So, it always fascinates me when I learn about people who knew at an early age what their career was meant to be, and I believe that to be the same for you. So, are you suggesting that it was your interest in history that spawned your interest in medicine?

Dr. Zlatko Pozeg

No, I think medicine came first and this is something I've pondered to a great degree. Why the strong, strong desire from an early age to go into medicine. And I do remember that feeling as early as I can remember. And I honestly don't know where that came from. I think it's a combination of influences and really just luck, because my family, there's no one in my family who has a medical background, and I just remember having a deep interest for, you know, surgery and what it would be like to be in sort of this theatrical type environment and going inside someone's body and fixing a problem. And for some reason, that's been a fascination I had. And I remember our family physician, I always enjoyed going to our family physician who was there when I was born and in the older days when family physicians did births and, you know, he had an office and a big desk and someone I always seemed to look up to. His coat and a stethoscope in a room full of medical books and always seemed very austere and respected and I thought, this is something I'd like to achieve. And actually, in actual fact, maybe that's where the book thing—he did give me some of his books after he retired because he knew I liked books, so I still remember him. So, I think, yeah, it's a combination of early, early influence that seems subconscious. And there is an element there that I can't explain, but that allowed me to pursue it with great fervor.

Maureen Farmer

And you certainly did. I believe I read somewhere that through high school, you studied medical books and then you studied in university. And I think you moved very quickly into medical school. Is that correct?

Dr. Zlatko Pozeg

I did, yes. So, I went to University of Waterloo at that time and the health sciences and knew I wanted to go into medicine. And I was fortunate enough, in those times you could get in before achieving a degree. So, I got in early and went to University of Ottawa for medical school and I was fortunate enough to get in early and and start my passion immediately. And that's when the book collecting started as well.

Maureen Farmer

And so, where do you keep your book collection right now? Do you have a special place for it like a vault or some type of controlled environment for them?

Dr. Zlatko Pozeg

Well, they're meant to be seen and looked at and enjoyed all the time. We're in the process of building a new house and a new library to go with it. So, the current place we're in doesn't have room for all of them. But I have five or eight thousand books. A lot of them are in storage, but most are just in our living room library that we surround ourselves with. So, they're there. We have two little kids running around and there they are surrounded by books all the time. And so they're there to be loved and enjoyed and touched and looked at. Yeah. So that's how I feel about having them. Yeah.

Maureen Farmer

Did you say 8,000 books?

Dr. Zlatko Pozeg

Yes, a lot of books. It's a lot of books. They surround every room. I have lots of books, much to my wife's grin at times.

Maureen Farmer

But that's fantastic. So, I'm sure the listener listening here today is curious about the type of work that you're doing right now and how you are able to help people in our provinces become healthy again. So why don't you tell us a little bit about some of the exciting things you're doing right now?

Dr. Zlatko Pozeg

Great question. Thank you. So, I was recruited here as a cardiac surgeon in 2017, and I had been practicing heart surgery for about ten years up to that point. And my wife is from the Maritimes, from Yarmouth, Nova Scotia. And we did have a desire to come eastward at some point. So, an opportunity arose that really fulfilled personal and professional desires or ticked boxes were checked in that regard. And, you know, they didn't really have a formal aortic surgery program here. And that was my prime interest in what I trained in. And so, it was a great passion of mine. So, it really worked out well. And they had new leadership here in the surgery group and someone whom I knew and has since become a great mentor. So, under his leadership in the group period, we decided to make the move here and have worked on steadfastly developing the aortic surgery division here. And that really means providing care to people of New Brunswick and Prince Edward Island with any sort of aortic illness. And a big part of that is an aortic disease clinic where we follow several hundred people now with various theologies of the aorta, mainly aneurisms, are the main thing, and we provide surveillance for them so they don't get lost to medical follow ups. That's very well organized. And we manage them medically and we have all sorts of options in terms of the most contemporary, sophisticated, up to date generational management of difficult aortic pathologies with our group here, whether it be surgical or endovascular. We're able to manage the entire spectrum of aortic disease here with the team we have developed. So, it's been great because a lot of times these people, if they're not managed under one umbrella, it's very, very easy to fall through the cracks and things get missed and follow ups aren't done in a timely fashion. And unfortunately, with aortic pathology, the results of that can be catastrophic. So, we think it helps people here a great deal. There's a lot of people who need this service. So, we're pleased to be able to provide it.

