This week I speak with Dr. Wael Saasouh, an anesthesiologist from Lebanon. He shares his perspectives about working as an attending in Lebanon, then transitioning to the US to do another residency in anesthesiology. He discusses many of the challenges that he and his wife faced working in rural Lebanon, in moving to the US, and in integrating into the US culture and medical system. Apart from the logistical challenges, I was really humbled by Wael’s spirit of perseverance, determination and optimism that allowed him to accomplish great things and encourage others on to achievements of their own.
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Dr. Saasouh: [00:00] The paperwork started back then and it’s still not over. We are in March of 2019 it’s frustrating to say the least and I feel with every international graduate and even us graduates. Sometimes your circumstances are way beyond you and you just have to power through. Hey, this is Justin Harvey, your host of the anesthesia success podcast. My wife is an anesthesia resident and I’m a financial planner and I work with anesthesia and pain doctors as my clients. This podcast is designed to help the anesthesia community be informed about their careers, their finances, and more by taking important questions straight to the experts. Thanks for tuning in. This week is part two of two of our discussion of the practice of anesthesia internationally and this week I talked to doctor, why Elsa soup, who is coming from Lebanon, but he’s actually right now doing a residency at Detroit Medical Center. He has the interesting story of serving as an attending internationally for a few years, but really designed to come to the states and being an attending here. And so he talks a lot about the difficulties and challenges that he and his wife experienced as they came to the states from Lebanon, what it’s been like to adjust to the American AC GME system, and everything that they’ve experienced culturally, personally and professionally. So really excited to speak this week with Dr Whale Sesu
Justin: [01:22] Hey, it’s Justin here. I’m pleased to introduce to you our guest this week, doctor Wael Saasouh brings us unique perspectives about medicine across international borders. He is an anesthesiologist from Lebanon where he completed his residency at American University of Beirut and wasn’t intending anesthesiologist there for several years. Eventually he came to the United States where he did several research fellowships with the Cleveland Clinic and is now working his way through another anesthesia residency at the Detroit Medical Center. So I’m really excited to speak with him about practicing anesthesia internationally and what it’s like to transition to practice in the u s and what the medical system like is here versus abroad. Well, thank you very much for being here today.
Dr. Saasouh: [02:01] Thank you Justin and so pleasure to be here.
Justin: [02:03] So I, I always enjoy digging through the CV to try to find something interesting to start with. And I, I haven’t noticed that you, you’ve done a little bit of Jujitsu. I have. So I’d love to hear about what your experience with that martial art has been like.
Dr. Saasouh: [02:16] That’s a interesting way to start this. My, my uncle used to be a martial artist. He, it was a tape on the black belt holder and I grew up sort of in the mentality that I like martial arts. I like to practice, not just, you know, watch the movies like every again, so I had some training growing up and then as I got to college, there was this Jujitsu club that I was immediately interested in. I joined without a previous experience, but then it turned out to be one of my favorite sports at the time. Oh, that’s great. Unfortunately it’s a little physical. So it was, it’s not something you’d keep doing for a long time if you’re not planning to do professionally. So I have to stop by the time I got the medical school figured my personal safety might be a little bit. Yeah.
Justin: [03:03] Cool. Oh that’s great. So how does it, just out of curiosity, how does Jujitsu distinguished from like, you know, one of the more, cause I, I think it’s more like grappling and like submission holds and stuff, right? Rather than striking is that
Dr. Saasouh: [03:14] it is actually both at some sort of a mixed martial arts with striking standing positions, ground positions, grapples. If you watch UFC, this is as close as I can describe it. It’s a, it’s basically an organized street fight, but, okay, cool. It’s so versatile and so it has so much potential for somebody who likes this that I immediately found myself attracted to it.
Justin: [03:39] Yeah. And I’ll tell you what, there’s, there’s probably times at which if you’re, you know, in the OR or you know, on a night shift and something happens where some guy comes in off the street or something, you never know when you’re going to need a skill set like that. Right.
Dr. Saasouh: [03:51] I hope I never have to use it.
Justin: [03:53] I do too. So I’d love to hear a little bit about your background by l and you know what it was like growing up in Lebanon and you know, your family and your hometown and all of that.
Dr. Saasouh: [04:02] I, grew up in a small town called hospital. shout out to anybody from there was listening. it’s in the southeast area of Lebanon. It’s, it’s a nice, cozy, quiet town. It’s one of the larger towns compared to other towns in Lebanon, but it’s, it’s small by, by any other means. so it, it had this feeling of being your cozy kind of familiar old town. You walk on the street, you know, 90% of people that pass by you. Both my parents were in active service with the Lebanese Red Cross. So I kind of grew up in the mindset of healthcare and it was sort of a, a time of war or conflict or political unrest, which is not unusual for Lebanon. So I grew up sort of seeing my parents do what they do. They basically volunteered because they both had full time jobs as teachers. And as a toddler I had my own Red Cross uniform and I still have a picture of it. It’s one of my more fond memories. But then as I grew older, went to college and everything, I wasn’t precisely planning to become a doctor, however things sort of work out that way. I did a chemistry major in college and I was doing a minor in computer science and I had my plans to do something with that combining both at the time. And this makes me sound a little older. It wasn’t that long ago, but at the time it wasn’t a very popular option to, you know, combine seemingly unrelated majors. I was always interested in computers and I wanted to do something like biomedical informatics or something of the sort and those things were not available for me over there. And looking at my future prospects, I sort of decided that medicine would be a better option.
