Sometimes all it takes is a fly rod and a quiet stretch of river to renew the spirit
It is nearly noon, and I have temporarily retired my fly rod in favor of a camera, hoping to capture the moment. I stand behind my friend Edwin watching him cast his fly line upstream into a small run, framing the shot to tell the story perfectly. This is a man whose success as a surgeon depends on precision. I watch him carefully place each cast, allowing the tiny fly on the end of the leader to float down to the trout without even the slightest hint of drag. It’s clear that for Edwin, precision creates a sense of joy. I share the feeling. When you are doing your very best, the world just seems to work better. It is a way of life that leads to greatness regardless of your career path. And it’s this passion that drives people like Edwin to strive to be the best no matter the task.
Edwin Spencer is not your typical doctor, not by a long shot. His open style of communication and sometimes lack of political correctness make for a refreshing respite from the world we find ourselves in today. My take on Edwin brings idioms like “facts don’t have feelings” or “it is what it is” to mind. Today we won’t have to filter our words or worry about offending anyone; we can just speak plainly.
We are fishing the best stretch of trout water this side of the Mississippi—the headwaters of the Soque River in Northern Georgia. The sky is bright blue, filled with puffy white clouds, and the gods of trout fishing are smiling upon us this day. I often travel to this stream to experience its fantastic trout fishing, and today it lives up to every expectation. Edwin and I have landed several rainbow trout, two of which were over 24 inches, and I see one jump before it breaks Edwin’s leader, which had to be over 30 inches. Yes, this will be a day to remember.
Times like these create a unique camaraderie. Spending time outdoors with a friend, sharing an activity you love, coupled with the absence of technological interruptions, provides time for expanded conversations. It offers the time to explore questions openly and without regard to who might be listening. So, as we walk from one pool to the next, our conversations wander along a myriad of topics, from faith and family, to the state of our medical community, and the challenges we all face in a post-pandemic society.
Edwin, I have always thought there is a connection between activities like fishing and a person’s chosen career. My greatest peace comes from being in nature and during those moments of repose I often find answers to my most difficult questions. Where do you find your most happy relaxing moments?
“Fishing is very restful, we get to spend time in nature with the Lord, appreciate things we love, and we get to have peace during that time. I try to get balanced and renewed every morning with quiet time with the Lord and Bible study and try to do something physical every day as that makes me better able to deal with and manage the activities of the day. Sometimes, this gives me insight into other aspects of life, including your job; for me, it’s surgery.
“No matter what I am doing, I’ll just let my mind wander and run through cases and go through them several times. I find that helpful. So, whether it is fishing or surgery, as long as you spend the time to plan ahead in your mind, it usually pans out pretty well.”
That echoes something my father believed: to get closer to God, all you had to do was go into nature. But really it’s just like you say, taking time to find the quiet space in the day to reflect is the key. For me there is a kinda zen-like feeling when I am creating something in the shop or tying a new trout fly, I can just get lost in my thoughts for hours. What is your method?
“The intricacy with which you tie trout flies and how well the fly will work is a testament to how much time you’ve put into it. When you’re tying a trout fly, you need to go and get a specimen to study. Then you can ask yourself, how many different materials will it take to make this trout fly look lifelike, and how will I combine them to create the fly? Then you’ve got to test it. It may be a sinking fly that needs to drift naturally in the current or maybe a streamer, and you need to test it and make sure that it looks natural as it moves through the water. And if you study and plan correctly, then it has a good chance of enticing the fish to strike.
“That’s sort of the same thing with surgery. There may be a complex surgery, and I am thinking and strategizing beforehand, formulating a plan of how to do this in my mind—planning out which implants to use and how I will approach the procedure and make my plays. You’re studying, planning, and hoping for the very best outcome for the patient. Being well-prepared helps ensure better outcomes.”
I think we could agree proper planning applies to most of life. Why did you choose medicine?
“Well, that’s a great question. As a child, I was in for a partial ACL tear. The surgeon ‘s interaction revealed a profound direction in life. The intricacy of the procedure led me to want to understand more. That steered me toward a medical career.
“To this day, I consider medicine to be a noble profession. But it takes a lot of effort to get there and stay up to date. You’ve put in all this schooling; you put in all this time, in residency, in fellowship. So you’re fully invested. And if you’re going to be fully invested like that, you want to be fully invested in changing people’s lives. And if you’ve got that drive, you want to be a little different in the way that you change people’s lives. It’s not only in taking care of them; it’s how you manage their care that makes a difference.”
True, no matter the path you choose, it takes a lot of effort to be a leader in your career. You have to be paying attention all the time. Where did the inspiration to step away from the status quo and be an innovator begin?
“I wanted to take it a step further. I thought, let’s utilize what you’re good at, math, science, and design. And I wanted to design something better. Some kids are a little different. As an example, there’ll be a radio or a similar device, and they are wondering how it works. So they want to take it apart and put it back together again. That was me. So, if there was an operation, I would ask myself, how can I kind of get this down to its basic parts and then put this back together again, but better? How can I make this even better? And then you use your engineering background or physics background and hopefully make it even more innovative.
