Episode 32: Sunday January 31

Drs. Sam Jejurikar @samjejurikar, Salvatore Pacella @sandiegoplasticsurgeon, and Sam Rhee present the last part of our special solo multi-part interview. Drs. Sam Jejurikar, Salvatore Pacella, and Sam Rhee welcome special guest Dr. Stephanie Cohen MD.

In Part 3 of the podcast, Dr. Rhee talks to Dr. Cohen about her experiences with international surgical trips and starting ISMS Operation Kids. If you are interested service for others, this episode is a MUST WATCH Sunday 01/31 at 11 AM EST (8A PST)⁠

Dr. Cohen is a Board Certified Plastic Surgeon by the American Board of Plastic Surgery located in Maywood, NJ. Dr. Cohen completed plastic surgery training at the New York Hospital/Cornell Medical Center and the Memorial Sloan Kettering Cancer Center in New York City. There, Dr. Cohen developed a special interest and skill in the area of reconstructive surgery, especially concentrated on the breast. Her dedication to the craft has earned her the nickname of the “breast whisperer” from her fellow colleagues and patients.

A long time dream of Dr. Cohen’s was to travel to developing countries and provide expert surgical care to those who have no other possible access to medical care. This became a reality in 2007 when she became a founding member and Vice President of ISMS Operation Kids.

#podcast #plasticsurgery #cosmeticsurgery #rheeplasticsurgery #boardcertified #plasticsurgeon #beauty #bergencosmetic #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic #femaleplasticsurgeon #girlbosslife #girlbosses

Full Transcript (download PDF here)
2021.01.31 S02E03 TRANSCRIPT
Dr. Sam Rhee: [00:00:00] Get me to where you started on surgical service. How did you get involved and decide? This is something I want to do for the service of others is go and do surgical cases. 
Dr. Stephanie Cohen: [00:00:13] So that was an interesting story. This was, this is in the making about 13, 14 years now. So obviously it was before 2007. It says on my website our first trip was to Morocco.
But how it all started was a funny story. Very good friend of mine who was Colleen. She was Colleen Hakimian at the time. She's calling Brennan now. She was a pediatric oncology nurse at Hackensack hospital. Good friend of mine and my other friend, Kathy O'Hara and we used to be a trauma surgeon at Hackensack, but now is out in long Island.
 Colleen was a question like myself. We both rode horses and she fell off and broke her Coxix and so while we were coming, going into the hospital and visiting her and making fun of her for breaking her, but we were keeping her, we were trying to keep her spirits up and we were all in the room with her.
And a bunch of us started saying, what I've always wanted to do. I was about. Five to seven years in my practice always wanted  to go on a mission trip. And she said, Oh my God, that's what I've always wanted to do. And everyone in the room said, Oh my God, that's what I've wanted to do.
So we started thinking about it and she's very good at. At organizing, in fact, she's gone back and gotten her degree in public medicine. And she's going to, she's going to go into a short do great things with with public service and international medicine. But but when we started this, we we met some people.
Who ran an organization out in long Island called operation international. And they had been running missions for many years and they were interested in branching out and and maybe getting an a second team together. To to do the same thing. So we sat down with them and, obviously there's a lot involved.
Our first mission was like on a wing and a prayer. We we literally packed everything up in my basement the night before, till three o'clock in the morning.  We took a lot of, we gathered a lot of expired equipment when that was not. Problematic to bring that to other countries.
It is now. But so many things in the United States expire that don't need to expire, tongue depressors and gauze pads. And you can't you can't bring those anymore because the other countries have all kind of caught on to the fact that an expiration date is supposed to mean something.
And they all checked now, but back then, we would just, we were literally just going into all the operating rooms and say, give us all the stuff you don't want. And I've thrown it together into suitcases. We recruited Dr. Victor Valdez. I don't know if you ever knew him. He was a pediatric surgeon at Hackensack hospital and we had a very wonderful pediatric orthopedic surgeon named Jim Tucci who was up in Westchester.
And it was three of us. And then we. We amassed a whole team, mostly from Hackensack. It was really just people. We knew anesthesiologists. We knew, Hey, you want to go on a mission trip. And and we did it, we went to this tiny little clinic in, in Morocco. And I would be willing to say that it was a bunch of  really smart, motivated people that if not for that.
We would've made a big mess of it. And and these people, the nurses, the S the O R nurses, the recovery room nurses the pediatricians that we brought with us they were just a bunch of incredibly dedicated really intelligent people. And we made it work. We could set this thing up in a tent if we needed to.
