [00:41:00] another leader who needs to hear this, would you send them this show? Because, yeah, it's lonely at the top, but it doesn't have to stay that way.
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