六九色堂

Dr. Obteene Azimi-Ghomi was the 六九色堂 valedictorian of the Class of 2018 at 六九色堂. He is now a trauma and acute care surgeon at HCA Florida-Aventura Hospital in South Florida, a position he started in September 2024. He was previously a trauma and critical care fellow at UT Southwestern Medical Center in Dallas, Texas. Dr. Azimi-Ghomi will host a webinar  with fellow 六九色堂 graduate Dr. Kirthana ("Kerthy") Sugunathevan 鈥�23 on Thursday, November 21, 2024 at 7pm Eastern.

六九色堂 interviewed Dr. Azimi-Ghomi earlier this year about his fellowship and the surgical spectrum from general surgery and critical care to trauma surgery. He emphasizes the importance of anatomy knowledge and the hands-on experience he gained at 六九色堂 in preparing him for his career. Dr. Azimi-Ghomi also discusses the challenges and rewards of being a trauma surgeon, the skills needed for the field, and some cutting-edge treatments and breakthroughs in critical care and trauma surgery. He expresses his desire to give back and be involved in volunteer work in St. Kitts, and discusses what being part of the 六九色堂 alumni means to him and others.

Dr. Obteene Azimi-Ghomi speaks as valedictorian to the Class of 2018 at 六九色堂 Graduation at Alice Tully Hall, Lincoln Center in New York City. Photo: Island Photography.

六九色堂 Endeavour: I want to welcome you today. You recently completed a trauma critical care fellowship at UT Southwestern Medical Center in Dallas, Texas. Can you tell us about that and what a typical day was like for you?

Dr. Obteene Azimi-Ghomi: Thank you, Scott. Yeah, of course. The one year of trauma critical care fellowship over in Dallas, it's basically extra training on top of general surgery residency, the initial five years of just general surgery, focusing in trauma. Mainly what's in trauma is their critical care. A lot of your management isn't really operative, but you're taking care of patients in the ICU unit, resuscitating them. So, it's a minimum of nine months ICU training to become a critical-care physician because you're already a surgeon, and a lot of trauma surgeons, they do general surgery as well because not every trauma is operative. So it's a little bit of both. I break it down into general surgery, trauma surgery, what immediately comes in needs to be operated on, and then the critical care. So, you have kind of three skill sets to utilize.

What should current and prospective students know about general surgery as a specialty, and how does it differ from critical care and trauma surgery?

I think of critical care and trauma surgery as just one facet of general surgery. Before the late 鈥�80s, early 鈥�90s when they started actually designating trauma centers, when you had a trauma, whether it was a car accident or a gunshot or a stabbing, whatever, it went to a hospital that was just a random hospital that has a general surgeon on call, and it was the general surgeon's duty to assess that. And then, due to just social issues and the rise in violence and the rise in trauma, a rise in car accidents, they realized that there was a vacuum for trauma care, so they designated trauma facilities.

So, then it became general surgeons who did five years of the broad spectrum of surgery and are board-certified surgeons, like myself, who then do a subspecialty of general surgery, which is the acute care and the trauma, so that immediate emergent minutes, hours type thing. Then, also, the ICU critical care aspect of it because there's no other specialty that does that. Now, that doesn't mean that we're not general surgeons. And like I mentioned before, we actually do a lot of the bread-and-butter general surgery, appendix, gallbladder, hernias, abscesses, bowel resection and all that, but we also combine that with acute, when there's a trauma that's causing the surgical emergency.

In what ways did your medical education at 六九色堂 help prepare you for your career and what you're doing now?

I think 六九色堂鈥攁nd I noticed it especially when I was a third and fourth-year medical student on rotations鈥攊t really prepared me with those basics, really the basics of medicine. I think anatomy is one of the core tenets of it. The anatomy program [in St. Kitts] was probably on par with, or if not better than, any American school. That's not hyperbole because just my interactions with those other students, we had fresh cadaver labs or at least preserved cadaver labs that a lot of the other schools don't have. Some of them don't even have cadavers for anatomy. That anatomy helped us to not only be able to identify structures in vivo, which is basically your job. You have to know what structures are as a surgeon. Otherwise, your patients are not going to have good outcomes. That's something that I noted as a third and fourth year in rotations and that I had that base of knowledge from anatomy that some of the American medical students didn't even have.