And we had supportable, anesthesia machines some spectacular pediatric anesthesiologists who could, Put these tiny little, two pound kids to sleep with without any pediatric care leading up to that point, get them all through, get them out alive. And and we made it through the first mission.
And then when we got back after the first mission we took care of, I think 85, we did 85 surgeries, that first mission yeah. And all orthopedic surgeon plastic surgery, and and pediatric surgery. We did, and then we had someone who went and did site visits every year, Colleen herself would go and do site visits, visit a place, get the organization we would fundraise.
And it's basically just literally a homegrown group where we do all our own fundraising. We do the fundraiser. I live on a horse farm. Don't know if I mentioned that before, but we do all of our fundraising on our horse farm. And in October, usually when we're not having a pandemic. And we get the money from our yearly fundraiser and we put that into wherever we're going next.
And the group has certainly grown in leaps and bounds. We have gotten smarter it is much more difficult to do to do pediatric surgery or to do general surgery. We are a pediatric team exclusively, so we really only do children. We bring pediatricians and pediatric anesthesiologists.  But we have discovered over time that doing ENT can be fraught with problems when you're in some of these third world places where they don't have ventilators if you have airway issues we've done ENT and then really not been happy that our out, we've never had a death fortunately, but we don't ever want to have one.
And we w we found that ENT was very scary to do even more so than doing cleft palates for airway issues, for sure. And some of the general surgery we've taken general surgery a few times and done pediatric surgery.  Think from the standpoint of really being able to help people and have them be able to recover.
Have the children be able to recover in the time that you're there? It's much harder to do general surgery. It's much. I think it's better for a pediatric surgeon to go to a university hospital and recruit in PA patients and work with the doctors that are there, it's much easier for orthopedics and for plastics, for us to come in, do the job.
Get them recovered and leave and and have much less skilled up, we'll always have we'll always have someone in country that can change change casting and, follow up for complex surgical complications and things like that. But so we've Mo mostly narrowed it down to being plastic surgery  and pediatric orthopedic surgery for the last several years 
Dr. Sam Rhee: [00:06:01] How did you identify these locations? So you've been to Ghana or Kenya, Egypt, Peru. Morocco. You've been everywhere. 
Dr. Stephanie Cohen: [00:06:08] Yeah. Jamaica Guatemala. Yeah, it goes Egypt was a really interesting trip. We were the only Americans, the people in that area had ever. Seen or imagined all the women had burkas. And it was there was a truck a pickup truck behind us with filled with men with AR fifteens.
That's their job was to protect us when we were driving from the hotel to the hospital. Every day, we worked at a university hospital in Benham, Egypt. It was. It was unbelievable. They cried when we left. They, they had, no, they had no idea what I was a female surgeon, that was like so bizarre.
And one of our, one of our greatest pictures from all of our mission trips is, no, none of the male surgeons at the hospital would talk to me until we get there on, usually on a Saturday, we start operating on a Monday. And the joke is that nobody would talk to me until Wednesday. And then S.
Little by little, they were seeing the patients come out of the operating room and seeing what they look like, and that they were getting fixed.  And one by one, they started to come into the operating room and look over my shoulder. And there's a picture of me in the middle of all these men.
There's a little tiny baby head  and I'm I'm doing, and I forget whether it was a cleft palate or a cleft lip, or it was a redo something, and there are about thereabout. 14 male surgeons. None of whom are wearing gowns or gloves or anything. They're all standing like on top of me, all looking down at the patient at what I'm doing.
And then just me, operating and it's a great picture because they like over, they overcame, they're. They're ignorance, and they and they really were interested and they really wanted to learn. And it was really fascinating. It was really fascinating.
I,  think the best thing I did in Egypt it was a little bit maybe too technical, but I think the best thing I did in Egypt was teach those guys not to operate on kids because they would see it. A problem and they would fix it, and then the kid would come back with a fistula in his cleft palate, they'd fix it when the kid was this big.
And then they'd see a fistula and a palate and they'd go, okay. The book says, this is how you close a fistula and then they'd wait about a week and then they'd fixed. Then they try to fix the fistula. So I was seeing kids. Yeah. I was seeing kids who were like, four or five months old who had four or five, six operations already.
Fix the damage that had been done on the first time. So I was saying, don't operate, don't know what you gotta do is don't operate on them and they'd say how old do they need to be an idea? They need to be this tall. When they're this tall, then you can operate on them again.  One of the things I did in Egypt was mostly teach them that.
When not to operate that's that was a really, that was a really important thing there. But how we find the places to go, really our our organizer Colleen gets a place in mind, word of mouth through the other organization. And it goes and does Goes and does a visit there.