Dr. Saasouh: [05:50] My parents had been kind of nagging me to become a doctor for awhile and I didn’t want to, but it worked out that way. And during my last semester of my chemistry Undergrad, I decided to become a physician, so I had to take all these other requirements and the prerequisites for medicine and it was just a such a crunch that I didn’t even have a summer break that year in order to actually be able to sit for the MCATS, make it into med school of that year. So I, so I don’t lose a year. Yeah. So that, that’s how I ended up in medicine. And then going through medicine, you don’t know, you go through rotations and you see how other residents live and what kind of lifestyle the attendings would have. And anesthesia’s was just the one thing that I was convinced I wanted to do.
Justin: [06:37] I’m curious as you know, as your senior year, you know, finishing up chemistry, was there like a, a catalytic moment or you’re like, okay, I, there was something had happened where I want to do medicine or was it kind of a gradual realization that you know, it kind of makes sense because I’m already do in chemistry and pharmacology is kind of right there and it just, one thing led to another.
Dr. Saasouh: [06:55] I actually, I was so confused as to what I was planning to do and I didn’t really have a clear idea of what my future should be like. So I had an appointment with my advisor and he sat down with me and he was explaining what I could do after it chemistry and basically given the opportunities I had over there, it was either get a master’s degree, do something in education or get a phd, work in a lab, travel abroad, do something of the sort. And I kept going through these options and then he just casually mentioned, well you could also do medicine. And it just went on. It wasn’t, it wasn’t something that he really stressed. And out of everything he mentioned, doing medicine was probably the most obvious option just because I was looking at my prospects for the future and I knew it was going to be tough, but little did I know it was not, it was a pretty long journey. But then if you like what you’re doing, it’s never easy. But then once, once you get it, once you do it, it’s a, it’s worth it.
Justin: [08:00] Yeah, absolutely. Tell me about your time at medical school. So that was in Beirut and so what was, what’s the medical program? They’re like, and do you have a sense, obviously, you know, you didn’t do any medical school here in the states, but do you have a sense for kind of how it compares or the similarities and differences?
Dr. Saasouh: [08:19] I believe it’s similar. It’s an American University, so it follows an American system. Mostly a medical school. It was just like medical school here have, you will study 26 hours a day and you use it for exams and on that that’s all you do. Basically transitioning from medical school and residency was also similar to what I’ve, I’ve heard my friends here say about what they go through. The only, the one major difference I can tell is that that’s a, I would say that’s one thing that I experienced that I wouldn’t have experienced here is that Lebanon has a dual influence. It has American influence and it has European of votes. So, and it, it sort of seeps into medicine where if a medication gets approved in Europe, then we automatically have access to it much, much earlier than the US would have because the FDA process takes a little bit longer.
Dr. Saasouh: [09:12] Pharmaceuticals want to make sure that the international market is good for them before they come into the U.S. because it’s a big gamble for them. So going through residency, I have the chance to work with some medications and some devices that are just making it into the market now here in the US. And it’s a bit of a strange feeling because right now we, we talk about a medication called sugammadex, which is basically the revolutionary neuromuscular blocker reversal agent, which works, but if ads on it has, it has its own Atlanta ages. I was using sugammadex when I was in my residency in Lebanon, so that was back in 2010 so nine years ago I was using it routinely and I just started using it here last year. And it’s the new thing and the research is geared towards it. So from that perspective, and I’ve used devices back then that have still not made it to the market here. So in that sense it is something that I consider a very valuable experience. The downside is, I mean Lebanon is a third world country, so your resources has a little more limited. You’re training in certain things is a little outdated, but in others it’s very up to date. So there’s a mix of this and that. But overall I, I don’t regret any of my experiences back there. They’ve all helped make me form a better character when it comes to medicine and anesthesia specifically.
Justin: [10:46] Yeah. That’s fascinating. It’s an interesting dichotomy of, you know, being, it sounds like more resource constrained but also having this, because it sounds like there’s less of a regulatory hurdle, I. E the FDA isn’t there, you know, put it, making everything take forever that, that you had access to things earlier on. Is that, is that kind of the way it is in Europe too, that things are a little easier to get to market rather than here in the states? Is that kind of the European influence?