Maureen Farmer

And for someone listening who may not have a background and I certainly don't have a background in this area, but I do know the minimally invasive types of treatments help with comorbidities. And so, where previously an open procedure might not be possible, now you're able to do an alternative procedure. Can you talk a little bit about that just to give people a sense of how it works?

Dr. Zlatko Pozeg

Absolutely. And that's a great question. It's hard work keeping up with the technology and its rapid rate of change. I can honestly say many of the operations I do today did not exist in my training. So, we weren't trained to do them. They simply didn't exist. And the technology wasn't there to support these operations. And now many of the operations I do are have been conceived in the very recent years are being helped by technology. And we've been able to do these less invasively, such that many of these are really only done through a needle with access to an artery rather than a big open incision. And this means, you know, being in a hospital one to three days versus two, three weeks or even more in some cases, and all the while still treating the disease and the aneurysm as well as we would have otherwise. So, it's been a radical change in the management of aortic disease. And in actual fact, we're managing patients who would have had aortic aneurysms in the past. And, you know, for various reasons, whether they be elderly, frail, have other medical issues, would not have been deemed a candidate for an intervention such as surgery. Now we can offer them a low-risk option, this endovascular stenting or minimally invasive approach, and there is much less risk and much less risk of dying or stroke or heart attack. And they can live longer or otherwise they would have been condemned to just have their aneurysm and have nature take its course, as it were. So, it's radically changed how we manage patients here today. And I think it's for the better.

Maureen Farmer

Yes. Imagine the positive impact on families and communities because of this wonderful technology and expertise that you have.

Dr. Zlatko Pozeg

It's been immense. Absolutely. And like I said, we're managing people, the patients we're dealing with and managing and the complex issues they have who otherwise would not have been managed and would have been sent home in a palliative manner and now are fixed and go on with their lives and have a strong quality of life as well.

Maureen Farmer

So, would they, for example, be able to go back to sports and things like that?

Dr. Zlatko Pozeg

Oh, yes, in some cases, absolutely. They resume normal life activities. Absolutely. Many young patients who come in with aortic issues or aneurysms (aneurysms are the main sort of pathology we deal with) so, the traditional patient would have an aneurysm diagnosed by whatever means. Usually, incidentally, it's found on a CAT scan being done for another reason and then they would contact the New Brunswick Center for Aortic Disease—the New Brunswick Heart Center, and they would get referred to me and I would assess them, they would proceed to the pathway of management and assessment. And sometimes that means watching them or they've reached indication for intervention, whether it be surgery or endovascular management. We would go down that pathway. And if they were surgical or had an intervention, we would schedule that and then once they were recovered, they would go back to their regular lives.

Maureen Farmer

That's fantastic. This is so fascinating. So, in terms of new technology, I'm always curious as to how new technology is introduced to people like you. So, I'm assuming that it would come from…where? I wouldn't know.

Dr. Zlatko Pozeg

Right. Well, the aortic community is quite a small community and it is I would certainly sort of a meritocracy. So, I think the more you do, the more you kind of put yourself out there and try new things. I think things do end up coming to you. So, you know, we do a lot first year and there's a lot of advancement. One particular area is the type of stents we use and. So, there are companies always out there developing new stent technology. And on a non-frequent basis, we are often asked to be involved in early trials of looking at these new stents and seeing how they work. Just because we have a lot of—based on my background—we have a lot of experience dealing with this. As I said, we're one of the bigger endovascular centers, certainly in the Maritimes and in the country. And so, we have a lot of experience. And this comes with the backing of sort of cultivating relationships in our specialty and across specialties. So, it really must be emphasized that this would not be possible with me on my own. This is a very strongly collaborative effort. And when I say collaborative, I really mean that in a true sense not only my surgical colleagues are involved, but we have radiologists who are highly specialized in interventional radiology, specifically aortic interventional radiology, whom I work with on a daily basis, who are tremendously skilled and without whom I wouldn’t be able to do this. And we have three here in New Brunswick and St. John who I work with closely. So, they would be one avenue by which new technology would be introduced. I also work very closely with my vascular surgery colleagues who are interested in similar work and then industry. So, I have contacts in industry and like I said, it's a fairly small group and there’s an Canadian aortic organization that we all sort of discuss and meet regularly and share cases and thoughts and ideas moving forward. So, there's multiple avenues by which this new technology reaches us. But again, it's sort of an experience based meritocratic system whereby the more experience you have, I think the more opportunities that that one has in leading—being on the forefront of new procedures.