She's an amazing person. And she gets to know literally the board of health and the minister of health and the vice president of every country. And everywhere we go she meets everybody and and gets us an area to go to. We have been trying since we started in addition to going a different place every year to start a sustainable project.
So we first tried in Kenya, we were in a little tiny place called Kakamega Kenya, which is in the Western side of Kenya, Uganda side. And we had gone there twice in a row. And by the time we got there for the second time, things are so malleable in those places.  You start a program, you start a thing.
And all the people who were at the hospital, you go back the next year and all those people are gone,  and nobody remembers the thing or that you were going to do. Do something. But we've actually found this site in Ghana where the the administrator of the hospital is a very well-educated guy who grew up in Ghana and wanted to help.
And, went to the, one of the most rural places he could find. And whereas he could be administrative a half of a hospital, certainly in a cross and be making a Rhee a regular salary. He chose to stay in this tiny little town in, in, in Ghana. And  Because of him and our organizer, Colleen Brennan, we've been w donating fitting operating rooms and donating ambulance baby ambulance and all kinds of equipment for that hospital, so that when we go back, we try to do as much teaching as we can and try to.
Try to elevate the hospital as, as much as we can. We do a lot of teaching. The recovery nurses, love doing a lot of teaching with the with the nurses that are there. It is interesting. There's no plastic surgeons, there's no plastic surgeons in God. I'm sure if you live in a CRI and you want to get a facelift, you could probably do that.
But but out in the middle of nowhere, I, a flight and seven hour drive away. There's no there's no plastic surgeon. It's hard to do teaching in a place where there. There are no no nobody's trained in, in, in that manner of speaking. There's a lot of I've found in a lot of these different countries and all different continents that there's a lot of general surgeon surgery trained in country doctors who are wonderful.
And they all love orthopedic surgery. They're all really interested in learning how to do orthopedic surgery and not too many of them are interested in learning how to fix burns or learning how to fix clubs. We wanted to, it is, we did want to differentiate from like operation smile and, those kinds of things, smile, train in that we didn't want it.
Go to a place and just do cliffs, while we wanted it originally, we started and we had the pediatric surgeon and the ENT and everybody, we wanted to try to go to a place and take care of much as much, surgical issues and children as we possibly could. And again, that, that sort of did get more narrow down just because of the logistics and the realities of taking care of those kinds of things.
But but we, we. We still wanted to try to do as many different things as possible, which is why, I probably do more burns and clefts actually, when we go to those areas, just so many burn 
injuries, 
there's just so many burdens. It's really, I, most lay people say, why are there so many burns?
I say if you really think about it,  you'll figure it out. These people, they do everything with fire. They light electricity, heat, warmth. Burning garbage. Everything they do is with fire. There's a lot of kids is not a lot of supervision. There's no, there's no real, super safe fireplaces.
Everything's just out in the open. So the burns are everywhere. And I learned a long time ago, not to do any acute burns surgery. We don't do any acute burn surgery cause I'm not changing the course of anybody's life. But it's the, it's a, it's the. I,  it's the long-term scar contracture surgery where I can, change a lot of things.
I do a lot of latissimus flaps for burn scar contractures, believe it or not. 
Dr. Sam Rhee: [00:12:22] Oh, really? Oh, for the axillary burn contractures. 
Dr. Stephanie Cohen: [00:12:25] Yes. We actually burn contractures. Yeah. And if scapular, flaps or fascial flaps, aren't going to be enough. I I have done several Latisha, miss labs on four or five, six, seven, eight year olds.
Yeah. Which is which is a whole. Yeah. And, you put a muscle flap on a contracture and then you just, you discharge it. Yeah. 
They're fixed. You don't have to worry about physical therapy or something like that. Yeah. 
If I could, if I can, when I'm triaging those cases, if I can find, I'll though they all get first, the patients, I can do a muscle flap on, they all go first.
Cause those are the things that, like I said, you can fix it. They could go home right 
Dr. Sam Rhee: [00:13:00] now. I always found that as much as the, these missions help kids, I think their impact also goes way beyond that in the sense. The surgeons that you impact and not just in terms of techniques or learning when to operate or not operate, but also culturally they're seeing people that are women and that are operating that's a new concept for them.
Some concepts are. Not that we're trying to impose culture, our cultural values, but it's just a different sense of cultural values. And they're also, you're imparting, they're imparting onto us when you travel. I would assume you've learned quite a bit that broadens your mind too, about what medicine is or what life is.