Dr. Saasouh: [11:09] I’m not sure if that’s a global statement that we can make, but a lot of the pharmaceuticals, a lot of the medical device companies come from Europe. Most of them have ideas or from or from anywhere else internationally. So I would imagine that it would be easier for them to put a product in the market there, before it makes it here. And when I was using something, say nine or 10 years ago, it must have been in production for the decade before that. Right. and that was when companies were a little more focused on their own local markets. By now most of these major names are international. So now the, the, the research and development happens everywhere, including the u s or sometimes you start with something and you start marketing it from the u s and then it expanded internationally. But that at the time I figured it was a little bit easier just because some of those companies, originated from, from Europe.
Justin: [12:06] Yeah. It makes sense. So I know, you mentioned that your wife is a nurse who’s done cardio ICU for some time. Did you, I’m curious, did you meet her during this period?
Dr. Saasouh: [12:17] I actually met her when I was a med student and she was a nursing student. Okay. And, it was a coincidence that we met, if you ever believe in love at first sight, that was it. she just happened.
Justin: [12:31] What was the circumstance?
Dr. Saasouh: [12:33] Well, I was on medical students, so I studied all day, every day of course. And I was sitting on a table with a friend of mine and that stranger at the time just happened to pass by with a bunch of her friends. And for some reason it was just that I thought that, well this is somebody I would really like to meet and it’s a long story, but I had to have my friends help, I had to have her friend’s help and everybody kind of collaborated and make it happen and it just happened.
Justin: [13:03] That’s great. It takes a village sometimes
Dr. Saasouh: [13:07] it took a village.
Justin: [13:08] Yeah, that’s fine. I know a little something about that too. So that’s, that’s, that’s great. okay, so you are a med student and then so as far as the transition from, you know, being a med student to residency, obviously here in the states we just had this thing that’s basically a national holiday for the Med students called match day where you know, you do your rank list and you apply to a bunch of different places and you find out where you match. What does that, what’s that process like in Lebanon?
Dr. Saasouh: [13:32] A little less nerveracking than, and a little less expensive.
Justin: [13:35] Okay.
Dr. Saasouh: [13:37] you basically do rotations. you meet program directors, you meet other faculty from other specialties. Everybody has their own version of a, an assessment that they make on all the medical students. And you sort of submit your preferences to them and then you get in touch with them and you tell them, for example, I told anesthesia I’m interested in becoming a resident with anesthesia. And there’s a date range where people can send you something which resembles offers, basically telling them, telling you that, okay, so we’re interested in having you join us for the residency program. And then you go, you evaluate all of those, and then you decide what you want to do and then you end up signing a contract. It’s not an automated system like the mattress in here. You don’t have to spend that much money to do it as that sort of, especially if you are still in the same institution where you’re applying to become a resident, you already have contact with these individuals. So it’s it’s less formal in a sense.
Justin: [14:38] Okay. So I’m curious, you know, you, you alluded a little bit, but what was, how was the anesthesia residency experience for you and you know, what’s the, you know, as far as the functioning in the hospital, how does the role of the resident in a hospital Beirut differ from what you’re experiencing right now here in Detroit?
Dr. Saasouh: [14:55] It’s very similar and obviously the fact that I’m going through it twice makes you kind of notice things that you wouldn’t have noticed otherwise. Yeah. Thinking back, I can tell that the life was very similar to the last I’m having right now. Same structure, same system. the one difference I can tell is that at least where I am right now, anesthesia as a three year residency proceeded by one year of say a transitional year or a, internal medicine year or something like that in Lebanon at my center, it was a four year residency program where you start PGY one year as an anesthesia resident and then you just go up the ranks, two PGY four. Other than that, it’s the same structure you have called days where you have one resident from every year that’s present in house. you have attendings like we do here. We did not have crns, we did not have anesthesia where I see just systems. So we had anesthesia techs who helped us with the equipment with starting a case with ending in case.
Justin: [16:00] So what about like fellowships? Is it, is it kind of a similar structure where you have the opportunity for additional specialization for like a one or one year segment for, for something like that?
Dr. Saasouh: [16:09] When I was doing my residency, we had a couple of fellowship options, certainly not as extensive as we have here. The concept is the same, but the number of options was less. And being a smaller program, they could afford to accept less fellows per year. It was mostly, cardiovascular anesthesia. Okay. And they were working on obstetric anesthesia at the time. Okay. A lot of the residents who wished to work in that same center would graduate, go do a fellowship abroad and then come back as a, as attendings as faculty.
Justin: [16:47] So then you’re wrapped up, residency and, and became an attending. So talk a little bit about kind of what that transition was like.
Dr. Saasouh: [16:54] That was an interesting transition. I’m growing up in a smaller town when I left for college because college was in Beirut and my town was so a couple of hours away, I have to move and, and you know, rent and live there basically. And doing, being in medicine means you study a lot so you don’t get the chance to go back to your hometown quite often. Your weekends are mostly, you’re either on the hospital or you’re studying for something or just trying to catch up on sleep. So when I finished, I had in mind a plan that I should go back, you know, live a little bit, and my community try to provide some of my expertise to the community because we had a one rural hospital in the area and, I wanted to be a part of that. But then you also have to decide financially.
