Dr. Gomez-Sanchez

Jackie: What is one thing you wish you had known during training?

Dr. Gomez-Sanchez: I’m early in my attending years, but one thing that's obvious as I transition into this role is that so much of the learning happens in clinic. I am probably similar to most surgeons and view my happy place as the operating room. I want to spend all my time there, and my main focus was on becoming technically adept. As you get better at the inpatient side, which is so much of what we do, you tend to neglect the clinic side. But knowing how to manage patients in the long term, knowing what they'll look like in three months and three years from their lower extremity bypass, is incredibly important. As a trainee, I did not really recognize this. In Vascular Surgery, we're almost like primary care physicians in many ways - we manage this chronic disease, and you see them year in and year out for the rest of their lives. So if I could go back, I would advise myself to prioritize clinic higher than I probably did. It would have probably served me well to learn some tips and tricks on how to make certain decisions and create certain relationships.

Jackie: That's wonderful advice, as so much of our training is inpatient-heavy. Looking at your Twitter, can you tell me what how you are a “Cat hat fashion icon”?

Dr. Gomez-Sanchez: I figured you were about to ask! This is my Christmas cat [scrub] hat - it’s Christmas cats taking selfies with their little antlers. I have my space cats, which has cats floating in a galaxy. The one I wore today is my rainbow cats; my favorite is this Grumpy cat hat. So I have a cat, and I love my cat. But the cat hats came out of a good friendship that I had with the coresident in my residency days, who was a big cat dad. He loved his cats, he talked about his cats a lot, and he had started collecting these cat hats. When we worked together, we started a bit of a competition to see who could have the most ridiculous cat hat. I got a few in that setting, and then, unfortunately, this resident passed away during his time here at UCSF. After that, it's been a way to honor him and to keep him on my mind, because he was also planning to go into Vascular Surgery. Every time I put it on, I remember to think of him and the contribution that he's had to my life, and that he would have had to other people's lives.

Jackie: Thank you for sharing this touching story, this is a wonderful way to remember a friend. What is the best piece of advice you have received?

Dr. Gomez-Sanchez: The best piece of advice I've received wasn't from someone in medicine. It was from a family friend who happened to be at the table when I was talking about my training. They turned to me and said, “You have to do the best you can, for as many people as you can, and try to forgive yourself for the times when you didn't get everything exactly right.” That has been such a cogent way to view your role in medicine, as provider in general, but especially as a surgeon, because nobody is perfect. You're going to make mistakes and feel like maybe there was something else you could have done. Should I have paid attention to this versus that? You need to remember that you're coming into this with all the best intentions, and if you carry that forward you can do the best job every day, for every patient. You're leaving this place a little bit better than you found it. Also, we're all pretty hard on ourselves when we make a mistake or when something doesn't go our way, and we're learning to forgive ourselves for being human. It's an important part of this whole process. It’d be great if you never made a mistake, but there’s the old adage that the only surgeon without complications is one who isn’t operating. You hold yourself accountable, and then you try to forgive yourself for your mistakes.

Jackie: What are you most proud of?

Dr. Gomez-Sanchez: Professionally, I’m most proud of the young residents and medical students whom I work with. You get to watch them thrive and grow. When you hear people say “Oh, they're a great resident, and they're doing it,” you feel that deep glow of pride knowing that you played a small part in their development into a confident and competent provider. Personally, I trained a horse in medical school, which was my decompression hobby. I have never done that before; I didn't really know what I was doing, but now when I get to ride my horse again, I just feel so proud – she’s lovely, well-behaved, and she's got all the spirit! And yet she works really well with people, and is very safe and kind. From a personal standpoint, that's one of my biggest accomplishments.

Jackie: That's amazing. What does it take to train a horse?

Dr. Gomez-Sanchez: It takes a lot of patience, consistency, and self-control, because they can tell when you're frustrated, and that makes them more nervous and uncomfortable. I would ride her a couple of times a week, and we’d do simple tasks over and over again until we were working well together. Then we would go around new corners and try to explore the world together. A lot of consistent messaging and soft but firm requests on my part. It's fun. I trained her to jump, and be a really good cross-country horse.

Jackie: That’s incredible! How did you get involved with teaching and mentorship?