Dr. Stephanie Cohen: [00:13:42] Oh, I think it's absolutely invaluable. And I think if we could take every teenage kid in the United States and send them on a mission trip , I would do that because it is absolutely the best thing for especially I think kids who grow up in this country and I've never seen just us.
Seeing what they don't have, a really good example from the very first mission trip we did in Morocco. Again, it was this little tiny clinic we come in. We,  take over we don't ask anybody anything. Cause we're like, okay, we're on a mission. We're doing this pushed everybody out of the way we do, and we do this and I'm over in the corner.
There was which. By the way we learned a lot about that. Like talk to people, get their names, don't push them out of the way. We've learned a lot since our first we were overly excited on our first mission. But on that mission there was this wonderful guy, his general surgeon they basically in Morocco, they train you and then they if you want to work for the government, they like give you a clinic and they give you like $8 and they say, do what you can do.
And this guy was wonderful guy trying to learn everything. He couldn't just do what he could do, but he, he had this little. Makeshift emergency room going. And this little girl came in and she had this, this was like an eight year old girl. She had this horrible laceration on her foot and he was, we were doing our thing and he was going to to put to close up this laceration of course they don't have any lighter cane.
So he's gonna Sue, it was going to debris, this laceration and close it, and it was big, it was a few centimeters long on a little foot and he was going to do it without any lighter cane. And my nurses from though, or they came running over to me and they were like, he's in this little section and the kid is wide awake and he's not usually lying to Kate.
And I said he doesn't have any lighter cane. And they were like but we have lidacain, we can give it to him. So I went over to him and I offered him, we can, I can numb that foot up for you. And you look at, and look at me kinda weird. And we're fine. We're fine.
The kid's screaming her head off, and he finishes and, I realized later on after. After having experienced that whole experience and being there and being immersed in it the whole time. Like he's not going to have a lot of came tomorrow after I leave. And he didn't have lidacain yesterday before I came.
And me coming in  and especially, The the it was really upsetting to the nurses that had gone and seen him doing it. They were really upset, they came to me and then we have to stop him. We have to stop him from doing this, he store during this kid.
And I said,  it's how they do it. And they don't have any other choices and they're not doing it because they want to torture the kid. They're doing it because it's the only way they. They can do it. And so whether we give this kid lie to cane or,  tomorrow he's not going to have any more lidacain.
 That was a really interesting thing to me. Cause there's not a place in the United States. You could go where they wouldn't have lighter cane to sew up laceration. If they didn't have it, they get it. What do you mean? You don't have it? That's not acceptable, you'd go get it somewhere.
Nobody would ever even conceive of suturing up a kid without any lighter cane. Yeah. I'm not going 
to comment on us drugstore dishes, but just keep going,
but you're right. You're right. You can't impose your values when, and you can't help them unless you help them. The way they 
live. Yes, absolutely. So you have to really integrate that and you have to understand what they're doing. I had another great story of a kid who had a a radial claw hand.
And I actually I actually did a policy.  on that kid? Yeah, it was after my partner, Janet sent me a paper on how to do it by, by by text message, I think. But but anyway the kid had a syndactyly on the other hand And his right hand was a syndactyly if I remember correctly and his left hand was this really, really badly deformed hand and, I'm all getting excited and getting ready to do this really interesting case.
And The ma I'm getting consent from the mother, and the consents are really, they're really touched. They don't understand consent, you, you start to try to explain to them that there's complications that might happen. And they look at you can you fix this? And you're like, yeah, sure.
And they're like, okay, so I can fix it. Like I don't understand. And that's a whole other topic. It's a whole other really interesting topic. But I started consenting her for the left hand and she kept pointing to the right hand. . This hand, I was like, I don't understand this hand, is not even functional.
This is a perfectly functioning hand. That kid could be a surgeon with that. Syndactyly his hand was functioning. Totally fine. And we kept going back and forth and kept going back and forth. And I learned later, I learned through that whole process that apparently in this area, this tribal area, the lesson.
Hand is the dirty hand and right hand. And the right hand is a good hand. And she was so concerned that kid was not going to be able to get a good job and a good life and go to school and all that, because it was the right hand that needed to be perfect and has really interesting to me, cause that was nothing that we would ever.
I never even think of it. And yet, and you run into those things all the time, where you have to really go with an open mind and really, pay attention to people when they're talking to you because it's so interesting. We had a pregnant teenager with with a tumor on her jaw when we had the head neck surgeon and we had a big team meeting because Why we tested her.
