EP 83: Serenity Now Finding Peace Underwater

Neurosurgery is a demanding profession that requires both skill and humility. In this podcast Neurosurgeon Juan Martin Valdivia Valdivia candidly discusses the highs and lows of the job, from the elation of a successful surgery to the heartbreak of a losing battle.  Together we dive deep into the emotional tolls of this profession and explore how he takes care of himself both physically and mentally though the use of free diving.

Connect with our speaker:
Feel free to reach out to Dr. Valdivia via email at janivaldivia@gmail.com

Dr. JB 00:03
Hi everybody, welcome back to the hope4Med podcast. I am your host, Doctor JB, and today’s featured guest is Doctor Juan Martin Valdivia Valdivia. He is a neurological surgeon in Tampa, Florida. He moved here from Ann Arbor where he was assistant professor at the University of Michigan Department of Neurosurgery. In his free time or what free time he has, he is a competitive free diver and is involved in free diving medicine guidance. Welcome to the show.

Dr. Valdivia 00:39
Thank you. It’s a pleasure, doctor. It’s an honor to share some time with you. Appreciate it.

Dr. JB 00:46
So I am so excited to share with my listener all about you and your story. So let’s just start from the beginning. Can you please share with my listener your origin story?

Dr. Valdivia 00:59
So I’m I was born in Lima, Peru and was born in Lima. And went to high school. I went to medical school in Peru and my last year of medical school and actually my last two years I decided to go into neurosurgery. I did basically in medical school rotations at Northwestern University of Miami, got good letters, good exam scores and I was able to enter an internship in general surgery at University of Illinois Chicago at MGH program. So I finished that and then I matched into neurosurgery. As you noticed, why Zona, where I was chief resident and finished graduating residency, and then I moved into Michigan where I took a fellowship in a complex and reconstructive spine surgery. I was faculty in Michigan at amazing time. Amazing journey of academic neurosurgery. I also did a fellowship at Emory and Endoscopic skull based surgery, concentrating on pituitary surgery. And then i was always coming down to Florida, coming down back to Peru to visit my family, my mom. And then one day I took a free diving class in the Bahamas and I was in the ocean. And I decided that the ocean was my home and I just had to move to Florida because of that. And I’m here. Yeah, that’s the gist of it.

Dr. JB 02:27
Well, so that’s a pretty good summary. All right. We are going to go back a couple of steps and explore more of why neurosurgery, you know why surgery in the 1st place, right and then why neurosurgery.

Dr. Valdivia 02:44
So why? Why I personally chose surgery? It’s funny you ask. Umm you know when I was in medical school, i don’t have a there any direct relatives that are either physicians or surgeons. So for me and to some to some that may seem a handicap going into medicine to not having a like a role model or having someone to teach you the ropes if you will. But I think it’s a it’s an opportunity because I was able to discover medicine and surgery on my own sort of like reading a new book for the first time. And I had obstacles, obviously. I made a lot of mistakes that as a student that i wouldn’t have if I had guidance, but. Yeah, and as far as I can go as far as to say that one of my teachers told me I was never, would never be a surgeon. But then you persevere, you continue. I became a firefighter in Peru while I was doing Med school, and I did a lot of rescue from motor vehicle accidents and fires. And I saw trauma for the first time, face to face, and I was sort of enamored with saving lives. And then I kind of translated that into surgery. Being a fireman taught me to sleep little, to be ready, 100 % of my performance at any moment, i think being a farmer is a very noble profession. So I feel that prepared me to a surgery residency where you sleep very little and you’re sleep deprived. And this was before the 80 hour week restriction in residency, so we used to work endlessly. And neurosurgery, why I started seeing a lot of neurotrauma, cranial and spine trauma, while I was a fireman actually, back in Peru. And that’s sort of sparked the interest to me in treating brain and spine. And somehow I started liking your anatomy. One thing led to another and made a neurosurgeon. I went into a case and that was it. Believe the first time I went into a cranial case in Peru just to watch or assist, the neurosurgeon told me. You know if I was sure if I was going to cross that door. Because once you cross that door, there’s no way back. And indeed once I wasn’t went into that case and never, I never wanted anything else.

Dr. JB 05:13
Ohh, so when you were in that case, you know, they say when you are studying to go into surgery or whatnot, if you can imagine yourself anywhere outside of the OR don’t go into surgery. So when you were in that case, were you able to imagine yourself any place but there?

Dr. Valdivia 05:35
Umm, no the only way I would I would do something different if only if I would be not able to perform surgery. I would still be in medicine because I love. Being a physician. And I love helping people. And that’s the that’s the fundamental principle of being a physician, is to try to help others and take the oath. If I wouldn’t be able to operate, yeah, I would be a physician, but not in a surgical capacity. And if I was not going to be a physician, I’ll be. I don’t know. A free diver, or an artist or something like that, or a musician. But i love what I do. And sometimes some, sometimes you win, sometimes you lose. And neurosurgery is something that humbles you, humbles you to your knees. You have to use a certain amount of ego and self-confidence to be able to perform beyond your baseline capabilities in a very difficult case while at the same time detaching yourself from a patient suffering. But sometimes you do great things. You can make someone walk again, see you again. Feel again and sometimes you can’t, even if you work. For hours. So this field really humbles me yeah.

