The AAMC (as part of our Specialty Perspectives series) recently sat down with Cole Nishikawa, MD, to learn more about his work.
Can you describe your work as a vascular surgeon?
Vascular surgery is essentially taking care of blood vessels throughout the whole body, except for the heart and brain. We deal with circulation problems and blood flow, and most of our work revolves around limb salvage. I also do a lot of wound care for the legs and arms, dialysis access, which is the creation and maintenance of those accesses, carotid disease, fixing aneurysms, and vein disease.
What attracted you to vascular surgery?
When I was a first-year medical student, I thought I wanted to pursue orthopaedic surgery, so I scrubbed into a lot of ortho cases at the surgery center. One of my friends told me that I should look into vascular surgery, but I had this initial impression that vascular surgeons were really intense and serious!
I ended up meeting a mentor who was a vascular surgeon and he was the opposite of what I associated vascular surgeons to be. He was a laidback surfer in Hawaii who also happened to write one of the first textbooks about guide wires and catheters for vascular surgeons. A case that I worked on with him is what really drew me into vascular surgery, a carotid endarterectomy. When you are a medical student, you automatically think that the carotid artery, which goes to the brain is a no-touch zone. I watched my mentor cut the carotid open, remove the plaque, and sew it back together. I couldn't believe he had done that! I also watched him operate on aneurysms and sew tiny arteries together and deal with vascular emergencies. I realized then how high-stakes and impactful vascular surgery is, while also offering a variety of case types.
Can you describe a typical workday?
I like to start my day with clinics at around 8 or 9 a.m. and then have OR in the afternoon. I complete my rounds at the hospital in between cases or after clinic. I also visit my post-op patients and see any new consults. When I have time throughout the day, I do vascular ultrasound readings.
One of the things about vascular surgery is that we don't follow a strict schedule. Some days, urgent issues will arise, like a clotted dialysis access or a serious bleed in the emergency room, and my typical routine can be completely thrown off! Ideally, I am home by 8 p.m.
What parts of your job do you find most challenging? What parts do you find most rewarding?
The most challenging part of my job is dealing with patients that are very sick. When a person has vascular disease, they typically have many other health conditions, like diabetes, heart disease, chronic smokers, etc. So I can perform the correct operation, get a good technical success, and restore blood flow, but then not get the outcome I wanted because of the comorbidities. This means the wound doesn't heal and the patient ends up needing an amputation even after the surgery.
But this challenge is also what makes vascular surgery so rewarding! I am able to restore blood flow and save a patient's leg or fix an aneurysm and save someone's life. The work I do can have a lasting, positive impact on a person's life.
How would you describe someone who would excel in a career in vascular surgery?
To excel in vascular surgery, it's important to enjoy variety because you operate from head to toe and need to know all of the anatomy! It's also important to have a desire to care for sick patients. In vascular surgery, it's rare to come across a healthy patient with the disease processes that we deal with. Personality wise, you want to be helpful under pressure and enjoy fixing things.
What previous experiences have helped you most in your current role?
My first job was at my family's restaurant! I started working there when I was in second grade, helping my family with cleaning and restocking. As I got older, I began running the cash register, serving, and cooking. This job taught me to help out where I am needed.
This principle works in medicine, as well. As a physician, our duties don't always align with the job description. Working in the service industry, I learned the importance of showing up and being present in the work. I learned to work hard and treat people with kindness. Those same characteristics apply to working in medicine!
Can you share a case you found especially rewarding?
When I was a newer attending, the hospital called me and asked me to come in because there was a patient in the emergency room with a ruptured aneurysm. I went in and the surgery went perfectly. Afterwards, I called the family and learned that the patient was the grandfather of one of the nurses on the Med-Surg floor.
This instance serves as a reminder to me that the patients I work on aren't only cases and procedures. These are people's family members. When I’m able to perform them, these life-saving surgeries make my job so rewarding and impactful.
Is there any advice you’d like to share with premeds?
To anyone going into a career in medicine, I would just remind them to be open-minded and stay curious. As you go through college and medical school, let your experiences and exposures inspire you.
Shadow as many physicians as you can, ask a lot of questions, and try out a variety of specialties to see what energizes you! Finding a mentor is also very important. They can help you figure out what their field is like.
Finally, don't compare your journey to others. Everyone has their own timeline and medicine itself is so hard, you don't need that additional pressure.
To learn more about Dr. Cole and his work, you can follow him on Instagram, TikTok, and YouTube.