“I was a nerdy kid. And so I think what makes me a little bit different is that I don’t want to just approach the operation. I want to learn how people have done it well and how it’s worked for them. But then I want to learn how to make it better, either through making better retractors, making a better device, making the experience for the patient better. So, we manage all of the different aspects of the surgery with care. So, in a way, it’s just being kind of nerdy about it. Does that make me feel at odds sometimes with the status quo of medicine? Not really. I am just trying to set a standard that improves patient care overall.”
As you were immersed in all of your education, did you ever have a person who became a mentor in your journey, someone that really inspired you?
“One of my mentors wrote a frequently quoted article, ‘The making of a surgeon…some assembly required.’ He was a Navy man and was from the old school and believed in breaking down before building up. Of the five years in residency, two were spent being broken down, one neutral, and two building you back up if he liked you. It was the good ole days when they could get away with dog cussing you and throwing instruments. One of the points in the article was that most surgeons become proficient, some really good, rare ones become great, and only the best are master surgeons. You can tell a master when you see one…they make it look easy. You think after watching them that, hell, I could do that. It doesn’t matter whether it’s a fly-casting master, a baseball fielder, a surgeon, or a surfer…they have one thing in common: they make it look easy. The other thing is that they never tell you they are a master because they don’t need to.
“I think in both surgery and fly fishing, you can strive to be a master, but perfection is unattainable because there is always something to improve. It’s also about enjoying the process of getting there, like fellowship with other fishermen and doctors and designing new flies or operations. The difference is that the operating room cannot match the beauty of a streamside in the fall, like here on the Soque. Trout don’t live in ugly places.”
I had a few of those kind of people myself, and truly I am thankful for the tough lessons they shared. They were hard men who grew up in a hard world. But hard men solve problems and ultimately create a much softer world, and a soft world creates soft men. I think that is where we are today, our youth have gotten soft, and since everything is driven by a cycle, we are probably headed toward some hard times. Looking to the future, perhaps our evolving tech will help offset those hard times and give us something to strive for, something our youth can feel inspired by. You’ve already been a big part of that, with your dedication to research and innovation in your field. How do you find time to research new procedures and design new tools?
“Finding time to do the research and design work is hard. There is very little time as the days are spent seeing patients and operating. Therefore, this is usually done at night and on weekends. Balance in life, work, research, and societal duties can be hard to achieve, and I’ll be the first to admit I’m not always the best at that balancing act, and my wife will have to rein me in at times. Work/life balance is probably the thing I struggle with the most. But in the end, the ultimate goal of improving surgical design through research and innovation, is to create improved patient care. This has to be done, regardless of the cost.”
Talk to me about the rising cost of health care and what you think can be done to maintain top quality care while not seeing costs rise to the point where patients cannot afford it.
“Healthcare costs continue to rise, especially with an aging population. As with most things, this is multi-factorial. In part, physicians have incurred more costs, such as implementing and managing the electronic health record, requiring offices to hire more personnel to input data, including scribes. The insurance companies and CMS have more regulations on what can be billed and how to bill. That requires more billing experts and compliance officers. Medical supply costs (like everything else) have continued to rise, and there are frequent shortages of common supplies such as lidocaine. Staffing shortages, including nurses and surgical techs, make it challenging to meet the surgical volume. The COVID era mandates resulted in many healthcare workers leaving the medical field. Many hospitals are now staffed with ‘travelers’ who make twice the money as previously employed workers. Many of the travelers are good, but what patients don’t understand sometimes is that the best surgeries are done with teams that are familiar with each other and have performed the same or similar cases multiple times together. This familiarity decreases mistakes and waste and improves surgical efficiency, reducing infection rates. The future doesn’t look very good at the moment.”
There must be something that can be done. Aren’t large groups like yours at Knoxville Orthopedic Clinic able to find ways to mitigate these rising expenses?
“All is not lost, but there is a fundamental disconnect. The practice of medicine is complicated and the role of the doctor should be the benchmark for the ultimate in patient care. There is no case I can imagine where an insurance company underwriter or any third payer for that matter, should supersede the opinion and direction of care of the physician for the sake of increased profits.
“To start with, the care of the patient is the responsibility of the doctor. I believe that both myself and my colleagues are always acting in the best interest of the patients which is the paramount covenant of our Hippocratic oath.”
With that in mind, how do we move forward with the best interest of the patient in mind?
“One example would be surgery centers like the one here at KOC. They are a saving grace and are thankfully increasing in number across the United States. Surgery centers can perform operations at a fraction of the cost compared to hospitals.
“Another way that costs could be decreased is by contracting directly with industry instead of third-party payors. In addition, allowing patients to invest in health saving accounts that would roll over and could be matched by employers. Give patients a tax-free way to invest in such an account. The patients would own this health investment account, as opposed to the government or any third party payor.
“In general, I believe patients will be better stewards of their money. In this way, health savings accounts could accrue more money over time, like a 401K, and be used to offset the healthcare costs. Instead of renting health insurance by paying premiums that, if not used, are gone, patients could own some of their health insurance and manage it.
“Regardless, as we all move forward, we need to acknowledge our faith, profoundly love our families and acknowledge the fundamental meaningfulness in God’s plan for each of us and our fellow man.”