I don't know, next time we learned a lesson not to test, but we did a pregnancy test on her and it was positive.  Honestly to God, the best thing that could happen to that kid was we hadn't tested her. W we really came to the conclusion later on that had we not tested her, it, it would have been the best thing for all involved, but we did.
And of course her family didn't know. You know that she was sexually active. And the, and we didn't want to do surgery because she was in her first trimester. Obviously she wasn't showing. And we kept trying to explain that anesthesia is  very unsafe and they were absolutely insane.
They didn't understand absolutely insistent that we do the surgery. And we had this big team meeting and even members of the team were on absolute opposite sides of this. Issue. And we ended up not doing it because my, my first thing is to do no harm.  We we ended up  not doing it was not, it was a benign tumor, not a malignant tumor.
And we in the end we decided not to do it. 
Dr. Sam Rhee: [00:19:31] Oh, that's so interesting. Yeah, that, that reflects that just. Yeah, that reflects about all the cultural and differences and just one situation that, and I could totally see how you could legitimately be on one side or the other side and have a valid argument about what you should do in that situation.
Dr. Stephanie Cohen: [00:19:48] Absolutely. Absolutely. There's a picture of me standing in Kenya in the clinic and the two hospital administrators had come coming had come down to talk to me. They wanted me to. Take this huge cystic hygroma out of this kid. We didn't have  our head neck surgeon anymore. This, six month old kid with this giant cystic I Gramma.
And and I, this is the place where they don't have a ventilator. So if the kid had an airway problem,  and it was like two days before we were set to leave. And if the kid had an airway problem, I was just like, we're going to kill this kid. They didn't care that we were going to kill the kid.
They just wanted to see how it was done. They'd never seen it before. And so there's a photograph of me and another great picture. There's a photograph of me standing with my arms crossed like this and. And then these two guys are like standing over me and they're pointing at me. And there are hospital administrators from, Kakamega Kenya and they absolutely do not understand what my resistance to doing this surgery was because they'd never seen it and they wanted to see it done.
And they wanted to see how it could be done. And I was insistent that the kid was too small and the cystic hygroma too big and we didn't have any way to support the kids airway after we, and our anesthesia machines walked out the door. And we were at an impasse and I had just, I walked away of course.
And I said you can't make me do it. So I'm leaving. And and obviously I didn't do it, but they were very upset with me. 
Dr. Sam Rhee: [00:21:07] It's the right thing to do for sure. So at this point, Both of us, I would say, have finished the first nine holes of our career. Yes, for sure. And we're probably somewhere on the back nine.
Dr. Stephanie Cohen: [00:21:20] Yeah, absolutely. And when you look on the back three or four, 
Dr. Sam Rhee: [00:21:25] I wanted to give you plenty of a latitude in case you wanted to say you were super young and yeah. I think the one thing I have seen with surgeons who are more established is they figure out what they want. They figure out what they want to do, and they have a better sense of their priorities.
Time is always more precious. We realize that. So what is it that you now think is important for you in the future to focus on, to do, to accomplish whatever it is that you think you have. 
Dr. Stephanie Cohen: [00:21:59] Always said, if I weren't, if I won the lottery tomorrow and if the work anymore, I would stop doing surgery at Hackensack hospital and just go on mission trips all the time, because  that's where my heart is.
 My wonderful Anesthesiologist PJ Mandalay is, comes on all the mission trips with me, and she's a pediatric anesthesiologist from Hackensack and she does all these little tiny babies when I'm putting them to sleep. And if the two of us could just team up and just do that all day long that's what we would do.
But I, but obviously that's not going to happen. And gotta keep working for a little bit, for a little while longer. It's an interesting question that you asked this now because obviously. W Rick and I have just recently taken on a fourth partner for our practice and obviously as things go, that, that means that we're, moving towards the direction where Janet and Paul, our partners start doing more of the heavy lifting and Rick and I started doing less of the heavy lifting in the practice.
Paul is very it. Paul throttle. He is our newest partner who is very interested in doing breast reconstruction. He did a fellowship in microsurgical, breast reconstruction. So obviously that was by design because I am headed in that direction where he will start doing more rather than less the heart, the hard thing for me moving forward in my practice is that,  there's sort of two parts of my practice.
There's the breast reconstruction and there's everything else. And everything else mostly falls into, cosmetic  or breast reduction,  insurance-based breast reduction, but pretty much everything else in my practice is cosmetic. I can't do cosmetic surgery all day long.
I'll shoot myself.  I, there are really fun things about cosmetic surgery. There are things I love doing. I love doing eyelid surgery. Breast reduction certainly make me happy. I always muse that if I went blind, what surgery could I still do? And I think it would be breast reduction but my my quandary right now  and Rick and I, spend a fair time, amount of time talking about like how we're going to slow down and where we're going to go and what we're going to do.
And  I'm ready not to work as much.  I'm I'm at that point in my career, my kids are all gone. I'm an empty nester. Without COVID I was an empty-nester, but my youngest is 24 and works in the city. And  am definitely at that place in my life where I could certainly see work in a few days a week.
I can't ever see, not working, I can't ever see going and. Riding my horse or playing golf or doing whatever I couldn't do that I'd have to, I'd have to continue working. But so for the overall plan for me, that really means doing a lot less breast reconstruction because breast reconstruction is the thing in my practice is like doing trauma surgery.
Like I never know when it's going to come up. And my schedule is not really my own as far as that goes. So I'm stuck with whatever the breast surgeons do, the surgery. And I have to be there the minute they're finished because there's a patient on the table, that's asleep with an open wound.
And so my life has been. Has really been circulating around that fact for long, for 22 years that if I'm doing something else in my office and there are four patients waiting for me, but they call me and tell me that Dr. Warden finished her surgery 45 minutes earlier than I thought she was going to.
I just got to drop everything and be there. There's a lot of disgruntled patients in my office. My staff is a wonderful staff because they deal with that literally every day. Disgruntled patients having to be shifted around or moved around because the mastectomy always takes longer or shorter than we thought it was going to.
And  so obviously in order to move to that kind of next phase, I'm going to have to do less breast reconstruction. So bringing Paul in was that was the number one phase of that. And then actually doing less as the other is the other phase of that. That's hard for me to do because I really, I enjoy.
Doing that surgery. And I enjoy taking care. I guess it's the patients that I enjoy the most and they get we get to know each other very well through the whole process because breast reconstruction is really quite a journey.  And we and there's a lot of sort of emotional impact on people and a lot, you get very entrenched in a lot of people's lives and that part will be much.
That'll be hard for me to give that up. I don't know that I'll ever give it up a hundred percent, but I, that part would be very hard for me to give up.  So I'm in a kind of balancing act at this point, I'm struggling. I don't, I know it's gonna go and Paul's going to do more and more of it and that's going to be the transition, but I don't know when that's going to be or how it's going to work yet.
I think the COVID. Shut down, gave everyone a preview of what it might be like. You can add this stress or not work so much. And I knew some surgeons was that actually enjoyed it quite a bit. They said, wow, I've been running the hamster wheel so hard. And now I was forced to sorta not. And this gave me and some people then it gave them some real fear or thought, what do I do once I actually get to that point?
Did you feel that way when you were a. 
COVID was really interesting. I did my husband was still working more than ever because people needed a psychiatrist more than ever. And so he was working from home and I,  our practice came to a grinding halt except for the occasional mastectomy that was still, for cancer that was still going on.
And and the, for the first time in my life,  as I'm sure you're aware for the first time in my life,  for a couple of months, there was. Date day after day where I was at home. That's never happened. And and it was really interesting in the beginning because in the beginning I felt very much not that I needed to work or that I was missing out on You know that I can't sit home, that I can't get out of my head.
Cause I got lots of stuff I can do at home. Like I said, I live on a horse farm. I ha I have hiking right behind my house. I'm an avid hiker. I've got dogs.  Have a lot. I paint, I draw, I do, I've got lots of, I play the guitar. I have lots of things I can do when I'm home. So I don't have any trouble taking up my time.
Like my father from my father's generation had. He could, he had nothing to do. And when he were done nothing, all he did was work his whole life and he didn't have any other interests. And I kept saying, don't worry about me. I got lots to do. But I did immediately after we came home and I was not doing anything in the world was descending into pandemic.
Feel very Responsible for using my talents in a way that not many people were able to. And so I did go back to work at Hackensack on one of the COVID floors. Yeah, I did for for it wasn't for a long time. It was for a few weeks right in the middle when things were at their worst.
And I became a hospitalist while I was working three days a week on the For Strawbridge and taking care of COVID patients.  That was born out of the just feeling really restless at home that I can help. And and the hospital needs help. And I may not know anything about pulmonology, but I can learn I'm a quick study.
And and I did, I learned a lot about pulmonology. I know a lot more about pulmonology now than I did when I started that. And and so I did my partner, Rick did Our partner, Janet was pregnant at the time. So we left her home in the office and sold her to see any of our patients. And the two of us went into the hospital and we worked.
