Clinical Challenges in Surgical Education: A Diver, Photographer, and a Chef Walk into an OR

Hello, and welcome to this episode of Behind the Knife in Surgical Education. We are the General Surgery education team from Cleveland Clinic. I'm Puja Armin, a general surgery resident and surgical education research fellow. I'm Judith French. I'm the PhD education Scientist for the Department of General Surgery at Cleveland Clinic. I'm Jeremy Lipman. I'm the DIO for Cleveland Clinic. On today's episode, we're stepping beyond the operating room to explore the art outside of surgery. Our guest is a surgeon whose life extends well beyond medicine. He's also a chef, photographer and diver. And we'll discuss how creativity, humanism, and artistry intersect with surgery, and what lessons we can draw from pursuing passions beyond the or. Dr. Adnan Aldi attended Penn State for medical school and completed general surgery residency at the University of Illinois Chicago. He completed a fellowship in HEPA biliary pancreatic and advanced gastrointestinal

surgery at Washington University in St. Louis, as well as a master's in surgical education and an MBA. He has served in the US Navy and was former president of the Association for Surgical Education. While his accomplishments as a surgical oncologist and surgeon educator are impressive, we're excited to dive even deeper with him today. Welcome, Dr. Al Sadie. Thank you so much and it's an honor to be here. Really a privilege, and thank you for inviting me. So first off, I honestly couldn't find much about your creative endeavors online, but I've heard through word of mouth that you're a photographer, a chef, and a diver. So I'd like to start by asking you a little bit more about your photography. So can you tell us when you started taking photos? Well, that was a kind of a consequence of the diving, if you will. I think what people reference when I talk about my photography is my underwater photography. And so I really started diving when I

was in the Navy seeing things that just made me feel so for lack of better word, insignificant. And it was just incredibly thrilling. And then that drove me into photography. Can you tell us about some of the early photographs you were taking at that time? Mostly at that time I was into macro life, so I was looking at really small, sometimes sub centimeter photos and pictures and creatures. And, you know, one of my favorite pictures was actually in, in an island called Uni gma, which is actually the western most island of the empire of Japan. It's basically a, what's called a pygmy seahorse. And this pygmy seahorse is a pregnant male sitting on a, on a C fan. And it's tiny. It's. Probably not even the tip of a pencil eraser, but it's just breathtaking. And it took me 35 minutes to take a picture underwater of one creature. So it's, it turned out to be an endeavor. And then you obviously start learning a lot more about the lights and why, how light makes a huge difference underwater.

And yeah, those are my early photos. Given that you got into photography through your diving, can you share with us how you first got into diving while in the Navy? I don't know if that's something most people in the in the Navy end up exploring in some way, but how did you start diving? That's a great question. There are such a thing obviously as Navy divers and the Navy actually started the tables, the dive tables that a lot of people used for, I would say decades. But nevertheless, you could be in the Navy and not dive. Obviously I was a physician in the Navy. I was stationed in the Pacific rim in different cities in the Pacific. And the one thing beautiful about the Navy, unlike the army. Air Force and other branches is that you're always close to a water. So that's how I got into diving and mostly it was recreational. And then I started diving with navy divers and then they kind of taught me a really different level of diving where I was able to do more complex dives, more stagger

dives, and night dives and cave diving and World War II wreck diving. Once you get into World War II rec diving, that drags you into a really impressive destinations where you go to like Chuck Lagoon and, and Saipan and Rota. And that coupled with my love of history and I really loved studying the Pacific Theater, especially in World War ii, where I would read about a, a battle and then I would just fly to that site and just dive the wreckage, which really brought a different way of looking at the World War ii for sure. Of all the different places that you've been able to dive and take photos, what do you think has been the the most interesting or the most beautiful? For different reasons, different things strike my mind differently. I would say the galago has a spot in my heart, and mostly because if you go to the outer rim of the Galago islands like Darwin and Wolf and Isabella where they're uninhabited you, you start seeing that the animals basically treat

humans like. They're just part of the nature. They're just unafraid. They are very intimate with humans, and that's where a lot of the underwater currents of the world kind of converged. So you see very unique animals, but also they're almost like SeaWorld on steroids there. Everything is bigger, everything is impressively much more wild. But I still feel like going to places like Palau and Rhoda and Saipan and, and seeing how, what happened in World War II and after is, is a different creativity, and you go down there and you see things and then it just changes you, I think. So you mentioned that it was while you were diving that you were inspired that. You're seeing things you need to take pictures of, and that made you feel insignificant, but you're talking about a one centimeter fish. So can you say more about what did you see? What was it while you were down there that made you think I really want to capture this and share it with other people? I don't think anybody wants to hear surgeons.

Get all sensitive and cry. But I would tell you the most important thing to me about being underwater is the fragility of humanity. I mean, we, we tend to kind of feel masterful and we, you know, pump our chests here on, on land and we do a lot of damage. But when you go into these deep oceans, especially in the blue oceans, you realize you could die in like. Millisecond and nobody underwater would care. You're insignificant. But also you see things that you realize are way older than humanity and yet have found a way to actually, you know, kind of maintain that stability in such a way that, that we just. Don't seem to actually understand. Even when we throw things like ships and bombs and unexploded ordinance into the water, it just becomes part of that whole ecosystem. There's so many things underwater that makes me feel. And it just basically kind of reinvigorates my sense of like, there's such a

bigger picture. You know? I'll just give you an example. I was off of Isabella Island in the Galapagos and I was tracking a, what is probably at least a 45 foot whale shark. This was part of a process where we were tagging them. So I was tracking it for a while and. I ended up being about maybe 10 miles away from the boat and now I have got a transponder on so they can find me. But the point being is like we do this and then we actually, now that we have this tracking, we look at the tracking and like literally these incredibly majestic, huge whale sharks. Are swimming in such a incredible speed. But actually when you look at them longitudinally over hours and days, you actually see that they're following Titanic fault lines. Not only is it such an incredible thing to see and to be intimate with and to touch, but then you realize like. There's just something, there's so many things we don't know, like how does, how do they even know where

Titanic fault lines is to follow them and then follow them across the globe? I hope that kind of explains how insignificant, but insignificant in terms of knowledge. Like there's just, we just don't know anything. I'm curious, after you started photographing your underwater experiences, did you start to dive differently? It's a great question. I did for a while start diving differently, but then once in a while, I do want to remind myself like why I love diving, and it's not really about the product of the graphy. So I intentionally tried to just leave things behind and just go dive. In fact, my last dive was in Tonga in the Pacific in Oceana, which is a nursing. Island or set of islands for humpback whales and I just decided to like for three of the six days, just like not take any of the photos and just try to actually pay attention. 'cause sometimes these photos can make you zoom out of what's happening. Then how did you get connected with,

with National Geographic and other areas where you're distributing your photos? How did that all happen? You know, it, it's like everything in life, everything is connections and being in the right time and the right place and the right time. I, I happen to be in Palau. Palau is one of the most magnificent islands. Like if you really wanna. If anyone is listening to this and wants to learn how to dive in, like the most precious place and the most safest place, and like most calmest waters probably Palau is the place to go. Palau was there and National Geographic was doing shark week and they needed some support. They needed a deckhand and, and I happened to be around and you know, the novelty of having a surgeon, being a deckhand was chuckling enough to some of them that they kept inviting me and one thing led to another. So it was a simple coincidence. So how often are you able to get out and dive and take photographs now? It's harder now. I try to do it like one big trip at least once a year, and then another

smaller trip. So usually twice a year to like real destinations. But then, you know, like, for example, I'm a liver and pancreas surgeon, so our meeting is in Miami, so I'll go a day earlier and, you know, do one of the coast in Florida or you know, some small dives here and there. Those are easier. But a real like kind of a diving expedition, usually one big one a year and one small one. So I'm curious, beyond your surgical career and meetings maybe taking you to great diving spots, what is the relationship between your diving, your photography, and your career as a surgeon and surgical educator? Are there explicit connections for you? There really is Puja, and, and I do, I appreciate that question. Way more than you think. You know, a lot of times people and I don't mean this in any negative way, but a lot, a lot of times people, when they talk about the joy in their life, they hyper focus on things outside work. That always like hurts me a little

bit because I find a lot of joy in what I do, a lot of joy. I find a lot of joy in taking care of my patients. I find even more joy probably, which is kind of ironic to me now. I used to kind of feel weird about saying this, but I find even more joy in teaching learners when I'm taking care of patients than taking care of patients. But obviously I love taking care of patients, but honestly, like, even though I, I'm very blessed in having a very full life outside the operating room. To me, they're all one. And I don't look at what I do outside as like what brings me joy. To compensate, for lack of better word, of what's happening at work. They're all just one. And I enjoy tremendously what I do in my, in my job. In fact, I feel like I wouldn't have gotten any of these opportunities if I wasn't who I am or what I do in, in, in work. And I don't mean this financially. I mean this as an opportunities of actually being able to go to different places that I wouldn't be able to go if I wasn't a physician. But not only that, like it has gotten me a lot of connections. So,

for example. I told you I was in Tonga doing my last trip, and this is what I usually do. You know, like there is such a thing as off-gassing after complex di diving, so you can't fly out right away. So usually what happens is I, if I'm going like, let's say for four or five days, the first day I'm going there and I, I'll just literally walk into the, to the hospital, the regional village hospital, and I'll just introduce myself and get to know who they are. The novelty again of being a surgeon there. Diving, you know, gets you connections real right, right away. And usually we have dinner together and then we meet every night after diving and I get to know them better. And then the last day I just go there and I just basically shadow them and I learn more about their hospital. And then over the next few months and years, I basically help connect them to places that actually can support whatever their need is. And through that process. I've gotten literally to take care of and operate and help out individuals in countless,

like I would say, a hundred plus islands around the world. And so again, it's just, it's all connected to me. There's a lot of. Similarities in what we do in medicine and surgery. It's really all about understanding like the fragility of who we are as human beings and taking care of others. This reminds me of a book that's co-authored by the Dalai Lama and the, and Desmond Tutu called The Book of Joy. And in in that book, the Dalai Lama says, taking care of others, helping others is ultimately the way that to discover your own joy. And then there's also another quote in that same book about. How understanding the insignificance of who you are in this world really kind of brings you perspective and joy and you don't take yourself too seriously. And I think that's where, to me, everything is connected. I think there's a lot of fragility and hum humility that comes from being a surgeon. For sure. That's fantastic. Can we change gears a little bit and talk

about your work in food? Yeah. And tell us how did, how did that come about? Yeah, I'm, I mean, I've always enjoyed cooking. You know, I kind of grew up in a, in a household where. We're five kids and we each had to like, take a tour to help out mom and dad and, and you know, I kind of gravitated to it towards the kitchen and I just, that's how I started learning to cook. And when I went to college, I was on the younger side, so I had to live with a family and the family I lived with was an Afghan family and they were immigrants from Afghanistan because of the first war in Afghanistan. And and the mom was. Like an executive chef in like the top restaurant there. So she was an incredible chef. And so instead of having friends every evening, I would spend the time with her in the kitchen. And I just even loved food even more and cooking even more. And then eventually I decided to, you know, take some classes and learn it. And and then eventually I started cooking in a, when I

was in Japan, actually, I was cooking with a local friend of mine just helping him out in the kitchen. As I said earlier on, there's a lot of, like one thing leads to another. He got a notice that how the building that they were in was going to be to tore down and they were gonna build condos, so he had to move his restaurant. And I was like, I can go in with you as a partner. And that was my first restaurant and that's how I got into restaurants. And one thing led to another and I just kept doing it. Your first restaurant was in Japan? Yeah, when I was in the military, so we just basically unofficially I, we, we opened the restaurant and my job was to kind of create the menu and yeah. Is the restaurant still open? It's still open. You said first restaurant you have more. Well since then, yeah, I've opened and, and now it's kind of a revolving thing 'cause I don't open them as a business. I open them because I enjoy, you know, the ability to host people, to take out friends,

to create menus. And so I open a restaurant where I am. And then unfortunately I've moved, and so then I'm like, okay, now what do I do with this place? So yeah, so I have, I had one in Seattle, which I am just closed. I've had two here in San Francisco. I actually had one in Phoenix, mostly because a friend of mine dragged me into it. It's a little bit of a moving target because right now we're kind of in the process of talking about opening a cooking school. So I'm kind of trying to organize my life and even close some of these restaurants. But yeah. Is the cuisine the same at each of them, or are they all different? No, they're, they're different. They're different. I would say the last, the last two have been actually mostly Mediterranean, north African. The other ones are a little different. Yeah. I mean, I understand you have a passion for it, but there's a lot that goes into a restaurant. I've seen tv. How do you figure all that out? Like where do you where Yeah. So this is part of the problem. I I, I

don't wanna sound like I've done it, right? 'cause I've learned as I've gone, and if you talk to my financial advisor, he like rolls his eyes every time I talk about a restaurant. But he is like, if that's what you wanna spend your money on, that's fine. So, so I'm not really. The per person to a, to ask that question, Jeremy. But usually what I do, because obviously we're very busy, is I always partner up with somebody that runs the front of the house and and then I just focus on the back of the house, which it works well for me because I don't have to worry about hiring and all that stuff. And, you know. Payrolls and ordering, and which is obviously a huge amount of work, but it also makes the business disjointed. So, but as, again, as I just said, it's, I do it mostly because I, I love the creativity in the kitchen. I love teaching people in the kitchen. I love you know, kind of, feeding people. So have the residents over at my house at least once a month and. Usually you know, we have the chief residents mock orals where I, I don't participate, but I host them. I have the interns over I, the

outgoing interns, the incoming interns, the prelim interns, all the APDs and PDs in my house. And I usually cook dishes from nine to 10 different countries and, you know, it's a lot of fun. What's your go-to Comfort food cooking. I am unfortunately a very large a very intimate carnivore and lamb is still my go-to comfort. So I, I cook lambs in different ways. I, I teach how to cook lamb and I, I love cooking lamb, but obviously it's all, it's all depends on the season and the, the time of day. But lamb is probably one of my favorite foods. What's, sort of an unusual treat you've discovered with all of this travel and and cooking something unusual perhaps, that you enjoy or found? Oh, that's a good question. What came to mind, which is a very bizarre thing to come to mind, was what. People use to tenderize meat. And it sounds like a silly thing, but like, I just found this to be fascinating.

How harsh of an acid do you use? Do you go like, you know, the lime, lemon vinegar part of the spectrum? Or do you go like the yogurt or like the nuts part? Or do you use, you know, something like tomatoes and onions and just blend an onion and like that idea of like. How gentle or how un gentle you are with the meat is something that's just so fascinating to me. And then you throw on top of that the variable of time because if you have time then you can really use some amazing tenderizer of meats. But if you're like in a rush and you know, we in the Western society like to be quick and fast, then you end up going more harsher and, and you lose a lot of taste. So yeah, that's what comes to mind. I'm curious if the food and restaurant business was your motivation for pursuing an MBA? Actually, I wish I had pursued it earlier on. I've never been a person that I

knew that I was not running the best businesses mostly because my financial advisor told me so, however, the reason I ended up pursuing it. It's one of those things that you, I've never thought business was my thing. There's this joint sponsorship between multiple societies and the a CS with the Brandeis School of Public Health and Business. So it's like they sponsor usually 40 surgeons a year to go to Boston and spend a week and doing kind of like a crash course on business topics. And the A-H-P-B-A, which is our society, and a CS, it's usually a CS in another society. I know that SAGES does it and A-S-M-B-S does it, and colorectal society do do it anyway, so they sponsored me to go and I went there and I was just like flabbergasted in how like the, the field of business and the field of leadership. Has so many answers to so many of the questions that we have in medicine and in healthcare and in surgical education,

or at least they allow you to look at it in a different way. I, when I did that week, I was like, yeah, I need to learn more, and so I signed up for the full MBA. You mentioned that there's answers in business. What, what are some of those questions that can be answered with your business degree? If we look at, for example, the idea of change and change management, you know, we all know that change is difficult in, in surgical education. Whether you're trying to implement nested EPAs or EPAs, or whether you're trying to teach people how to be more competency based or whatever, whatever the point is, like how do we actually, you know, enact this change and how do we actually approach it? And honestly, like, I don't think I ever learned that. Despite the fact that I went through a master's in education and a medical degree and all that. But you look at this world of business and you realize there is like so much, not only theory, but data behind that field, and then you realize that you've just been stumbling on

things. You know, even a simple thing like the idea of, you know, leadership and how to become a, a chief or a chair of a or a head of a division or how to even sponsor somebody or, you know, what is, what is the importance of informal influence versus formal influence? It sounds like terminology that's a little bit like. Kind of out there in space, but it really does take a lot of what happens to us and puts it in perspective. And you're like, this is all science. You know, we all get surprised, but it's all science. You know, this idea of the fact that informal influence, which means networking and connections and getting to know one another and trusting one another is actually more powerful than actually having a title, like being a chief or a chair or a program director. That happens every day, but we just, we don't put a word onto it and we don't understand the science behind it. And I feel like those things, when you learn in an MBA, you, you realize now I can actually do it intentionally rather than like cross the road. And eventually you won't get by, hit by a car, you know, like the passive learning process.

It is great to hear you reflect on how all of your different creative and business ventures have congealed in this way. That is very impactful in medicine, and I'm hearing a lot about harmony between all of these passions and. All the connections that you have gotten and been able to feed because of your various projects, what can our listeners take away from everything that you've done? And specifically, how would you advise trainees and medical students who are considering a career in surgery, but who might hesitate about choosing surgery out of fear that it would become their whole life? I am gonna borrow some things from a program that Jeremy Dr. Lipman is very involved in which is a program that runs for medical students in the American College of Surgeons. And that is that surgery you see on TV and the surgery you hear about. 10 years ago, or even five years ago, it has changed dramatically. And I'm not saying this to say that it was bad or good, it just

changed because the world has changed and now there's a program, the different faces of surgery. And I truly, truly love that title. And the reason why is because surgeons are so different. It's, it's almost like saying like, there's a tree in my backyard. You don't know what I'm talking about. Maybe it's a little tiny little herb or a bush or a big tree, or. Redwood, you have no idea. And that's the problem with us saying the word surgery 'cause it means nothing as a one word because there is such different facets and there is something in it for everyone. Whether you like to work, shift work or whether you like to never work at night or whether you like to work elective stuff or whether you wanna be completely outpatient or completely inpatient. There is just such an incredible field and it used never used to be like that. And I think that is probably one of the most beautiful things that's happened to our. And realizing that there is so much beauty in the fact that you're able to connect with patients in such a human way, that you're able

to get to know somebody and then they would give you permission to actually be incredible invasive in them to actually cut them. I mean, like it's unfathomable when you say it that way, but it's such an incredible, incredible privilege and honor and it's basically given me the ability to actually be incredibly. Close with my patients, to live with my patients, to cry with my patients, to see some of them live and thrive and to see some of them die and to have, make sure that they die in peace. And that's just been just a true honor. And if I had three lifetimes, I would do it for three times. And then it also has allowed me to be able to take care of patients all around the world. That combination with education, you're just never gonna get bored for the rest of your life. And then in terms of what connects all of these things, I still feel like, you know, a lot of times we get so busy in what we do in medicine that we don't stop to like, you know, so to speak, smell the roses. And I think just taking a moment to actually realize that what we are doing, like we are literally

taking care of. Patients who are living and dying because of things that we're doing. We are literally cutting human beings. I mean, it's, that doesn't humble you. I don't know what does, and I feel like the variables that exist in that process is, is so intellectually stimulating. It's again, the same thing with taking a picture underwater. I mean, there's so many variables, like where is the light coming from? How much oxygen do I have? How much movement, how much drift is there underwater? How big is this? This creature? Like is it gonna move or not? What do I wanna focus on? Do I want to focus on the eye or in the body? And how much does it see me as a threat? And if I try to move closer for a better picture, it's gonna run away. And it's the same thing, taking care of patients. There's so many variables. Do they even want to live longer? Maybe the main thing that they really want, it's just to be at peace and be with their family. And I think it just makes you feel like in the end, you're just a student of nature and you're just trying to do your best. Annan can't thank you enough for all your time and sharing so much of yourself

with us. Really appreciate it. Can't wait to see your next adventure, and we'll all sign up for your cooking school and it's, you're too kind.