Dr. JB 07:07
So, you know, if we could explore that, you know, the wins and the losses and how you cope with both.

Dr. Valdivia 07:17
Ohh, we’re getting deep. Nothing better than that. And our neurosurgery is one of those things where, you use your hands, your mind, your capabilities and your self-determination relentlessly to try to do a great fit for others and to preserve function as a human being. Preserve function means being able to, as I said, walk again, go back to send patients back to their families on holidays, to be able to live. And so, and not always we can do that. How do you cope with loss? Differently you know, every human being is different. Myself, even if I work on someone for hours, that is very sick and comes with a trauma. And the patients ends up dying after surgery is difficult. I don’t think any human being can be OK with that. Because deep down, you feel a loss. There’s something that you lose. And when you when that happens once and twice, 3 times 1050 times in a neurosurgery career. Yeah, that’s draining and it can translate into many things. Insomnia, sleep deprivation, mood changes in different people in different way. The way I cope with it is i tried to treat all patients like if they were my family and trying at the same time to detach myself from feelings. And as difficult because I wouldn’t be able to perform the same surgery on my mother, for example, because I would be so emotionally attached to it that I won’t be able to perform, perhaps. So you have to do both. You have to perform well while at the same time not being affected by a loss. I tried to work out, I tried to be in the water. I freedive, I hold my breath when I dive and that’s so takes me out, and sometimes I even can’t do that even if I try to. So I don’t have the perfect answer for that doctor.

Dr. JB 09:29
Truthfully, I don’t think there is a perfect answer yeah no. Yeah, that really hits home when you feel, you know, my biggest, my biggest, the one thing that really hits home to me is when and when kids die. Yeah, I don’t know how to handle that very well. And I don’t think if someone comes out and says I have the perfect formula of how to handle that. I don’t think that’s true. You know, I think that always hits you when you’re a surgeon. Yeah, because you try and you try, especially with trauma, with head trauma. yeah i’ve had very good results and some that no matter what you do, you just can’t. There’s so much we can do and. Ah. Yeah, that’s all I can say about that.

Dr. JB 10:27
You know, truth be told. I’m an emergency room physician and we all sorts of stuff and there are difficult cases and yes, children. Umm, you know? It’s hard to recover from a pediatric code, right? You know for me my. Struggles are with. Patients that come in and they’re walking and they’re talking to me when they show up in the emergency department and then with within Amir. Minutes to hours. They died.

Dr. Valdivia 11:13
Yeah it makes you appreciate life because it’s so fragile, you know? And I don’t know how to explain. I yeah I don’t know how to explain how I’ve obviously you feel a loss you know and different human beings perceive loss differently some sometimes some physicians may feel like they love the child. You know sometimes they lost their parent sometimes they just love to lost a patient. But trying to explain that it’s too much I think it’s not a flight from my wings you know I feel like you just learn you keep going and but every loss though. Every patient has lost because of the disease teaches you to be perhaps more aggressive the next time. And even if you learn that or you do try to be better still, you can lose someone that’s really hard in your surgery. I don’t think that’s where very, you know, that’s discussed a lot yeah.

Dr. JB 12:18
You know, the loss of the patient and the way that it affects healthcare professionals is not something that’s discussed. That much at all?

Dr. Valdivia 12:28
Yeah, it’s really hard with kids. But you know, sometimes in your surgery we have great outcomes and it depends on timing, decisiveness. Focus technical abilities and thought process so that they can make you diagnose something that is subtle. Act the right and the right moment and act decisively. My biggest and my biggest. One of my biggest. You know, success stories will be if I, if I basically comes in and able to walk and the patient is able to walk by the time his discharge or right after surgery. It’s a huge success. I mean, I feel amazing, you know? but. Or taking a pituitary apoplexy case to the OR because the patient is going blind and then the patient is you come in the room the next day and the patient is telling you, oh, I can see you now, I can see your face. I mean, that really is really cool. That’s the word I can use, you know? As really is feels really good when patients got able to see again, walk again or hold a pen again or see their family members or you know that’s huge. Especially for families. So some sometimes you win, you know, and sometimes you lose. And you know, you need to sacrifice a lot. You know, sleep, sometimes you, everything comes seconds, sometimes you my philosophy is that when the patient is on my hands and their life is on my, it’s under my watch. Everything is secondary for that couple hours or six hours, whatever hours you’re in the operating room and going to the bathroom is secondary. And Hungary is secondary and sleepy secondary. Now that’s not easy for human being because we’re not made for that. You know we’re not made to put that second a lot and we’re not created like that I think but sometimes to be successful. What do they say? Sometimes you have to shoot a hostage, you know, so you have to you sacrifice and you feel reward on becoming second to others. I think there’s something to say about that so.

Dr. JB 14:49
I agree that there is something to say about that and there is a time and a place where that is needed. But what would happen if every single second of every single day you are second to others?

Dr. Valdivia 15:04
That’s no good. You know you have to. You need self-care In neurosurgery, you need self love, self-care You need to rest. You need proper sleep. And your surgery residency is there’s at least when I was a resident, there used to be little of that. You know, we’ll wake up at five, AM we’ll be in the hospital by five thirty or five forty five start rounds until six forty five and then proper rounds with the chief resident at seven AM until seven thirty and the seven thirty got to be in the OR Sometimes you start around six five finish your at six PM and then there’s another case you wanna see. You have to stay over and that’s past midnight. And then next day is the same seven days a week sometimes. And in your surgical residencies? You know, you really, you really keep your finger on the pulse of patients so to speak. You have to know exactly what your patient is going through. You have to look at trends. You have to almost predict how the patient is going to do in the next 12 hours. If somebody’s going to blow a pupil, somebody’s going to get retention and somebody’s going to have paraparesis that is missed overnight. You have to be prepared for that because you have to act and. At the same time, learn and at the same time. So no surgery residency breaks you before it makes you, so to speak. It breaks you down, it breaks your old habits, and then it builds on those. Builds on that from with new habits like. You know, I think that I think I heard somewhere that if I had a neurosurgeon take care of me, I want that guy to be. Very nerdy, serious, lacks sense of humor and be very decisive and OCD at the same time, but also have compassion. So this is it’s not your typical, you know, lovey, dovey, happy go, lucky kind of person. You have to know how to be like that to perform and God help you not to bring that home. You know, because if you bring that home. And things don’t work out. And i definitely don’t try to bring any work home if somebody sick or yeah, no at home and used to be home and at work is work.

Dr. JB 17:30
That’s a very interesting point that you bring up. And so how exactly do you separate the two? How do you? You know, and at what point in your career did you actually realize that was really important to do?

Dr. Valdivia 17:44
I realized that was important when I was probably in Florida. And also Michigan as well because when you when you finish neurosurgery you like. I think as a resident you one has so many skills. And, no, I don’t want to speak for everyone, but a lot of people feel like if you have a hammer, everything looks like a nail. You know, if you want to act, you want to use what you learn for eight years long or seven years or whatever. So it’s easy to get carried away on trying to work and do very complex surgeries initially and you’re not doing that and then that wears you down answering phone calls in the middle of the night to get cases etcetera. But that that’s really that doesn’t take care of you when you’re sick when you’re down. The way I separate that myself is umm. I just sort of not think of work when I’m at home, and I don’t have a meditation regimen or anything like that. I tried to be in the water as much as I can. I feel like the water sort of cleanses and heals everything for me personally. And I feel like being in the water, especially in the ocean. It’s like the big mirror, you know? Being in the ocean, to me, really separates me from work. Most of the times it’s like the big mirror, because whatever you bring to the ocean will be reflected if you bring anger. Anxiety, it will be reflected back in like, tenfold. But if you and i honestly believe this is not science. You’re asking me a question. I’m answering you. So if I bring to the water. Openness and. Satisfaction, achievement, peace, presence, mindfulness. I feel like the water. I don’t know, just like you. Reflect that back on you. I feel like your yeah. I honestly feel that that’s I’ve been working on this. I have my own thoughts about. How to how to use breath hold diving tool for mental health so i still teach that to people sometimes and I used I use the water for my own detachment from work.

Dr. JB 20:18
Well, let’s talk about a little bit about mental health and healthcare professionals. Do you think that is an area of importance that should be highlighted?

Dr. Valdivia 20:30
It’s huge. It’s huge. I mean, you are. I would say if I looked in the mirror to myself, I would tell to myself that you are your worst enemy, you know, because. I can only speak for neurosurgery. This is all I do and I feel like. It’s so exciting as the so stimulating to do a neurosurgery case when it’s so technical, so refined, and you have to be completely present. I feel like. How you can? How you can cope with loss? How can you cope with stress? It depends on each individual differently, but maybe ask me that question a different way. I want to make sure I can answer you correctly.

Dr. JB 21:24
So you mentioned mental health and how you know free diving is good for your mental health. And so I wanted to know in terms of mental health amongst healthcare professionals in general, is that a topic area that needs to be addressed?

Dr. Valdivia 21:40
As a huge topic, it’s a huge topic because one big topic on that is burnout. If the general public’s thought or was aware of how much burnout we have, it would be yeah, it would be in the news, Bernard, is real burnout means that so the curve of stress in a human being, you start performing when you find challenge, you start performing above your baseline, above and above and above and above until you hit a plateau. And then you keep performing above your baseline and then your performance drops even when you’re trying to do and. In many cases, long shifts, you know, sick patients and then your performance drops because a human being is not made to perform above their baseline all the time, every day, right? Mental health is a huge issue of feel, like burnout has to be looked at in surgery justice, just as he’s looked at on pilots for example, you’re not allowed to fly for so many hours after so many days, but in surgery. In neurosurgery, it’s. I don’t think that’s a that’s discussed enough. But we pride ourselves in your surgery to be there. At least when I was arresting, the more you worked and the less you slept the better. The more complex cases you could do without any. Rest or breaks. It was like a chip on your shoulder, you know, because how else would you be able to perform in the middle of the night if somebody comes dying? The only way you can perform is to stop being human. For those you know five hours and you take care of someone. The right way you put hanger second, you don’t need to go to the restroom, you don’t need to sleep, you don’t need to feel. You just perform and save a life. I mean, what, what? What else? You know that would be the perfect thing, right? You go, it’s like a robot. You act, you attack the problem, fix. Yeah but human beings are not made to perform like that twenty four seven. So yeah mental health and huge issues. So burnout is important. I in neurosurgery i am sure in my opinion i’m almost certain that there’s the incidence of burnout is high. And in your Sergio resin as well presence so.

Dr. JB 24:10
Have you experienced symptoms of burnout yourself?

Dr. Valdivia 24:14
Many times, many times from when I was a resident until, yeah, every year. Every month. I don’t know how to. I mean, it’s just part of my life and that’s OK. And burnout means, you know, coming home at two AM and waking up at five and then going to round see patients. And be there and be responsive and talk to families and give bad news and give good news and then keep going and then a case and you feel it’s at 7 and you eat at 8 and you go and sleep at 11 and you wake up at five and then you do it again. Yeah, and then the patient comes into a trauma with a blown pupil. You do a 6 hour surgery, patient dies still because he was too sick to begin with. That’s for now and you have to like. Sort of. You, I said good. I think a surgeon that really wants to not be affected by that. You have to roll off your knife to the sort of speak, you know, you have to let that go, you have to let it drop and peel off and you keep going. And from time to time you take a break a mental health break whatever activity you want to do you need to do it. So disconnect and personally yeah when I take a week off, 2 weeks off, it’s like a rejuvenation. It’s going to Renaissance and then you better by neurosurgery stuff. I mean and there’s different types of neurosurgery. I practice hospital, neurosurgery where we. Umm, we are tertiary referral center that attends to cases from over 10 other small facilities and we all, they all come to my hospital and it’s great because we have great variability and cases, diversity of cases and it’s very stimulating. But yeah, there’s going to be burnout for sure. There’s hiding. It will be will be stealing. But neurosurgeons are trained to work under burnout conditions. Neurosurgeons are trained to burn, understood to work under stress. No, I still perform yeah.

Dr. JB 26:29
So, you know, when you described all of those things about, you know, going to sleep late, waking up after a couple of hours, redoing it again and eating late, sleeping, you know, for a couple of hours and going back. And, you know, dealing with all these stressful situations, you know, in terms of, like the i guess, symptoms you’re experiencing. Yes, stress, high stress, right. And then also I just thought like exhaustion, right. You’re just exhausted and you still have to perform, right? But right. And so those things, right, uncontrolled stress, you know, leads to, you know, exhaustion. What other symptoms of burnout? Have you experienced in your career?

Dr. Valdivia 27:13
Ohh for sleep deprivation is one of them headaches and that’s that comes and goes. I don’t. I mean, I haven’t had it. Probably once every three months it goes away with coffee. Physical still, you know? Yes, I feel like I cannot speak for everyone that has a burnout, but burnout means performing at a high intensity. And when the performance starts dropping, meaning you feel just extra tired one day from operating many times and. There’s no feeling the satisfaction you used to feel, even, you know, because that man was tough or something, you know, that’s burnout. I personally experience burnout. Yeah, I would say awesome. I mean headaches. Sleep deprivation is probably the most important one. But honestly, those little short breaks, free time, it makes the whole, it makes a difference then when I come back to work and brand new and just feels different. But I cannot tell you, I mean many symptoms that I have had burnout other than not being able to sleep well, even if you have, you’re not on call. And sometimes that happens sometimes if you’re on call and it’s been a stressful week or a couple of weeks with patients and you won’t be able to sleep well. I mean, that’s human, you know? Yeah go ahead.

Dr. JB 28:47
Well, there’s a couple of things that you’ve brought up a couple of times, you know, during this conversation that I do think we should highlight is. It’s human, hey. We’re human and I think that sometimes healthcare professionals are not viewed. In that light, unfortunately, right. And you know. We are asked and tasked to do more and more with less and less.

Dr. Valdivia 29:16
Wow, that’s a big topic, doctor. You asked me to cross a fine line, doctor. Healthcare oh boy, that’s a big topic. We can talk for hours. The future of healthcare? yeah. Working more with less, yeah. Well, let’s take a look at that. You know, like what? What do we do medicine for? What are we going to be a physician? We take a note. To take care of others, right? To do no harm. And that really stuck to us, at least not maybe to most people I know. But Healthcare is not just that. Healthcare is worth using your resources I. With Paradise in value and quality to deliver adequate healthcare to the community, right? So it’s not, it’s not just doing the fee per service model or habitual all fee per service. Like the more consoles you see and the more procedures you do, the more you make, but it doesn’t take care of the patient as a whole. An example would be if a patient comes with chest pain, for example to the hospital against the million dollar workup chest CT scan. Roll out PE, EKG, troponins, echocardiogram, cardiology gets consulted and thoracic surgery gets consulted. At the end, the diagnosis was unknown or maybe just anxiety and the patient goes home, still with diabetes, still with hypertension, still with diverticulitis. That has to be chronic. And they just say follow up with your primary care. When the bill is huge, the patient has no long term plan, but still that was healthcare, right? Multiple services and multiple fees for each service, right? How about? How about the model of? Cheaper value, right? So it’s cheaper per patient. You make that patient better. You prevent hypertension, diabetes, obesity, anxiety, depression. What about that? You know what? Wouldn’t that be ideal to prevent all those things from happening in our, in our communities, especially communities at risk? umm. Yeah, that’ll be that’ll be like the utopic ideal. I don’t know how to make that happen though. But in neurosurgery, prevention is huge, you know, preventing spine disorders, for example. We see the other end in neurosurgery. We see when things are really bad, how to prevent what I do, a lot of what I do is spine and for example, what i tell my patients how first of all try to avoid surgery to most of my patients. And if I did a really good job, I’ll be out of out of work, but. The idea is to avoid surgery unless it’s absolutely necessary or the patient really would benefit from it. I tell my patients to control your weight, avoid smoking and getting the water. Take up swimming or do an inversion table or stretch every day and do yoga. Leave a healthy lifestyle. It’s difficult to in state and on all patients to make all patients follow that. But it would be ideal if because if i tell you if everybody did the same we’ll be seeing less service and that will be better I think umm yeah.

Dr. JB 32:49
You know, when we talk about spine and spine surgeries, one thing that I’ve been coming across a lot in terms of healthcare professionals, in terms of surgeons. But they do suffer a lot from spinal. Problems, right. It’s one of the causes of early disability in surgeons because of have you, have you been seeing that?

Dr. Valdivia 33:17
Have seen it, but I don’t have statistics on that. But if you ask me to fire from the hip, I would say that. Still his spine surgery unless you’re using a fancy ecoscope what we call it where you just look at a screen and you operate out of a tube and you are using loops and you are you having your neck like this on almost all surgeries where cervical, thoracic, lumbar. Yeah, that creates degenerative disc disease and possibly kyphosis and on surgery, cervical spine akin to using a cell phone. You know, why do everybody comes to my clinic with neck pain? Because, and I tell him, text him when the waiting room like this all day. So then the upcoming 2-3-4 generations are gonna be coming with neck pain to the clinic because they’re all attached to this, right? I’m sure there is. I mean when in spine surgeries, sometimes cases may last an hour, 45 minutes to 4-5-6-7 hours you’re standing and because in surgery you are so present. In the here and now, you forget about the time. You’re standing for hours and hours or hours, and then when you finish you realize it has been four five hours. And now you are. Now things are more like, Oh well, my spine now hurts a little bit and I’m sore, but in the moment you’re not, you know, concentrating on that. I don’t know what to what the what’s a good fix for that? That’s feel, that’s why if I spend for example hours on end in the ORI come home and I start to stretch and be in the supine position or prone and just try to stretch to a stretching session for 15 minutes at least you know it’s just to take care of the engine, otherwise you won’t be able to perform and operate the same years to come. But that’s how surgery is, you know? I feel like that’s why we love surgery so much because we are present in the now. We are we’re not in surgery. We this is maybe off topic but in surgery we at least myself I believe that certain techniques are important to really deliver your best to that patient. One of them is visualization. If I’m scrubbing my hands you know just before the case i’m visualizing the surgery in my mind and I feel like when I do that or I do it the night before when I when I come in and put my gloves. Morning gown. The surgery just flows better, much better when you visualize that many times before the procedure. If it’s a right sided surgery, you’ll visualize the right side. If it’s a tomorrow certain shape, then you visualize the structures around that tumor. So when you’re in it just flows. Visualization is huge and that’s something that is used. Greatly in free diving as well for performance or sports performance. Also self programming. When you’re about to do something very difficult, you self program yourself as a mental trick to be able to perform. For example, you tell yourself, yes, I’ve done this before, I have done this many times before, therefore you have more confidence to perform. And when you’re in surgery, we are not thinking about tomorrow, we’re not thinking about what we have for breakfast or. If I said the right thing or if I upset someone, you are there is here and now and that’s all. And there’s some beauty to that. That’s why surgeons like surgery because you’re immersed, you know, it takes you away from everything else or your worries to what degree. I feel like if you come to the door and you’re worried about something else and half of your mind is concentrated on that worry versus the patient, that’s not good for surgery. He has to be the patient and the case. Now that’s all. So that’s it’s my philosophy.

Dr. JB 37:25
Well, that kind of goes back to my statement from before in terms of the knowing that surgery was right for you because once you found yourself in the operating room, you really could forget everything else, right? Like if you could really just focus in on beam operating room and not thinking about when is this case can be over or you know, I can’t wait till tomorrow or any other thoughts like that surgery is not for you, right. Like I think that was a valuable piece of advice when I was doing my surgery rotation as I was retracting, I was definitely. Imagining myself. All sorts of other places, right? So I was like, oh, surgery is not for me, you know, but I definitely think that that’s definitely valid. And then going back to the whole. Stress, right, because you have to contort your body in different positions where you’re doing surgery, right, to get that right angle and whatnot. And, you know, I don’t think that there’s an, you know, an easy answer for it. But I do think going into it, realizing that, oh, you know, this is actually one of the potential, I guess occupational hazards of this, of this specialty and maybe, you know, being more intentional. In terms of like, you know, engaging in like functional fitness exercise programs, right, that kind of focus on strengthening, you know, different muscles to minimize harm.

Dr. Valdivia 38:53
Yes, I mean i don’t. One thing I can recommend if I was advising myself on how to do more self-care is Umm, you know stretch every day, every morning, even when you get out of bed. I have a physio ball and I stretch my spine, my neck and I get in the water whenever I can because it’s just good for your mind and your spine and your joints. Mental health, you know, recognizing ego and having emotional intelligence is important. Meaning being able to manage your own emotions and understand your own emotions and the emotions of others as well and their expectations and manage those expectations and emotions. That’s emotional intelligence and that that’s the goes along way with career stability and his career period. I feel like self-care in surgery is very crucial. And recognizing that, you know, ego is a handicap. You know, ego goes is rampant. Insurgents I think, and it’s useful to a degree. When you are in a difficult case, you need to feel that you need to have self-confidence and believe in yourself. But there’s a fine line between that and ego or exaggerating ego. Yes, he helps when you’re doing a difficult case and you have four or five hours to go. You have to tell yourself that you are. You’re able to do this, you can. You got this. But using the same home is not going to work. He was a handicap, so be careful with that. If I told that to myself in the mirror, that’s what I would say to myself, yeah.

Dr. JB 40:34
So we’ve mentioned self-care and the importance of self-care a couple of times during this conversation. And you know, i remember you said, you know, I don’t do like yoga or whatnot, but free diving, you know, when I, when I encountered it, when I was in the Bahamas, I think is what you said you wanted a vacation, you got introduced to and then the Bahamas. Could we revisit that experience and you know, was that the first time you were ever in the ocean?

Dr. Valdivia 41:00
No i grew up in Peru and I grew up surfing when I.

Dr. JB 41:05
Could what was different about that experience?

Dr. Valdivia 41:09
It’s different in other activities, I feel like they’re based on what degree you have to have some sort of adrenaline to enjoy the emotion and is very physical to a degree. Aerobic, yes. And also to look out, you know, you’re looking out one activity to either scuba diving, looking at fish and you’re looking at the waves and etcetera and whatever, but in free diving you’re looking inside. And it’s just you and your thoughts. And that can be a scary place to many. You know, it’s just you and yourself alone, underwater on breathhold, obviously under safety. You know that I have to disclose, you know, you shouldn’t ever be that alone. You should never free that alone. You should always follow a safety protocol. You should always get certified by any instructor that is that is a certified instructor to follow the basic safety rules. Otherwise you could die. You know, if you have a syncope, an assisted syncope in water. Your chances of death are high. Extremely high, if so.

Dr. JB 42:20
Can we take a step back and just go to the basics? What is free diving?

Dr. Valdivia 42:24
Free diving is any activity that involves breath. Hold underwater, and it can be as simple as just going on there for five seconds in your pool. Which you should never do alone. But it can be as intense as hooking yourself with a liner to a line and going. Four or five atmospheres under, meaning 60 meters under or 5060 meters under. And only you can perform that if you are present here now. And it’s easy for me to say and I’ve done it. But it doesn’t happen every time, it doesn’t happen every time the same way or every week, depends on what’s going on in your life. But it’s a beautiful experience because it really tells you what’s inside you. And as I said, the water and at least the ocean wherever. I mean, it’s like the big mirror if you come completely clean, your heart and your mind. You you’ll be a more enjoyable dive experience because it’s just you or your thoughts. And if you’re going in anxious, you won’t be able to perform that well. It’s interesting that you mentioned what, why free diving? I mean, such a amazing thing. It’s free diving. In short, we are born, we’re genetically cold, with mechanisms to survive underwater to a degree. Two degree and to certain amount of time we have physiological mechanisms such as the blood shift or what it used to be called mammalian dive reflex or more commonly called now dive reflex meaning peripheral basic restriction bradycardia, increasing cardiac output increases cerebral blood flow, all that allows a human being to be underwater. For a certain amount of time and you just unlock those mechanisms when you train for that. And I can tell you the most amazing experiences for me and freedom in is I’ve been where I’ve. I have no thought. So it’s not freedom. It’s not what you say. It’s not freedom of thought, like we call it in the West, you know, like there’s the ultimate freedom is freedom of thought. Yes, it is. It is. But there’s something beyond that. There’s freedom from thought where you don’t think, you just are you just aware. And for me C it’s easy for me to say as well. I don’t. It’s not. I cannot do that all the time. Barely rarely. But when I am, it’s just that you entered this flow state, what is called flow psychology, where you are immersing an activity so much and getting constant feedback that only matters. What only matters is that activity where it all your only present. There’s no sense of past, future worry. You’re just now. And if I can expand on that the idea would be to separate yourself from thought. They get, Cartelli says. You know, if you separate yourself from thought, you’re not your thoughts. You just watch them fly like clouds on a sunny day. You watched them and they just come and go. And when you’re in that state and diving, it’s just I don’t know. I am not 100 million diver, but i can get deep 23 and if I filled out a couple of times. And not many. I’ve been very happy. I’ve been extremely happy and when I when I come up from water then I feel completely. Detached from. Not only thought, but the sense of time. Yeah, if you ever want to experience that anyone, if you are able to experience anytime during diving, it’s just amazing. It’s just self therapy. And this is this perhaps may sound a lot esoteric and pretty out there to many, but you know. That’s life.

Dr. JB 46:35
Do you go down with an oxygen tank?

Dr. Valdivia 46:39
No it’s just breathhold yeah. Just breath holding. It’s obviously done in safety conditions with other safety divers. You hook yourself to lanyard and you have fins and you have. So I feel like it’s almost self therapy because the more you can control your thoughts, your anxieties and be mindful and aware of yourself and your body, the better you will perform. So it’s a way, it’s a, it’s akin to biofeedback if you will. In the future I plan to use this for to see if I can affect mental health in some. Fellow divers, if I could yeah. But I find it beautiful. I find it’s a beautiful activity. From the outside, it looks risky. You may think I’m crazy, but. In safe conditions. It is a it’s a very eye opening, almost. How do you call it? Very yeah very emotional 23 activity that every, almost, I would say not every human being, but most of us will find joy in practicing.

Dr. JB 48:01
I could definitely see, you know, in terms of when you mentioned. Flow state and being in a flow state, you know, you describe how when you’re in the OR and you’re doing the surgery, you’re also in a state of flow, right? Everything else falls apart, right? or. And you’re not thinking about your needs, you’re just present. You lose sight of time and space, right place, and you’re just there doing acting right. But now, with free diving, you’re able to recreate that same experience of that flow safe. You know in a more peaceful. Environment, right? You’re you don’t have somebody else’s hand, you know, life in your hands, I mean you know, but the concerning thing about that is. When you lose sight of. Time, right. When you really get into the flow state and you are deep underwater, like is there a timer, you know, in terms of like the safety mechanism because you’re, you know, you don’t know how long you’ve been under the water. Now when you really get into that state. So is there somebody that’s like, oh, you’ve been there too long and then they start pulling you up and kind of getting you out of that state of flow. Is that part of the safety mechanisms?

Dr. Valdivia 49:19
Yeah, OK, so now we’re going into free, like the technicalities of freedom. Yes, if I could expand and when I walk you through a an ideal performance dive, an ideal performance dive will be in a platform or a boat with a arm and a line, let’s say set a 50 meters or 60 or 70 and with that weight bottom weight and then you have wet suit and monofin or fence or not. And then you have a lanyard either on your waist or your wrist, you clip that linear to the line. So you’re not going anywhere away from that line right and then you are in the water and you’ll do what we call breathe up or what we most commonly now called relaxation phase, where you breathe tidal volume so that your CO two is it’s a normal range between 35 and 45 and then your oxygen saturation is ideally above ninety five ninety three ninety five ninety eight. And then you do a big inhale. Some and you can either do what we call packing or in medicines called glossopharyngeal insufflation where you use your mouth as a pump and you not only go into total lung capacity, but you go beyond total lung capacity you can get over a leader in. So you’re fully inflated with air. You know I’d be alive and then you could send. And then you have alarm sometimes on your watch at the my watching, my under my hood and my wet suit and you know there’s an alarm at certain amount of time or adept umm. I have to announce before doing that to my safety, by the way, I’m going to a certain amount of meters, please meet me at certain depth depth. And I’m going to take two minutes. And from the surface of the surface, and they’re counting, they’re filling the rope. They can feel when I’m going down because of the friction of the lanyard. When I turn, I do a pool and they can fill that pool as well and they count and sort of guesstimate where I’m, where I’m going to be and they go and meet me on my ascend, let’s say at 20 meters or 10 meters. And they follow me up to the surface, watching me straight on, watching my movements, my flow, my proportion, my propulsion, my technique. If there’s any deviation of technique or propulsion or my eyesight, there might be a sign of hypoxia. So if I’m losing that side of the rope, or I’m pulling and i’m having lots of more control, which in medical language will be hypoxic. Fit or tremor, yeah. They will Get Me Out right away. So that plus sometimes uses sonar is at the platform. You see the diver go down, they go up, you see the speed and sometimes in the more fancier like competitions and you use something called well, they use underwater camera so you can see actually what’s happening and if they’re hypoxia on a sand usually which happens mostly in the sand. You will see changes in form propulsion technique. And yeah. So it’s a very safe sport if you’re done, if it’s done right. And obviously if I, I’ll tell you when I had a blackout or what we call it a blackout, but it’s feeding related Seabee in medical jargon would say. I was sleep deprived. I don’t know why I was doing the keto diet that week. I probably was a mistake. Announced a conservative depth for me, but still was surprised to go down to 50 meters, turn around and send I ascended. Grade was about to do the Surface protocol and i lost consciousness for two seconds and then I woke up and I kept doing the surface protocol. So I was unaware of my of my syncope and aware I only was told that I had a syncope. Then but again, you know I was supported immediately by safety divers and you feel like the sense of community and free diving is. I haven’t practiced many other sports, but the sense of community is very strong because once you’re in the water. And you are going to do a session of reviving. You communicate with your safety diver and you immediately put your life on their hands. When you ask somebody can you save? To me is called for saying, can you save my life if something happens? So we watch each other’s backs and it’s a big family. So yeah, so there’s many safety mechanisms. I hope that answers your question.

Dr. JB 54:02
How does that feel being part of such a community?

Dr. Valdivia 54:06
It’s amazing. It’s amazing. I can tell you better things. The most amazing group of people I’ve ever met. I feel like they’re their family, no less, because I know that if something happens to me, they will rescue me and vice versa and I’ll be there. Would know with no other intent other than loving. Your community. Yeah it’s a very strong sense of community and it’s just unique. Yeah, it’s almost like sacred to be in the water and be able to like trust someone else terms with your life. If something happens, don’t rescue you and you have to trust when you’re diving and you’re completely immersed in that flow state and all that you have to trust, you have to be happy. And when they trust you with their safety, then that’s an honor too. So it’s reciprocated every time.

Dr. JB 55:05
And it seems like you’re in a very vulnerable. Position and situation, you know, and as a surgeon who’s used to be in control of everything, you know how was that become so vulnerable?

Dr. Valdivia 55:19
As difficult it’s totally different. I mean to a degree is different community are because you’re not in control of everything at all, you let go. And letting go is not easy. And i don’t I cannot do it every time it’s difficult if I’m if I’ve had sick patients last month it’s difficult to die that month. There’s no question it’s not every time just because I hit certain death I can do it every time the same way the surgery I mean you have it’s you have to stomach those cases and it won’t let you die the same way. You know be a problem will be performing much better if I didn’t have my job but. I like my job too. I mean, I like to three people, so you have to balance it. But yeah, you’re not in control. You have to let go and trust whoever is around you.

Dr. JB 56:10
So, you know, I think free diving and what you’ve been talking about is absolutely fascinating. If my listener wanted to find out more about you, how can they do so?

Dr. Valdivia 56:22
They can I’m afraid. Having instructor, although I don’t do many courses because I don’t have. I barely have time to train myself, but if they want more information about that, they can reach me on my Gmail. Janivaldivi@gmail.com or my whatsapp is 520-850-9305 so yeah, if there’s any physicians who are interested in learning more about free diving medicine or just people you know interested, you don’t have to reach out to me. There’s many instructors in Florida and everywhere, and make sure you just take classes from somebody knowledgeable. I can’t promote any agency specific, but. I feel like most anxious will give you the basics to be safe, which is number one priority and free diving is being safe.

Dr. JB 57:22
And so with that and then closing, do you have any pearls of wisdom that you would like to leave with my listener in terms of their wellness?

Dr. Valdivia 57:35
Wellness no. You’re asking perhaps not the best person because i’m a neurosurgeon that works long hours with few. Breaks for free time dedicated to holding my breath, going deep. But I can tell you that what I use for Wellness is you know, recognizing your limits. Being mindful of your own emotions. Being mindful of ego, recognizing that ego is the handicap and is useful sometimes to perform activities, but then it’s not. It’s not useful most of the times. Recognizing science in your own body, knowing your body. Knowing the signs of disease and normal state. And always finding an activity to really detach from stress. That is the best way to do it. I’ve I feel like it’s to be happy and content with your own self. And that’s why I feel free. Diving gives me that because if you cannot be happy with your own self and thoughts and emotion, being in a quiet room alone or underwater with your own self. Then that’s difficult to do it outside that, you know, taking enhancement drugs or stimulants, stimulants or. Just it’s not what I would recommend for Wellness. No alcohol or drugs or rock or it’s not Wellness. Wellness to me means being just present here, now with yourself.


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