Dr. Saasouh: [17:42] So that was more of a lower income kind of work. And then for the bulk of my time, I had a position in another community hospital, which was powers away. So I kind of split my time between working in my main hospital and then going back to my hometown and covering weekends and helping with the ICU with the Olr and that sort of thing. And that, that was, that was an enlightening experience because what I trained, it was an American system. It was a major center if you had a lot of things available by the standards of the country where I worked were two community hospitals that were really limited on resources. So you learn to work around some of the things and you learn the work by yourself because I didn’t even have anesthesia techs day. So as an attending I was basically in the, or by myself doing all of these cases and they weren’t the very high equity cases. Granted, but still you’re putting somebody to sleep and it’s a major responsibility, but it teaches you things that it helps you grow, it helps you develop your, your character, your personality, your, your medical fortitude basically. It enhances it so much when, when you’re forced into a situation like that.
Justin: [18:54] Yeah, absolutely. And so, you know, your wife is still a nurse. What’s she doing at this time while you’re kind of going back and forth between these two community hospitals?
Dr. Saasouh: [19:02] So the One Community Hospital where, I had my main job, it was on Monday to Friday, sort of 24 hours a day on call kind of position. Okay. Because I was the only fulltime anesthesiologist there. And their operating rooms, yeah, they’re, they’re operating a rooms were limited. So there, there were only two rooms. So the surgery department was basically surgery and anesthesia and that was the only full time are there. And we have surgeons come in and do cases every now and then depending on the day of the week. So I took over that part of the hospital, sort of tried to help. It was a new hospital, so I try to help them start it from the ground up, get the necessary equipment. And, my wife who was working as a cardiovascular intensive care unit nurse at the American University of Beirut at the time, once we got married, we wanted to, you know, live in the same house. So she moved with me to my full time job and she assumed the, nursing directorship basically, and the hospital where she, she took over the nursing staff, she, tried to organize the, the staff’s ranks and, you know, deal with the, with the, without part of the hospital.
Justin: [20:15] That’s great. It sounds like you both really engaged very quickly in leadership roles in ways that a newer organization like a new hospital in a rural area I’m sure really benefited.
Dr. Saasouh: [20:25] We did, it’s a headache, but it’s also, it’s also something we’re we’re grateful for because you get this feeling of achievement, you’d get this feeling of what I’m doing right now is making a big difference in a, in a sort of a large community. So with all the headaches, we’re still happy that we did.
Justin: [20:44] Yeah, that’s, that’s excellent. and one thing I appreciate about a lot of my friends in the medical community is it’s so mission driven, that, you know, hearing stories like that are not actually that rare just because it, medicine tends to attract a lot of the types of people that are made out of that stuff that they just want to give. I’m sure. I’m sure. And I really appreciate that. so that’s, that’s an interesting, you know, that it drew you to, you know, near your hometown this, this desire to kind of build this and be a meaningful contributor to this new medical center. But at some point you started to think, well, maybe I want to continue my career development a further than beyond the borders of this town. So talk to me about how that transition happened for you and your wife and, and what that looked like.
Dr. Saasouh: [21:29] That’s exactly what happened. Getting into jobs like these, while they may be truthful in a way that what you’re doing is making a difference, but you end up doing sort of the same thing or you staying in the same realm of things the whole time. Being in a community hospital means you’re not in an academic center, you don’t have a lot of opportunities to grow as an academic physician. You don’t get a lot of research opportunities that the structure is just not there. And it’s sort of like private practice and in a sense it is. It’s just in a hospital setting. So at, at one point I decided that I still have a few things to offer and I would still like to grow academically and intellectually. So I had to make a decision whether to go back to my training center and then get a job there or make a move that’s slightly bigger.
Justin: [22:27] Yeah, I would say considerably bigger. Yeah.
Dr. Saasouh: [22:30] And scores these decisions you don’t make on your own. So my wife and I sat down and discussed it at length over months and she, she had spent part of our life here in the U S and was not opposed to the idea of coming back here, especially that wherever we lived in Lebanon, we felt that at some point, this is not the ideal scenario for us because of the political unrest because of the every now and then there’s always something going on. And it just wasn’t ideal for a new couple trying to start a family and, and get stability. Right. It is a beautiful country. We, we miss everyday we spent there, but at some point you just have to think this is the golden time for me to grow a little more. So I should do that. And then if I decided to go back and live there on the longer term, then I can do that.