Dr. Gomez-Sanchez: The opportunities are everywhere. The Vascular Surgery Interest Group had a recent meeting where they ran simulation sessions, and I joined to take people through an open AAA or teach them to sew and tie. These opportunities have been around my entire time at here. You spend an evening or a couple of hours somewhere, teaching surgical skills to either younger residents or medical students. Of course, we always have students coming onto service. There’s also a lot of built-in mentorship in this university that helps you get into those spaces. Being a PICSES mentor formalizes the process. When encountering a student, you could make it clear that you’re available to be a mentor, that you are interested in their pathway and interests. I also mentor students every year by setting up mock interviews. I go through their application with them, help make sure that everything is flushed out and that they're ready for some of the difficult interview questions they're about to get.

Jackie: Could we discuss what type of mentorship you've received, and how mentorship has impacted your surgical career?

Dr. Gomez-Sanchez: I didn't have much mentorship in medical school, and I felt a little bit out of place. I wasn't sure how to get it, or where to even start. Once I came here to UCSF, it was a lot easier to find. Some of the people whom I viewed as mentors during my younger residency days really guided me as I figured out what I wanted to do with my career. I started out thinking I was going to go into Plastic Surgery, and I end up in Vascular Surgery, which is very different. Some of my mentors who I really respect are vascular surgeons; I started thinking that I would love to do their jobs. You admire, then you want to emulate, which is often the first step in developing these mentorship relationships. You don't always have it immediately in front of you; it's not something you will necessarily be given. But step one is to figure out who you want to be like, then you can pursue opportunities that might get you there. I have a lot of mentors that have been Vascular Surgeons specifically, such as Dr. Warren Gasper, who was the first person to make me realize that Vascular was a good place for me. He mentored me from a clinical standpoint, and I felt comfortable coming to him for career advice when I was switching pathways. He has also been my research mentor as I've started to develop my projects. Dr. Conte has also been an excellent mentor, as I've developed my understanding of what I wanted out of my career, which is a very difficult question. As you start to exit your training, someone asks, “What do you want to do with your life”? That's a great question here. I would be remiss not to mention Dr Lucy Korniblith and Dr Jade Hiramoto in my list of inspirations/career mentors - both of them have really exemplified the kind of excellence and grace under pressure that I strive to have in my career. These mentors have been really helpful, and I see in them something that I want to be. This is how I have pursued my mentorship relationships. It's incredibly important, because if you feel unsupported or that nobody cares if you end up succeeding, it's hard to remain motivated to keep pushing. Once you have these relationships with people you admire, it allows you to spread your wings and pursue things that will make you happy in the long run.

Jackie: Thanks for sharing – it’s really heartwarming that you've been able to get good mentorship. What is your favorite quote?

Dr. Gomez-Sanchez: My favorite quote that I try to use in everyday teaching is: “It was everyone's first day once”. Many students come to surgical rotations, they're very nervous, and when someone is watching them do something, they get flustered. I tell them that it was everyone's first day once, and no matter how nervous you feel, everybody has been bad at this before. Nobody started out their career being excellent all the time at everything. If you are having trouble, you should remind yourself that you are in good company, and that it's the first step towards being great at something new.

Jackie: That's so nice! As someone who's been in those shoes, I appreciate the kindness. What if, for example, it's your second or third time trying, and you're still struggling. Any advice there?

Dr. Gomez-Sanchez: If it [surgery] were easy, everyone would do it. Just because you're not the most natural surgeon in the world, doesn't mean that you can't develop muscle memory or train yourself. There will always be people who are ‘natural athletes’, but the vast majority of people get to greatness because they tried really hard, and they didn't give up at the first sign of a problem. That tenacity is what you need to be excellent in any field, and it also develops your character. Somebody who goes through life always being excellent the very first time they try something, they don't learn to overcome adversity. They don't learn to overcome the disappointment when they haven't succeeded at something. The day that will inevitably come where you don't do the best you could, and you may not have the mental reserve or fortitude to realize that you're you can still bounce back from any setback. I would encourage people not to give up if it's something that they're interested in being good at. You can learn anything. Keep going.

Jackie: Thank you so much, Dr. Gomez-Sanchez, for your time and advice, we really appreciate it.