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The Rewarding Life of a Surgeon

Dr. Joseph C. Carmichael always looks for “the best medicine.”

Being a surgeon means unpredictable hours and long days. But it’s all worth it when a patient fully recovers and is back to enjoying time with their friends and family, says Dr. Joseph C. Carmichael, chief of the division of colorectal surgery, UC Irvine Health.

Once he rotated through surgery during his medical training, Carmichael knew the specialty was for him—despite the challenges. At the end of a recent 14-hour day, for example, he longed to go home to his family, but knew he needed to sit down for an hour-long talk to reassure the family of a patient who was scheduled for surgery the next day.

Surgery requires that patients place deep trust in their doctors. “As one of my patients said today,” he recalls, “‘I’m putting my life in your hands.’ When you feel that level of responsibility, the hours can go by pretty easily.”

Carmichael insists on exploring all options to make sure what he’s doing is the right thing. Take, for example, his decision to become a doctor. His interest in medicine—and surgery—was piqued after observing operations during a stint as a Boy Scout Medical Explorer. His curiosity grew in his late teens with hands-on patient experience gained as an emergency medical technician in the emergency room at a small community hospital in his hometown of Springfield, Mo.

Still, after high school he wasn’t 100 percent sure about his future. So when he won admission to a six-year combined undergraduate and medical school program at the University of Missouri, he turned it down. Instead he studied cell and molecular biology at Tulane University and volunteered in the medical school’s operating room and emergency room.

Convinced that medicine was the right choice, he applied to medical school back at Missouri. “I would have kicked myself if I hadn’t gotten into med school the second time. That would have hurt,” he says.

You begin the day like any other, and by the end of the day you’ve removed three cancers.

Embracing minimally invasive colorectal surgery

He is often asked why he chose colorectal surgery and typically jokes that he “fell in with the wrong crowd.” That’s another thing about Carmichael; he likes to laugh. “It’s the best medicine. If I can get a patient to laugh even a little bit, it’s a nice thing.”

He credits good mentors for his choice of subspecialty. One was Dr. Michael J. Stamos, a colorectal surgeon and currently interim dean of the UC Irvine School of Medicine. The field’s advanced technology — laparoscopic and robotic equipment — to remove extended colorectal cancers also fascinated him. Carmichael established the first robot-assisted rectal surgery program in Missouri and performed the first robot-assisted rectal resection in Orange County after joining UC Irvine Health.

Colorectal cancer in men and women overall is the third most common cancer, affecting one in 18 persons in the United States. The fact that there’s a very good rate of cure, sometimes with surgery alone, makes it rewarding.

“It’s such an immediate reward,” Carmichael says. “You begin the day like any other, and by the end of the day you’ve removed three cancers.”

Funny then, that this associate professor of surgery is the primary investigator at UC Irvine Medical Center for the Organ Preservation in Rectal Adenocarcinoma (OPRA) clinical trial, directed by Memorial Sloan Kettering Cancer Center in New York City, investigating a method to treat rectal cancers without surgery. Patients in the study who would have typically been scheduled for surgery after chemotherapy and radiation instead receive additional chemo.

“We’ve been able to eliminate cancer in 39 percent of those patients and we are estimating that about 90 percent of those patients with complete response will never require surgery. We’re outmoding surgery,” Carmichael says. “It’s important for our patients to understand that we’re not pushing one agenda—that we’ve really got their backs, and that we’re ready to be innovative and look at other things outside of doing operations.”

Accompanying patients on their journey

One of Carmichael’s concerns about becoming a surgeon was that he would only be operating and that he wouldn’t get to know his patients well. After a decade he’s found the opposite to be true. He cited a patient he saw that very morning in his office.

“I’ve been through this amazing cycle with this guy from the moment I met him in my clinic five years ago until now, when we feel his cancer is cured,” says Carmichael, who’s been listed three times among the “Best Doctors in America.” “He’s got his whole life ahead of him. There have been a lot patients who inspire me.”

Today he’s working to motivate young people to consider medicine as a profession. At 41 he’s come full circle from his days watching surgery as a Boy Scout; now he encourages high school students by participating in a similar program at UC Irvine Medical Center.

As if his practice hasn’t been enough, treatment of cancer became very real for him over the past couple of years as his wife, Liz, underwent treatment for a rare lymphoma. “We believe she’s in complete remission,” he says. “She’s a heck of a motivator for me.”