Maureen Farmer

Yes. And of course, you know, there's you know, necessity is the mother of invention. And I know because of the issues relating to Covid-19, of course, we're recording this in the midst of the second wave in early 2021. How has that impacted your ability to collaborate with industry and with other professionals across the value chain in this space?

Dr. Zlatko Pozeg

Well, it's been an interesting and a lot of change of changes have come out of this. I think ultimately we will find for the better, in terms of patient care. I think by virtue of technology, we have greater access to experts and industry. For example, you know, because of Covid, we're doing a case here in the next month or so, which involves one of the newest stents on the market for treating a certain type of aortic disease. And it's with a particular company who has developed an exceedingly high level method of live streaming, so, you know, they come in a day or two before to the operating room, cameras, TVs, microphones are all set up. And, you know, we do the case. We have the company support and the experts in the field who have done this particular graft and they're able to be live streamed and almost as though they're there. Whereas before Covid, we would have had just perhaps one representative from the company in the room and not have the benefit of 10, 20 or 50 people being live streamed in to help us with the case. So that has helped. I think, you know, and continues to evolve. So that has helped us a great deal. Does that answer your question? I’m sorry if I got side tracked.

Maureen Farmer

No, not at all. That absolutely answers my question, because, you know, the virtual world is not going away. And, you know, finding ways to collaborate over the Internet is a growing technology and it's being refined all the time. So, are you saying that this particular technology is not a regular streaming service? This is something that's new and unique to your particular procedure or your particular hospital?

Dr. Zlatko Pozeg

For this particular case, we've never done this before. So, you know, like I said, we usually have a representative from a company for doing a new device or a new piece of equipment—they would be here. Who would come from—if they're local, they're local, but often they're not local. They would fly in and be with us and proctor us, for example, through the case. But, you know, with Covid, we're not able to do that. And so, people are at home or in their offices, in their hospitals and live stream. And so, our case will be live streamed, for example, to you know, company managers, Proctor’s, other surgeons and all who will be able to, you know, provide us with tips and tricks of doing a novel and new case that we haven't done before and using this newer type of stent. So, I've not done that before in that in that fashion. And neither has our team here. So, and I think it'll be invaluable.

Maureen Farmer

Yeah, absolutely. Lots of growth and capacity building there for sure.

Dr. Zlatko Pozeg

Absolutely. Yeah. And the flip side is with the patient contact. I mean, I think this will facilitate patients being more engaged digitally. I think, you know, with telehealth…it has become a big issue in medicine during Covid times. And I think in New Brunswick, as you know, in the Maritimes, we have great geographic disparities. So, you know, if I have a clinic of 10 people, you know, six or seven of those may be coming from three or four or five hundred miles away, you know, just to see me, you know, they take a day off work beforehand. They have the appointment and drive back the next, you know, so it's a big, big event to come here to St. John for an aortic surgery appointment. So, I think this will facilitate us reaching more people and providing care.

Maureen Farmer

That's absolutely fascinating. And it's such a, you know, unheard of technology being able to improve the lives of people in a way that was not possible, not even all that long ago. So, I'd love to talk a little bit more your career. I love to say that, you know, people work on their career or should work on their career as much as they work in their career. And I'd love to know a little bit about overall, I guess at a macro level, maybe what has surprised you the most, I guess, in your career so far?

Dr. Zlatko Pozeg

Good question. You know, in surgical training, we're so focused on what we do in the operating room that in actual fact, once we're well on to our careers, that ends up being the smallest portion of our career development. You know, maybe because we're so good at it by that point. But really, it's all the other things that occur outside the operating room that are important. You know, I alluded to developing and cultivating relationships, communication, you know, having a plan, goals set and that sort of thing. So, you know, all that sort of thing, all those things that we weren't really taught as we went through training. But really, that ends up being what propels one forward in their career and achieves results and advances us and makes a difference, so that surprised me the most—the degree to which all those other things needed to be fostered and developed and worked on, and I think that caught me off guard. And I think I'm well on my way with the mentorship. And I think mentorship is a very important thing in any field. Which, we haven't done well historically and in surgery, having great and mentors and cultivate those sorts of relationships. So, you know, especially here and being in the form of a leader in the aortic surgery group here and learning all those things of how to cultivate relationships, develop collaborations and be an effective leader in a team is absolutely critical. And learning how to do that, needing to learn how important it is to do that is probably what surprised me the most.

Maureen Farmer

So, are you suggesting in medical school or in your other training, you weren't directed to leadership training? It wasn't part of the syllabus? Would you say in general that there's not much focus on that?

Dr. Zlatko Pozeg

No. I think we're so focused on the medical aspect, on the anatomic anatomy, physiology, all the sorts of detail and part of that is pragmatic. It's hard to get all that information in. And I think, you know, now I think medical school is different today and it's sort of learning how to be a learner rather than that just pounding information into students all the time. So, I think things have changed. And, you know, education has had to move along with the times as well. So, I think that has changed in the interim. But in my time, no, that was not the case. So, we've kind of had to learn that on the fly as we go here. And some do it better than others.

Maureen Farmer

Yeah, sure. So, one of the things I'm often asked, because I do have medical students from time to time who call in and want to have a conversation with me. They want to know, you know, what is the best strategy for (and we're kind of going backwards here in terms of medical school), but what's the best strategy for making a good application to medical school today? What would you say that would be?

Dr. Zlatko Pozeg

Oh, good question. I think a broad background is good. I think, you know, early on it was just sort of being focused on science and medicine. But, I contribute a lot of my success to having a greater interest in the humanities and a broader interest base, whatever that may be. Mine happen to be history and book collecting and, in the arts, that sort of thing. So, I think that's important.

Demonstrating the ability to be a learner and adapting with the rapidly changing information technology and so on is critical. I think, you know, the basic things will always be there in terms of having good grades. And that sort of thing is a given, obviously, and keep trying. I think the other thing is sometimes it's just…good people just don't get in just because of numbers and quotas. So, I think you just have to keep trying and realizing that you may not gain success on your first attempt. So, I think a broad interest in other interests, other than medicine, I think will keep you in good stead. And I think medicine has become much more humanistic, you know, and I think those qualities are more and more important. I think most people can learn the basic medical things or know how to learn them when they need the information. But it's the other things in medicine, the humanism. I think that's more important. And to see those qualities in individuals, I think those are the most successful physicians, in my view.

Maureen Farmer

Yes. And we talked a little tiny bit about this earlier…about mentorship as well. And I believe based on my own experience and just observing others, that having a mentor is just as important as being a mentor. And I think it's helpful to offer that type of leadership toward others, especially on our teams and within that broader community. So being a mentor and having a mentor, I think are really good assets for the future.

Dr. Zlatko Pozeg

Absolutely. And it's something that, you know, the old school mentality in surgery hasn't allowed for that. But that's changing drastically. So, we really emphasize and focus on it, and I make sure I always have someone I look up to as a mentor, historically and in my current life, who, you know, in various fields, not just necessarily medicine, but in life. And, uh, and I have no problem in reaching out to them when I feel the need.

Maureen Farmer

Yes. I like some of the historical figures, too, especially Albert Einstein. I get a very great deal of delight reading his stories and his self-deprecating humor and, you know, others as well. I think it's helpful to look back into history and look at some of those lessons.

Dr. Zlatko Pozeg

Absolutely. And these people have created sort of core principles and behavior, behaviors that they've espoused and lived by…that is applicable to all of us still and transcends time. And so, I think it's still applicable to all of us in all aspects of our lives.

Maureen Farmer

Well, Zlatko, this has been amazing. I really enjoyed our conversation. Is there anything else that you would like to share with our audience today?

Dr. Zlatko Pozeg

No, I appreciate the opportunity. Thank you very much. And it's been a pleasure talking to you. And I'm happy to talk with you again in the future. It was very enjoyable. Thank you.

Maureen Farmer

You're welcome. It's my pleasure. Maybe we'll have an opportunity to talk a little bit about the technology piece. I think people will find that very, very fascinating as it assists you in caring for your patients.

Dr. Zlatko Pozeg

Absolutely. I mean, our specialty is very, very technology driven. It's highly technology driven. So, I'd be happy to delve into there, take a deep dive into that with you in the future.

Maureen Farmer

That's wonderful. Thank you so much.