Dr. Saasouh: [23:22] So we made, we made the decision and it was a difficult one, but we made the decision to, to come to the US and then also a little, did we know how difficult that transition would be because you expect things to happen. And things to be a problem, but then you can never think of everything that can happen. And as a foreign graduate applying to a position here, I technically cannot function as an attending in the u s without having an American board. Right. And my residence, it doesn’t count because it’s not ACGM he accredited at Sun International, it’s American, but it’s an international program. So I have to do a residency again and you would know that getting into residency in anesthesia, I was already difficult for somebody who’s, who’s been doing medical school at the same center where they want to apply. Being an international graduate made it gave it so many more layers of difficulty. So I had to do something else at the meantime in order to enhance my CV, make myself more appealing so that somebody would actually decide to bring in an international graduate rather than accept somebody who goes in the u s and that carries a lot of significance because there’s a visa involved, there’s a status restraints and then a lot of those things.
Justin: [24:40] Yeah. So talk to us about that, that process. So you know the visa process and finding somewhere here vocationally where you can do, you know like a research fellowship I think to to be able to make connections and started to open the door to start those conversations for for the residency program, how did that work for you?
Dr. Saasouh: [24:58] Being on a visa is limiting in many ways because you’re not free to decide where you want to go on. Then you just go there and you do what you like doing. You have to go through certain channels, you have to jump through certain hoops and the one advantage I had was that I did my residency already so I was eligible to apply for certain fellowships. Those that are not ACGM your credit we showed you is one of them. Some other fellowships are also eligible for that. The same advantage I had was also a disadvantage because the fact that I did residency and I worked in Lebanon means that more time has has elapsed since the time I graduated medical school. So when you apply to a residency program they always ask you what year did you graduate medical school? And for me, it sounded like I graduated six years ago, so it made me less appealing.
Dr. Saasouh: [25:49] But the fact that I did was a residency made me somewhat more appealing for some programs. Not everybody likes to see that. Yeah. So I decided to go into research first and I was in talks with the Department of outcomes and research at the Cleveland Clinic, which is a major force of research in the US and internationally. And I was lucky enough to get a position there as a fellow for two years. That’s their formal fellowship training. So based on that, we made the move to the u s and during my second year I started considering applying to residency programs. Okay. And it was still very difficult and residents will tell you if you’re applying for a residency position, you need to be recently graduated to be not internationally graduated from an international medical school. Right. And research, it doesn’t really count that much unless Ed Department is interested, specifically in residential, can do research applying for fellowships.
Dr. Saasouh: [26:44] So if you have a good CV with some publications, that’s always, an attractive thing. So it took a lot of effort and it took a lot of, applications and you start applying randomly because being at such a disadvantage from the get go, you can be picky where you apply and where an American graduate would get, say 10 or 20 or 30 interviews as an international graduate. If you get anything close to five interviews, you’re the king of the world. And while this was happening, I was also fortunate to get accepted to a position as a neuroanesthesia fellow at the Cleveland Clinic, which was great for me because this is clinical hands on experience. While research was not clinical hands on and applying for residency, you tell them I graduated six, seven, eight years ago, but then I recently had clinical hands on experience as a neuroanesthesia fellowship. So I believe that that really enhance my chances to get accepted to a residency program. And I ended up with two interviews for the entire season and okay. The one of them that worked was a Detroit Medical Center and I’ve been grateful ever since.
Justin: [27:55] Excellent. So during this time when you’re doing these research fellowships while the first research fellowship and then the neuro anesthesia fellowship, what was your wife doing during this time? Was was was she also working as a nurse?
Dr. Saasouh: [28:06] So this is the other part of not anticipating every problem that would come up in our minds. When we went in Lebanon, we were thinking the u s is in such demand for nurses, especially critically, trained nurses, somebody with experience at that American Center. We thought that you would find a job in a second. What turned out to be was that me coming in on a visa, she had to be on my visa. So she was on what we call a spouse visa, which does not allow her to generate income. Wow. So she ended up actually in not being able to work here since 2014 and it’s been five years on, she hasn’t worked. Oh my gosh, this is probably the most frustrating thing we’ve had to go through because she needed to apply separately and get her own visa. And you’d think that once she’s here, it becomes easier. In fact it becomes harder because some employers, the very few that do this are actually used to doing it for nurses who are foreign trained but who are living abroad and they have sort of a process in place where they would bring these notices and on a job offer she was already living here and for some reason that just threw everybody off and they and we couldn’t, we just couldn’t get her a job.
Justin: [29:26] Wow. So at what point in the process did she realize that she would not be able to be employed? Was that after you moved here
Dr. Saasouh: [29:31] You go through a period of denial where you keep trying and you keep trying. She had four nurses. There’s a, there’s an exam called the end clicks, which is basically a qualifying exam that would allow you to apply for a nursing license and a state. She did that while we were still back at home and she passed it and then she got a license to practice in New York by default because that’s what she did. That’s how the application one, we moved to Ohio and she, she got a license to work in Ohio because you can transfer but then we can get our job in Ohio.
Justin: [30:06] Wow. So you literally had moved here and you were doing your work before she even realized that she was not going to be able to be employed.
Dr. Saasouh: [30:15] Yes, yes.