And then when they didn't, then when things were just  chilling down and they didn't really need us anymore.  We stopped doing that and then I stayed home. So more to your point. Once I started doing that I think you're right. I think I really got to have a visual on what it would be like to actually stay home and not get up and go to work every day. And I liked it.
I think I S I suspect that would get old, I suspect that would get old. I suspect I've always had this feeling that had been chasing like time off my whole life. You know what I mean? And what would it, I think once you got over that hump once you feel like, okay, this is all there is time off.
I think that I think that would get old pretty quick, but but a short amount of time, I think it was like a nice sort of reset. It was kinda like, okay, this is where I'm at. And these are the things I like to do. And these are the people I like to talk to. And those are the people I don't like to talk to.
And those things make a difference. And that, that was, it was it was a very, interesting time in, in our, all of our lives. I'm sure. For kind of a, we're  reassessing all that kind of stuff. 
Dr. Sam Rhee: [00:29:43] What do you think about the future of plastic surgery now that you look at it?
Is it going to get better for plastic surgeons worse? The same? Is it bright, not bright? 
Dr. Stephanie Cohen: [00:29:53] I've already said a couple of times on this podcast that I miss feeling like a real doctor when I go on my mission trips. And so I, I, one of my favorite things about. Again, being on a mission trip  is like thinking on my feet, being someone who goes, sees a problem, figures out how to make it work and fit and tries to fix it, and it's not always successful and it's not always perfect. But yeah. The truck in the truck, the trying is the, is what you're doing. You're trying. And that gets so bastardized here in the United States with all the legal implications in the lawyers and writing down everything you thought and everything you think they want to hear and everything  you even, even everything you didn't think, you write down everything and make sure your ass is covered.
You make sure that the patient understands everything that maybe they don't want to understand. There's so much. Nowadays with that, with the whole liability issue I don't see that getting better anytime soon. Unfortunately, it's been building and building for a long time.
It's one of those things you don't see going backwards. I think the younger generation are gonna. Work differently with it though, like a, it's like the same thing with the computerized, with the computerization. Believe it or not, Rick and I still have paper charts in our office.
Oh my God. Yes. I, where as I'm a fairly computer savvy person, in my house, they all come to me to fix a computer.  We have just. Really been lows to go through the hassle of it because it is just so easy to write a note in the chart. It's just so simple. And and whereas I see my junior partners, and they've got Epic and they can get on and off and on and off and do whatever it is that they need to do.
And they're much more adept at it. And obviously we'll move into that next phase where it's easier for them. And they don't mind it, but it is always an extra step away from the patient. All the liability and all the computer stuff and all that, you're taking more and more steps further and further away.
You're not looking at the patient when you're talking to them. You're looking at a computer screen when you're talking to them to get further and further away, it's getting further and further from that, that that old fashion idea of the white coated doctor going into a room and, feeling around and poking around and talking to a patient and I think one thing that Hearkening back to the idea of like, how come my practice and Rick's practice has got along so many years and there's not a lot of issues.
I think one of our main things, when we take care of patients is, like listening to patients, I get so many patients who come and I, they want a breast reduction. They've been to four different consults and they say, Oh my God, you're the first person who actually asked me, like what it is that I want.
You know what I mean? And I'm just talking to people like they're people, is a, is such an important thing for physicians to do. And I think we're losing that. We're losing it because we're getting so many barriers between us and the patients. And that's too bad.
It's not all horrible though. I'm not like a super pessimist, I think again, I think that my partners who are wonderful, caring, empathetic people and wonderful physicians, I think that they. Care about that stuff too. I don't think that it has made them uncaring doctors.
And I think they'll learn how to deal with that other stuff, probably better than I did because it was new when I did it. And we're just on that cusp of, I think things changing very dramatically. And so it's always hardest for the people who were in the middle of it and remember the way it will used to be and, it's not a change for you if it was that, if it's been that way since you started.
Yeah. I'm not super pessimistic. I think they'll figure it out, but I hear 
Dr. Sam Rhee: [00:33:20] echoes of Lloyd Hoffman in a, the personal care and connection with patients. Yeah. I hear that in you. I hear yeah. Yeah. The fact that things are going to change and but trying to maintain that is, is hard. I just went through all the, I just revamped all the paperwork that patients have to sign when they come in for a new, like a new patient.
It's amazing papers 
Dr. Stephanie Cohen: [00:33:44] that they have to 
Dr. Sam Rhee: [00:33:44] sign that they it's absolutely crazy. It is. I think that you're right, the new generation will be much more facile about maneuvering around those issues. And I think patients expect it. I will tell you that when I try calling patients, I never get them, but when I text them, I get them.
Dr. Stephanie Cohen: [00:34:04] Certainly I'm a big texter. I love texting. I'm all about the texting. 
Dr. Sam Rhee: [00:34:09] I think the means of communication, the manner in which we do it. You're right. How do we maintain connections with our patients. 
Dr. Stephanie Cohen: [00:34:16] I think that's super important. What, I mentioned a little bit of a segue, but along the same lines where you're talking about the future of plastic surgery, I do worry it, with the training of medical students and of residents that you know when back when we did it  the idea was he went to general surgery, then you decided what you wanted to do.
You went to plastic surgery. I,  there are definitely some advantages having integrated programs where people are getting a much broader scope of other other subjects like orthopedic surgery and had neck surgery. And there's. Spending they're getting into plastic surgery earlier  than they were before.
It, wasn't just all condensed into this last two or three years. But my concern about the way that training is going especially now we're seeing the new Hackensack medical school  and the way that they're getting their surgical training in the student years.
 They're not they're seeing so little. Actual plastic surgery. And when, plastic surgery, reconstructive complex surgery, I learned about plastic surgery through learning about the complex reconstructive stuff. And everybody knew that when you became a cosmetic surgery, it was after years of having been a reconstructive surgeon, and then you sorta skipped into retirement and started doing, eyelids and facelifts and things like that. And I'll never forget the time that a third year I asked a third year medical student what he wanted to do. And he said he wanted to be a cosmetic surgeon, wanted to inject Botox for the rest of his life.
And I was just like, I don't know how to respond to that. How'd you go to medical school? Like 
Dr. Sam Rhee: [00:35:45] I agree. A thousand percent, I think There are a lot of people that think they'll just come out and have a Tik TOK account and they're going to do just fine opening up a cosmetic surgery practice.
And it was funny. I was just talking, we just did a, we talked about buccal fat excision on an episode with my two co former co-residents. And we talked about how all of us learned, not. Two F around with Stenson's duct, because all of us had seen some slash to the face where we had, yeah. Find it. We add a tie, a silastic tube or whatever, and, or fix it in some way.
And once the anatomy of the face, it's a very simple operation, the buccal fat excision, but it's, if you don't have that sort of experience at extra. Depth of knowledge or layer of knowledge. Yes. Makes all the difference in the world. And that's for a simple operation. Once you start talking about real stuff now, all the things you learned.
As a reconstructive surgeon, you're learning by mistake as a cosmetic surgeon. 
Dr. Stephanie Cohen: [00:36:45] Yes. Yes. Yes. And, think about just the world in general when we were in school  and when we were in our early residency or in medical school w what did you know about plastic surgery?
What, back in the eighties or the nineties, or the early two thousands, like it, wasn't everywhere, you didn't, so you have these young students now who look around and they, they go, I want to, be the Kardashians doctor.  Want to be that.
Person.  And I think when I was in medical school, I, we all knew that there was cosmetic surgery out there, but it wasn't so in your face and it wasn't so front and center. And how you became the person  who does that surgery was, it was very different then.
Yeah. So it's the whole paradigm shift,  know there are lots of kids, I think now who are. Students who, who don't even really know that in order to do a breast augmentation, you have to do a plastic surgery residency, and what's all entailed in that. Not just learning how to do a breast augmentation, it's it's very different.
Dr. Sam Rhee: [00:37:44] Hopefully the pendulum will swing a little bit the other way too, at some point, 
Dr. Stephanie Cohen: [00:37:48] we'll see. Maybe  maybe the COVID epidemic will get people back to thinking about what's really important to, although I do have to say my practice is cranking right now because everybody, yes.
Busier than ever, because everybody. Yes. Everybody wants to just have some them. And now's a good time because they don't have to go into work and they can recover. I know it's been really crazy not going to sniff at that, but 
Dr. Sam Rhee: [00:38:14] we'll see what happens. Stephanie, it's been wonderful talking to you.
I really appreciate it. I wish you the best of luck. For both your charitable efforts for your career? Yeah. For everything else that's going on. And I think there's going to be a lot of value for people just to hear your life experience. Just a little short bit of it. And hopefully yep.
People will take something away from it because I certainly 
Dr. Stephanie Cohen: [00:38:37] did well, thank you. Like I said, in my email, I don't know how you have the time for all of this, because it's amazing that you do it. So it's it's really it's really interesting that you decided to do it and and and really great.
I think 
Dr. Sam Rhee: [00:38:49] it's really fun. Thanks again, stuff. 
Dr. Stephanie Cohen: [00:38:51] All right. Thank you. Okay. Bye. Bye.