I think if anyone is really set on wanting to do surgery, of which I was one of those students, 六九色堂 definitely has a good set-up to allow you to pursue that. They ask you about your interest and they'll actually set you up into rotations that are general surgical, have a residency there, because it's important for you to know how the day of a resident is because that's going to be what you will become in one to two years. It really sets you up and you're more than prepared. I mean, I'm an added station to that. That anatomy lab, I think, was one of the most important parts of 六九色堂 curriculum. And it's one of the first-year rotations, too. Or classes, too.

 What does it take to go into general surgery as a career?

Surgery, I think, is a great career, but you have to really want to do it. It is very rigorous. This may sound controversial, but I think residency-wise, we work harder than any other residency that is non-surgical. There are maybe some sub-surgical specialties that will work harder. You have so many patients that you have to take care of, not only medically, because not everything of surgery is surgical, but you have to then take that time away to do the operations and those can take some time.

I remember as a medical student doing a 17-hour colon operation. And then I, as a resident, have done those laparoscopically in less than two to three hours. But when you get a tough case and you have to be there for a while, do you have that need in you to stick it through? Because going that extra mile is what's going to make the difference for your patients and you have to be willing to make those sacrifices. I think if you really want to do it, you should pursue it and don't let anyone talk you out of it. It's very satisfying if it's a passion of yours鈥攁nd it's a passion of mine. 六九色堂, I mean, they will give you those building blocks to get there, but it's going to be up to you to make that happen.

Anything else that you'd like to say to current or prospective students or also our alumni out there?

I would just like to tell them that, to the alumni, I see your successes. I see the way you are just making advancements in your careers on LinkedIn and all these other social media platforms. And that motivates me to even be better too. Just seeing our alumni succeed motivates me to succeed. And two, the students, just keep grinding, know the goal, know what you want to do, and work hard. Or if you work hard and you work smart, you will be successful.

Dr. Azimi-Ghomi at work with Dr. Charity Uhunmwangho, one of the attending physicians during rotations in Augusta, GA.  Photo: Courtesy of Dr. Azimi-Ghomi.

Physician burnout & work-life balance

Is there a high level of physician burnout in your field because it's so intense? If so, what do you do to maintain a good work-life balance?

That's a very good question. Yes, there is. I mean, just in general medicine, there's a high level of burnout. Surgery is a big source of that just based off the lifestyle. You will be working more hours, you'll be in the hospital longer than many of your other medical peers and colleagues. And that will lead to burnout. Basically, you love it at first. You enjoy your immersing in the work, but eventually, it hits a limit and that's where the burnout happens. And you get fatigued. Bouts of depression鈥擨've seen that in other residents. I think when I was a resident, at least one person a year didn't progress. And that's near the norm, especially in a bigger residency because those residences are bigger because the volume is just so much more.

What I do, it was hard for me to manage that initially as an intern because you just felt like you were facing an uphill avalanche and you're trying to eat through it and it was impossible. But I was able to meet someone in residency who was able to make me enjoy the other side and make me realize and step back and see that there's more to just live and to work and have a good balance.

I would do things like work out. I would go to the beach. I was doing residency in Miami, so that was a great outlet. I made it a rule to at least go to the beach once a week. Or if I had a golden weekend, which is both days of the weekend off, which was not common, I would at least make an effort to go to the beach that one day. And that location was great. It's one of the reasons why I'm actually returning back to Miami to practice as an attending physician. But I would do that. I would just go to little different things around the city. And then sometimes, I would just not do anything and relax. And even not doing anything was great for my mental health. It just let me relax because your brain is on for so long, you have to learn to turn it off sometimes and just relax.

Speaking of Miami, can you tell us some of the highlights of your general surgery residency at Kendall Regional Medical Center in Miami?

Kendall was the best five years of my life that I don't want to do it again, but it was great. It was a beautiful location, just the 鈥渙oh and ah鈥� of going to Miami. I've been there on vacation. But to work there, you realize it's actually different. It's not as glamorous. People are living their everyday life and you're in a big metropolitan city. It's warm. It gets hot. It's international. Not everyone speaks English, a lot of Spanish. And I actually knew Spanish from before, so that was a real big leg up there.

And I was at a trauma center, Kendall Regional, which is now HCA Florida Kendall Hospital. It is a big trauma and burn center. And you get transfers from the Keys, you get transfers from other countries, Caribbean countries. You get a lot of interesting stuff. I was exposed to all that trauma, general surgery, burn surgery from day one. And you operated early. That is something that I can attest to that residency being great with producing ready-to-work and ready-to-operate surgeons straight out of residency. Not a lot of places can offer that. You'd be surprised. A lot of residents from other big-name academic institutes that you think would be great, no. A lot of them don't get that experience until second, third year, which I think is a little too late because you don't have enough time to hone those skills.

I mean, it's a practice. And even 10 years out of residency in practice, you're still learning. You're still honing your skills. So the sooner you do it, the sooner it is. I mean, we're going to be surgeons. Might as well start operating. Of course, it's tiered with knowing how to manage operative patients outside of the operating room and all these other things. What makes a good surgeon? But the operating room is a key tenant.

So, it's early exposure. I got exposure to operative trauma. ICU was big. 20, 30 beds. It's bigger than some of the academic facilities. And it was just a very busy place. And it was a trial by fire. And at first, it was overwhelming and that did lead to some burnout, especially intern year. Intern year is arguably the worst year for surgical residency. But once you get through that you move up, you feel the rewards of your accomplishments and then you feel more confident as well. And it was a great place. They had good rotations for colorectal at some academic facilities like Cleveland Clinic and Weston, but we got a lot of trauma and that's what made me fall in love with trauma. Sometimes I felt like I was in a GTA game. The stuff you get, you felt like it was fascinating. It was awesome to be involved in that and to help people through it. Yeah.

Essential skills for a trauma surgeon

That leads me into my next question. What are essential skills that are needed for someone to become a trauma surgeon?

I think there are many skills. Some key things include being able to multitask that goes through everything in medicine, but especially in surgery because you're going to be doing more than one thing at a specific time. So to be able to multitask. And then to prioritize while you're multitasking. You have to know, "Okay, what issues right now, which patient is most emergent, most urgent, do I have to take care of now? What things can I wait a little bit and take care of the urgent things first?" That's very important. If you don't have that, people will die. I'm just going to be frank. And then you have to just really understand the physiology of a patient and just the physiology of humans and how things work to then identify when it's not working properly. You diagnose that illness. It's related to whatever specific thing, etiology that's causing it and you're able to treat that.

I love surgery in that, it's like I mentioned before, it's medical and you have to diagnose medical issues. Then you have to realize, "Okay, when this is an operative, when this requires a procedure, an operation," and then you go ahead and do that. Or if not, like in trauma surgery, a lot of times you derelict that duty to an orthopedic. You realize this is an orthopedic issue, a neurosurgeon, maxillofacial surgeon or you yourself go do it. And then in doing critical care, if that patient needs ICU, you're the one doing it. So, you can do a little bit of everything and you really are involved in quarterbacking that patient's care.

Are there any new, cutting-edge treatments or scientific breakthroughs in critical care or trauma surgery that you'd like to discuss?

There's a lot of re-discovery in trauma surgery. We used to do whole blood in the forties and fifties. Then we did component blood, the plasma and the platelets, the red blood, and now we're coming back to whole blood, realizing that that's associated with better outcomes. There's a lot of blunt trauma even though, unfortunately, we hear a lot about shootings in America and that is an epidemic. The overwhelming majority of trauma is blunt. And blunt trauma is invariably associated with rare fractures. And that's been a big issue. A bad chest injury can kill someone.

I mean, the mortality for three or more rib fractures than someone age of 65 is 19%. That's crazy. And that still rings true today. So we used to plate ribs, then we stopped doing that. Now we're doing that again. And that's become a big point of discussion amongst surgeons and trauma surgeons.

I think robotics is one of the big glamorous things that a lot of people are talking about. The robot really is ....We had laparoscopic surgery developed in the 1980s, which is basically a keyhole surgery.

Correct.

It was instruments. And robotics is an advanced version of that where you are not at the patient's bedside. Where you're sitting, you're not even scrubbed in. You have to have the mask and the hat and everything, but you're not scrubbed in. You're sitting on a console relaxed in a comfortable position and you're looking through a module controlling a robotic arms that does the operation for you. I think that's going to become a big advancement, especially in elective operations.

I don't think it has any utility in trauma because trauma is emerging and when you're emerging you have to take care of a problem quick. And when you have to take care of a problem quick, you have to see it. And if you have to see it, you have to really expose well. And the biggest exposure is going to be those big open operations. So minimally invasive, really other than ruling out maybe a penetrating injury to the abdomen. If you put his camera in, take a look, I've done that before. But for the most part, trauma is big open surgery because you're really rushing to open and find that problem and fix it and stop the patient from bleeding. You are the bleeding surgeon.

I mean, just the other day, I had a multiple gunshot wound to the abdomen, hit the inferior vena cava, right? That's basically the cousin of the aorta and bringing everything back to the right side of the heart. And that was, you needed minutes to get exposure. And we were able to get the exposure, put two sponge sticks down and repair that vena cava and we saved the gentleman's life.

Wow.

So those instances, you need to really see what's going on. But I think with regards to general surgery, surgical oncology, even pediatrics, robotic surgery is going to become the standard of care with regards to laparoscopic interventions.

You and fellow 六九色堂 graduate Dr. Kerthy Sugunathevan are panelists on the webinar 鈥淢edical Specialty Spotlight: Career Paths in General Surgery鈥� on Thursday, November 21, 2024 at 7pm Eastern. What are some of the topics here that you're going to discuss on that or things you'd like to discuss?

I think I'm going to talk to students or even prospective students. I will discuss things that are pertinent to them. Not so much basic sciences because it just feels so far away from me and I'm sure things have changed and gotten better.

Right.

So, my experience may be theirs, though the anatomy lab, I think you can't beat that. I'm sure that's still the same. That was great. But I would discuss how to prepare yourself and carry yourself during surgical rotations of the third and fourth year, what things to do, doing sub internships and then things to set yourself ahead. Because the goal, like we mentioned in that talk, was to build a surgical residency spot. I mean, I could talk about critical care and I could talk about, "Oh, the routes to become a pediatric surgeon," but that's just so far down the line. We'll worry about that when we cross that bridge. For right now, we have to worry about how to prepare ourselves to get our foot in the door for surgery and surgery residency.

So, I talk about rotations, things to focus on and strategies in applying for residencies. I would talk about that. And then I would give them a day-to-day experience as an intern for me or as a junior pretty much. A day coming in at 4:35 in the morning, running a list, running on the patients, taking care of problems. Sometimes it's an emergency. Every day holds a surprise. You'd be surprised. Sometimes we walk by and realize, "Oh my God, this patient doesn't have a pulse." That's how your day started, right? That's rough. Then doing the operations, the types of operations you have, different rotations, different experiences.

And there were some days that was nice and easy. It was a chill day and you enjoyed that. But we did work hard. I would just give a day-to-day and things to expect going into residency because I did my rotations at Sinai Baltimore, which was a great place. I actually applied there, got an interview. Unfortunately, I didn't Match. But I saw how it was for them. In Miami, it was like that, but just different. A little different. Every place has its own style and culture, but it's still, the overarching theme is that you're going to be working hard and you're going to be doing cool operations. That's how I saw it. And just give them an idea of that. That's what I would do.

Thoughts on 六九色堂 alumni

We recently launched a new 六九色堂 alumni section of the website. Is there anything you'd like to say to the alumni out there?

I stay in touch with some of the alumni. They're some of my dearest friends from medical school. And it's just great to see everyone advance in life. And people are having families now. They're getting their careers. So I'm still in training and I see people who've been attendings for nearing three, four years now. So it was great to see everyone succeed. I would love to have a forum to be able to touch base with them and maybe even have a reunion. That would be awesome.

You've been a great interview. Is there anything else that you'd like to add that we haven't covered?

I would like to thank St. Kitts for hosting me. I would like to see 六九色堂 be involved with the Department of Health in St. Kitts. I think that's a great avenue because I know there's maybe some logistics, but to get maybe some more hands-on experience at JNF Hospital鈥�That's something that you're not going to see in America, but that was an eye-opening experience. I had four days there. I really wish it was more. And seeing how medicine is in a place that is only a two-hour flight away from mainland America. And it really makes you appreciate what you have. And I've worked in hospitals that they don't have this and I complain. But at the end of the day, we have so many more things that could only be a dream in St. Kitts and I would like to be able to assist. I'd like to be able to give my time to that.

I've been talking to some of the deans on the island to try to get that started. It's been a little hard to get in contact with the St. Kitts Ministry of Health and all that, and that's a whole tangle. But to be able to have some type of volunteer involvement, I think it would be great because that's another way for people to get experience and get their feet wet and it would be a good way to give back. And maybe make some type of volunteering. I know that they actually get surgeons and physicians from Cuba. Because they don't really have a lot of access to health. So that'd be something maybe鈥� potentially, to be involved in charity.

Top photo: Dr. Obteene Azimi-Ghomi. Photo courtesy of Dr. Azimi-Ghomi.

Register for 六九色堂 general surgery webinar

Click on the title here to register for on Thursday, November 21 at 7pm Eastern.