Justin: [30:16] Wow. Oh,
Dr. Saasouh: [30:17] She actually ended up getting another license in Florida because one of my residency, options was in Florida and still, so she held licenses in at least three states, but she couldn’t use it, use them for anything
Justin: [30:32] Because of the visa,
Dr. Saasouh: [30:33] because of the visa issue and, and at least application on a job application for somebody who’s international takes a very long time. Yeah. You keep doing it. Keep trying. So we did that for two years and then, you know, eventually you’d say, this is a lot of money that I’m spending that doesn’t look like it’s going anywhere. And we, we talked to senators, we talk to program directors and nursing coordinators and nursing directors and none of that helped. Wow. Finally one way when we last talked. Basically she got a job offer from Florida and that was in December of 2016 okay. The paperwork started back then and it’s still not over.
Justin: [31:13] oh my gosh,
Dr. Saasouh: [31:14] we are in March of 2019
Justin: [31:17] oh my gosh.
Dr. Saasouh: [31:18] It’s frustrating to say the least. And I feel with every international graduate and even us graduates, sometimes your circumstances are way beyond you and you just have to power through. It’s not easy being away from home and not having the social support system around you.
Justin: [31:35] Yeah. And I know you mentioned, you know, the transition and the current environment, even the residency system here doesn’t, is not conducive to like great, thriving, emotional, emotionally fulfilling relationships abroad support network, especially for somebody who’s coming in from abroad. So what was that experience like for you? You know, coming here, not having a lot of relationships and a lot of people to rely on. How did you and your wife build a life that was, you know, one that you were going to be happy with?
Dr. Saasouh: [32:02] Well, I can tell you it wasn’t easy. Yeah, we were lucky. Then when we moved to Ohio, there was a community of a Lebanese people. They’re already, we didn’t know any of them at the time. So you start going to certain events. He started meeting some people and you, you start, you know, word of mouth, friends of friends and you have to be kind of daring and outgoing and you have to actually see how these relationships because sitting by herself and an apartment will never help.
Justin: [32:32] Right. That’s definitely true.
Dr. Saasouh: [32:34] And, being away from family, you have to make your own family so to speak here. And you know, being on a, on a research, on a resident salary, you can really expand your own family much. You can really start family planning until you started making that real income. We tried to see how a lot of people, we tried to meet anybody on everybody when we thought would be a good friend. We were lucky enough to meet a lot of people from eleven’s background. we met a lot of my cold silos, my co residents. We have such great friends. A lot of the people in my same shoes. So people who are international came in trying to do the same thing and you sort of develop bonds with these people because of your situation. We went to each and every graduation ceremony that we were invited to all the resident activities in the hospital. the Cleveland Clinic had a nice resident spouse association, which my wife was part of. And you know, these little events sort of help. Yeah. It’s never the same as being at home with your own family, but it’s, it certainly helps. And it’s something that, that is a good addition to your life as somebody who was trying to make it back from zero.
Justin: [33:47] Yeah. What would you say is the most challenging thing that you’ve experienced as, as part of this transition, whether it be clinically, professionally, personally, you know, what would you say has been the toughest?
Dr. Saasouh: [33:57] If I think back to what I’ve done so far, after finishing college, I completed my medical school in Lebanon. So that’s four years. I did anesthesia residency, which is another four years. I worked as a junior attending for two years. So this wasn’t exactly my dream job, but it was something. So that’s 10. Then I did two years of research training. That’s 12 almost a year of neuroanesthesia 13 and now I’m doing four years of anesthesia residency again. So that’s a total of about 17 years of being either in a startup position or a resident position or a trainee position, right. With whatever it means in terms of income, in terms of status, in terms of stability. both financial and mental stability because you always look at your surroundings and you’re in the lowest ranks you can imagine. And that went on for is going on for 17 years.
Dr. Saasouh: [34:56] Right. Where my, friends from college who graduated 17 years ago, or should we should say 15 years ago, are already in positions. They already work in companies. They already make their income. They have their families. Yeah. Even though I know exactly why I’m doing this, I can see my, my goal, I know where I’m headed. I know that it’s worth it. But being in that phase for such a long time and feeling that you can’t really do much with what you have, you just have to make the best of it. Yeah. That was probably the toughest part of all this.
Justin: [35:30] Yeah, that makes perfect sense. And I greatly admire your vision for that. And also your perseverance to be at PGY 117 it’s still going strong.
Dr. Saasouh: [35:40] I am grateful that I’ve been able to, to do this and I couldn’t have done this on my own. So many people along the way have been supportive and helpful starting from my wife and all the way to my immediate family, my extended family, my friends, my relatives, my co residents and code fellows and my superiors. You have to have a social support system every step of the way in order to be able to make it. Nobody can do everything on their own. So I’m, I am ready for painting and every person, I won’t be able to name everybody because there’s so many.
Justin: [36:14] Cool. Make sure and send them the link to this podcast. And I’m very well, very well appreciate hearing from you. So what is, you know, as you’re looking at, you know, your ambition for the future, what is your goal for vocation and what, how do you envision your, whenever you sort of reach the whatever you really want to do as far as what your practice is going to look like, what, what do you envision that looking like?
