man playing guitar with granddaughter

The rewarding life of a surgeon

January 31, 2019 | UCI Health
uci health surgeon dr joseph carmichael
Once Dr. Joseph Carmichael entered the surgery rotation during his medical training, he knew the specialty was for him — no matter the challenges.

Being a surgeon means unpredictable hours and long days. But it’s worth it all 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 in the UCI School of Medicine’s Department of Surgery.

Once Carmichael entered the surgery rotation during his medical training, he knew the specialty was for him — no matter the challenges. At the end of a recent 14-hour day, for example, he longed to go home to his family, but knew that he needed to sit down for a long talk to reassure the family of a patient who was scheduled for surgery the next day.

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

Careful deliberations

As a surgeon, 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 while earning his Boy Scout Medical Explorer badge. 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 in New Orleans and volunteered in the university medical school’s operating room and emergency room.

Finally convinced that becoming a doctor 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.

Embracing minimally invasive colorectal surgery

Carmichael says he’s often asked why he chose to specialize in surgery of the colon and rectum. His typical response: “I fell in with the wrong crowd.” That’s another trait; 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 nationally recognized colorectal surgeon and now dean of UCI School of Medicine.

Advanced technologies — laparoscopic and robotic equipment — to remove extensive 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 UCI Health.

Colorectal cancer: The most preventable cancer

Colorectal cancer is the third leading cause of cancer deaths in men and women in the United States. If caught early, there is a very good rate of cure, sometimes with surgery alone.

“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.”

Curiously, this associate professor of surgery is the primary UCI investigator for the national Organ Preservation in Rectal Adenocarcinoma (OPRA) clinical trial, directed by Memorial Sloan Kettering Cancer Center in New York City, of a method to treat rectal cancers without surgery.

Studying nonsurgical cancer treatments

Patients in the study who would have typically been scheduled for surgery after chemotherapy and radiation instead receive additional chemo. The study is currently underway, with publication anticipated by 2020.

“We’ve been able to eliminate cancer in 39 percent of the patients studied, 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 of practice, 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 of patients who inspire me.”

Encouraging youth to consider medicine

Today, Carmichael is working to motivate young people to consider medicine as a profession. At 43, he’s come full circle from his days watching surgery as a Boy Scout; now he encourages high school students who participate 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,” Carmichael says. “She’s a heck of a motivator for me.”

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