Dr. Saasouh: [36:35] I have a few ideas of them might look like and this vision keeps changing and getting reformed along the way. Because thinking back to the time when I started my research fellowship, I didn’t know if I was going to make it into a residency. So at the time I was thinking year to year saying, well, what do I have so far? I have a residency from Lebanon. I can go back and be an attending again there. Now that I have this research, I can do some more research here. I can do something like that, say for a pharmaceutical company or a medical device company. Combining my background with my research experience. Then I got into neuroanesthesia and then I started thinking, well, maybe this is an option. I can always do this here. If, if I can get a license in a state or I can go back and become a no anesthesiologist, I’ve worked there.
Dr. Saasouh: [37:26] Then I got into residency and now I’m thinking, well now I have the option of being board certified, working here as a general anesthesiologist. Or I can combine that with my research or I can do consulting work for medical device companies or pharmaceuticals. So this, this division is kind of evolving as I go through these stages. Yeah. And at this point, I am a little over two years away from actually getting a formal residency certification or become board certified. So thinking towards there, I have to decide whether I want to go for another fellowship, say on Acg, CME accredited, the fellowship, or do I want to start working as an attending on started making some real income for a change? Or do I still want to pursue my research and then they’ll go academic path or should I go into the industry and do something there or should I combine those? Do I want to live in the US primarily or in Lebanon or I’m Mystro show. Both. It’s with all the time that has passed, I can’t really decide what the best move is, but I am working on all of those aspects and, and hopefully by the time I finished I would have a better idea of what kind of life I would like to have.
Justin: [38:38] Makes Sense. Well, I really appreciate your time here this evening. I just got two more quick questions for you and then we’ll let you go. I appreciate you carving out
Dr. Saasouh: [38:46] It’s a pleasure being here. Thank you for that.
Justin: [38:49] The, the first thing I want to ask is, I’m sure there’s people in this audience who are thinking about, so you took a risk, right? You, you were established, you and your wife are both working and you had this idea that you wanted to come to the states and work your way up from the bottom again after. Having just done that and, and doing it across international borders has been very challenging. But it sounds like also very rewarding for somebody else out there who’s thinking about similarly doing a, an international venture like yours, perhaps for additional training or some kind of medical mission or something like that. What kind of advice would you give to somebody in that kind of place?
Dr. Saasouh: [39:27] I would give them the same advice I would give anybody who’s considering medicine to start with. If this is something you love to do, then go ahead and do it. Because medicine in general is such a longterm commitment regardless of your background or your target job. It’s not just you who’s in it, it’s you, it’s your spouse, it’s your significant other. It’s your loved ones, it’s your family, your circle of friends. This ripples out and impacts so many people beyond yourself. And if you don’t really love what you’re doing, at some point you will feel like this is not worth it and you would quit. Right? And you are presented with many opportunities to quit along the way. And every resident knows this. Everybody will tell you, I could have quit so many times so far. And some, some people do and not because they’re weak, they just do because they find that other opportunities are better for them, which is something I respect.
Dr. Saasouh: [40:20] It’s not easy to quit something that you’re so invested in, but if it’s something you’re planning to stick to and persevere with, you really have to like it. So don’t do it. Because becoming a doctrine means I get a better pay. Well you get better pay, but you get higher taxes than you have more expenditure into that. There’s a lot of positives and negatives to everything to decide, but if you really like what you’re doing and if you have a clear vision of what you want to do and it works out within your realm, so you and everybody else around you, then absolutely go for it. If it doesn’t, just don’t do it for the wrong reasons and everybody has their own reasons and I’m sure everybody has to overcome their own hurdles to get through this. Yeah.
Justin: [41:03] Cool. Well in closing I want to ask you one final question and you are someone who has overcome a lot of difficulty and put in a lot of hard work and extraordinary amounts of perseverance. I’d love to hear a brief story of a time when you have considered all the time that you’ve put in and all of the expense, emotional and financial and relational and you, you know, considering what you had done, you were pleased with all of the hard work and in that moment you thought that you know what, all these sacrifices and everything that I’ve done, it’s all been worth it.
Dr. Saasouh: [41:36] That will take a little bit the answer. So first off, I want to say anybody who decided to become a physician or a an engineer or whatever job that takes so long and it takes a lot of effort, takes a lot of time to finish. That’s already somebody who goes, who sacrificing a lot. Even if everything else is available. Even if they come from a wealthy family and they didn’t have to go through anything, they’re already sacrificing a lot. The time that they spend into this is invaluable and being this physician specifically, I can speak to that just because I’m in the, within this realm, being a physician is already a big sacrifice. It doesn’t matter what kind of specialty you go into and after that, if you come from a financially less privileged background, then it’s an extra layer of work because you have to build your entire reputation from the ground up.
Dr. Saasouh: [42:28] Right. I add to that the fact that I come from an internationally, I had to leave my country, my family sacrificed all of those and then start from the, from zero again, there’s always sacrifices on. Everybody has their own sacrifices. I will not be little any of the sacrifices that anybody else has made because I know this is not easy, and for physicians, they go through the most rigorous training. They go through the most gruesome programs basically and the on earth to become physicians and everybody else has their own version. Of this. It’s not just physicians. So no matter what kind of achievements you have, you should feel proud that you’re actually to where you are because it took a lot for you to get there. So from the beginning, I would say everybody shouldn’t be proud of everything they’re doing because they’re doing something that not everybody can do.
Dr. Saasouh: [43:20] In my case, my journey has been filled with moments of pride over achievements I’ve made. But there’s always this bittersweet feeling because you apply this tangible, some guilt, and you always think that, well, what if I stayed back home and stayed with my family? Wouldn’t they have been happier? Or you say, what if I didn’t do this and I had another job and it didn’t have to pursue this whole thing again with my spouse on? I’d be happier. I’m then a little more relaxed. You always think about the goods and the bads of of everything you’re doing, but that doesn’t take away from the achievements you’re achieving. Yeah, I always feel like it’s worth it when I call my family. So I call my family on Sundays basically once a week through the magic of the Internet. And I haven’t seen them since I moved to the u s so it’s been five years.
Dr. Saasouh: [44:09] It always feels good when you tell them that I’ve just submitted, say a paper somewhere and got accepted or I’m invited to a conference and presenting something there. You always get this feeling that they’re proud of you and you’re doing something you set out to do on, you’re actually achieving it. At the same time, you feel bad because you’re missing out on so many other important life events. You get family, health issues. You got people getting married, people passing away and you can’t be there for them. So yeah, it’s always important to keep your mind in the clear that you’re doing this for a reason and if you think it’s worth it, you should go for it. Yeah. One of my proudest moments lately was, something that I did through my research on my years at the Cleveland Clinic. So my last year or so I was working on book chapters, two book chapters and two books.
Dr. Saasouh: [45:00] And that process takes a while. So a couple of months ago, the books were published and I was sent my complimentary copies of those books. So I was just sitting in my living room. I opened the box and there’s those two books and I just go through the author list on, my name is Derek Lcc. That feeling of, wow, I just did something, you know, important. Yeah. And your life as somebody who’s doing residency and doing research on your own time and you’re doing, you go into conferences and you’re sacrificing vacation days to go there. It’s always nice when you see your product in your hand or when you look at an article and then your name is there. Somebody can search for it and they can find you. So I’m sitting there, I’m just admiring my books basically. And my wife walks in and she must have seen the look on my face.
Dr. Saasouh: [45:47] You must have, cause she knew that I was waiting for those for awhile now. Yeah. Technically they took three years to be published. So she, she came in and she said, you know, I’m proud of you for doing this and I’m, I’m proud of you that you’re actually achieving things you’re working so hard to achieve. And in an instant, it just made me feel all of them. A level of, you know, this is worth it. I am, it’s always good to feel appreciated and why am I doing this? I’m doing this because I want a better life for me and for my wife. So the fact that she’s on board, the fact that she understands the sacrifices and she’s being so supportive, even though we’re going against all sorts of comfort that we can find. So I don’t have to be a resident of forever. I don’t have to do 17 years of this kind of work too to have a good life. I could always go back and still working as an attending, but no, we’re sticking through. We’re going through it and it’s good that she appreciates it. It’s good that she understands the meaning of the achievements and it always makes it more worth it. Yeah, absolutely.
Justin: [46:52] Well, I really appreciate you sharing that and I appreciate your spirit of perseverance. It’s contagious. So if anybody is out there listening and thinking, oh my gosh, I want to just throw in the towel, you know, you’ve been in training for a long time or switched programs or whatever, that you’re a great example. I’ll have a thank you know what it means to stick it out and see it through. And I, I’m really, really pleased to have met you and I really appreciate you joining us today on the anesthesia success podcast.
Dr. Saasouh: [47:18] Thank you. It’s been a pleasure and I really hope this, this helps somebody or opens their eyes to what else is there. You can always just get sucked into your own problems and you, you think that you’re the worst lives no matter what stage of life. And then you listen to what other people go through and sometimes it gives you inspiration. Sometimes it gives you hope. My biggest achievement today would be if somebody listens to the story and says, well, you know what? I can do it too. And I really think a lot of people can do a lot more than they think. It’s just sometimes you have to go through bad times to get to the good times.
Dr. Saasouh: [47:50] Absolutely. Well, we’ll leave it at that. Thank you very much for your time today. Thank you. Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcaster. I also run a financial planning company called quantify planning, where I work closely with anesthesia and pain docs to build and implement customized financial plans. If you’re interested in working with a financial planner who knows many of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com for more information. If you’re a resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list, so check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia, success.com to join our community, residents, and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast.