Exploring the Human Side of Healthcare with Dr. David Salko

Lisa Belisle: She should be. Actually, Dr. McDreamy, doesn't anybody want a picture with him?

David Salko: They do. So I think he's a great guy, and the brief conversations we have, he's so supportive of the community, which is really cool, and supportive of the work that the Dempsey Center does. So giving back to that felt good. If I were to go online and say, hey, I need to raise money for something, based on the work that I do as a primary care doc, it's very giving work, and you explore your generosity a lot in what you give for time. I don't like asking for stuff for myself, but this felt really good to be able to say, hey, I'm raising money for this thing, this is a really good endeavor, can you support it? And a lot of people did, including yourself, which I appreciate. So this is something that I think will grow for me in being able to support the Dempsey Center with spreading their ability to take care of patients and support patients through cancer. It really helps a lot of primary care offices too, because we might not have the same amount of time to talk to somebody about a cancer diagnosis or the mental aspects that go into being a survivor of cancer. So those things were inspiring enough, and getting into it, I think, was like most of the things in my life, they just showed up and I said, all right, let's have a go at it, and I'm really happy with it.

Lisa Belisle: So the thing when I visited the Dempsey Center that I was struck by is that it's a very holistic approach. They meet patients where they're coming from. So if you're a patient who needs a group counseling session, then they've got that. They've got resources, they do acupuncture. I know you and I recently were in touch about that. They have massage. They deal with patients of all ages. And I think this is something that, particularly in the Lewiston area, but certainly in many parts of Maine, there's just not that access for patients.

David Salko: And I think now they're going to have mobile access, so they'll be able to go to more patients rather than having to come to the center, which is exciting for them. Certainly, I think you can agree from the primary care aspect and what we've done as family physicians, that there's more to medicine than just the medicine. Have you selected the right anti-hypertensive medication? Are they on a cholesterol pill? Are you following all the guidelines? There's way more to that than just the medicines and taking care of people. And the example of the Dempsey Center is really about taking care of people's spirit, their heart, their mental health. A lot of those things are wound up in that. When those things are well and supported, I think the medicine goes much better. I've taken care of many, many people that have had cancers. The patients that I've seen do well, I guess from a medical standpoint, are those that have the support and they seem to have a mental state that's a positive outlook. They always have a good attitude. Even when things might not be so good, they take on the challenge, like the Dempsey challenge, knowing that the journey is really where they're going to get effort from, not where the end is going to come. So I think that's important, to continue to have venues like the Dempsey Center and probably in primary care offices and other offices to support folks' mental health and how they get through things.

Lisa Belisle: Well, that's a really good point. And I know that there are many offices now that have co-located behavioral health services, and I think that is really powerful, because back in the day, and probably when you and I started, we actually had a little more time to talk with patients. Our schedules were not quite as jam-packed. And I actually believe that patients have become a little more complicated over the years.

David Salko: I agree. The system of medicine is a tough one. It's driven by things like volume and access. And medicine only gets more complicated. It's not like we got rid of three classes of pharmaceuticals, we just keep adding them. So there are a lot of challenges. Patients have become more complex. When they do get an office visit, there's low access. They need more in that short period of time. And that's a challenge. I don't exactly know how the system will solve that. I'm excited to be a part of it, of course, but I think it's going to take a lot of creativity and a lot of efforts to find different venues to meet that challenge that the patients need.

Lisa Belisle: Well, and I think that is the opportunity for us in medicine, is that we kind of open up the definition of a team, and we open up the possibility that patients might have other places that they can go to access different parts of their care. And it doesn't always exist. But I think when it does, it's so powerful, because we as doctors, or if I'm a nurse practitioner or I'm a physician assistant, I just cannot do everything for a patient. And I'm not sure that we ever really should have tried to be everything for a patient. That's my opinion. What do you think?

David Salko: I agree. Historically, the training was the one-person show. You're the doc, you make the rules, you set the prescriptions, you do all the things. Now, realizing where medicine has gone in the last two decades, it's a team sport. And if you're not playing a team sport, you're probably at significantly higher risk for burnout, which I prefer to call lack of engagement, but everybody's a little crispy. Knowing that you have other people helping you care for your patients and their needs is vital. The idea that one person can do all that, it's not even imaginable now.

Lisa Belisle: So I know that you and I both happen to have fathers who had practices in small towns for many years. And having met your mom, who is just a wonderful individual, who also was sort of part of that running of the office when there was a family practice that your family had, do you feel like there's something that we can learn from those spaces, which increasingly rarely exist, from having the small practices in the smaller towns where everybody is known?

David Salko: Yeah, one of the probably richest elements is the relationship and trust. So if you have a team and everybody really knows each other, they know their strong points, they know their weak points, they know what they need help with, they know when they're run down, and you have the trust that, hey, I need this done, this is a today thing. And when it's family backing you up, that's very strong, but it grows from there. And I think the relationships and trust that existed in those small-town one-doc offices were amazing. And that element needs to still live in today's system. If you don't have some of that glue that binds people together in an office, it's far less successful. It's always the idea that the sum is greater than the parts. And that's really demonstrated in small family medicine offices of the past, and maybe of the future if we can figure that out.

Lisa Belisle: Given that my dad, Charlie, because he was the reason you came to Maine.

David Salko: He's the reason.

Lisa Belisle: Okay, well, there you go. The reason you came to Maine. He helped educate literally generations of family doctors and arguably other clinicians around the state and probably around the country. It was always funny for me to meet his patients because they'd say, oh, you're Charlie's daughter, I've heard about you. And it became very clear that my father would mine the stories of our ten-sibling family to share with his patients to help with their parenting conundrums, let's just say. And so I would hear stories that were fed back to me about myself that I had not realized had been shared in a really respectful way, I think. I'm wondering, did you ever have that experience yourself, where you would hear about things that your parents might've shared about your experience in a family?

David Salko: I think that had to happen on a regular basis. I sometimes tell my boys, I'm like, there's two ways you can learn things in life, from your own mistakes or someone else's. And along the way, I can remember that my dad would share stories, and definitely you knew we were part of a crowd. When I was in school or anywhere else, they would pick out the Salko kid. I was one of five kids, so only half of what your dad created, but still a lot, still a good pile. But you knew that. And I know he shared stories about us in the office, and I did get a chance to practice with him later. I don't think anything came back too aggressive from it. But people would often come in, we call them super adults now, they would come in and say, oh, I remember when you were little. I remember when you needed a diaper change here or there. And those kinds of things can be embarrassing, but it was amazing the amount of trust they applied from the stories that he would tell. So his stories might've been about us growing up, or how we did in sports, or how we did in school, but he was sharing this level of love and trust that he had for us and for me. And I got to feel that on the other end. And full disclosure, I do the same thing. So I go to the office and I might share stories about my kids, whether they're dating or how they're doing in sports. And I think that allows me to be a little bit vulnerable for patients, and it allows me to share some aspects of my life that I've learned from. They might not be super personal, but when it's an aspect of my family that I feel willing to share, I think it brings that human element in, and it says, I'm not some sterile white-coat-wearing ChatGPT AI bot providing you medicine today. I'm a real person, and I'm going to go home and I'm going to see my family after this. And I think the patients I've cared for a long time, they know my family, they know my style, and I think they appreciate it. And they'll often do things like, I know I came in the last appointment today, but I know you have to get home to your family. And that feels good. There's a shared respect in what we're doing, and that doesn't happen as much anymore. So it does take time. As you've practiced for a long time, I think it's probably somewhere around a decade of caring for people that you go, wow, I follow these people for enough time that I'm getting a lot of ripe fruit, I'm gaining the rewards of the time that I've spent caring for these folks. That feels really good. That's a real good hook to stay in primary care. For anybody considering it, stay in it, it's worth it. It's tough, but the longer you go, the more reward there is.

Lisa Belisle: I think that's definitely true, because change takes time. So if you have a patient who comes to see you, you can't expect that they're going to shift everything about their life and have a healthier lifestyle as a result of one conversation. Sometimes it can feel a little bit less rewarding than my sister and my brother, both of whom are orthopedic surgeons. They go in and they fix a body part. You and I, the fixing of the body parts, that doesn't happen with one surgery. So it is something that requires an investment. So I guess I wonder, one of the things I asked you about before we came on is that I've obviously had health issues, and I've mentioned on air before that I went through cancer myself. And I know that you also have had health issues, for sure. And as a physician with your own sense of vulnerability, do you think that that has lent a different perspective to the type of medicine that you practice?

David Salko: Definitely. I mean, anybody that goes through their own health challenges, I think they realize what the system provides, what a value health in itself is. When you don't have it or lack it, there's a lot of fear. There's a lot of anxiety built into that. Sometimes there's anger. So there's a lot of emotions around saying, wait a minute, I'm sick. Generally people who are younger, sometimes they're referred to as the Superman or the invincibility syndrome, the idea that I will never get sick. And one thing I've learned through my health challenges is that I'm really no different than anyone else. I'm built as a human. I will break down as a human. And the longer you do medicine, you see common courses and paths where people break down. I may have an advantage. I can see those pathways so that I can better prevent them. And then you share with other people how to prevent them. My story, and probably the most important thing that I learned, was you have to have certain things that you value in your own health. And one thing that I was short-changing myself on a lot was sleep. I think we're trained in a certain way to say, I may not need that sleep, I'm a resident, I can live for 48 hours on a few cups of coffee, maybe a few more. When you're younger, I do believe it's easier to recover. So it reinforces the idea that you don't need sleep. I have diabetes, and that's a challenge, to be able to manage blood sugars, eat right, not be tempted to have ice cream or cereal at night. Everybody goes through this, and I'm happy to share that with patients because I realize everybody goes through those same challenges. So having that, and the poor sleep, I did end up with an infection in my back, and it was pretty significant, to have sepsis and osteomyelitis, which is an infection in the bone. And that was a wake-up call to me. I think my wife would probably share it wasn't enough of a wake-up call. I got it again two years later. But since that time there's been a shift in how important I know certain essential elements are. So the lifestyle medicine that we might be more likely to talk to people about, sleep is important, and it's an essential element. I joke a lot with patients when they come in, especially when I see them for physicals. I say, there's only two medical problems. It's only two. You only have to worry about two things. And I simplify it for students that way too. I said, there's neglect and abuse. You're either neglecting your body or abusing it. And if you could eliminate those two things, that's most of lifestyle medicine. So I've enjoyed using that simplification to tell people to quit smoking, to get more sleep, to eat a little bit better. So they're making healthy decisions today for their tomorrow.

Lisa Belisle: I've never heard it simplified to that extent before. And I think it is really powerful because it just makes something pretty serious out of something that we may not think is that important. Like, oh, well, I'm just going to stay up a little later and I'm going to finish writing notes on my patients. I'm just going to get up super early tomorrow so that I can do chart prep for my patients. Both of these things, I think, are real-life examples you might be able to relate to.

David Salko: They are, yes.

Lisa Belisle: And you think of it as like, well, it's what I need to do to do my job. But ultimately, if that, let's call it abuse or neglect, either one, it does leave you less able to actually do your own job and to successfully navigate getting a life-threatening infection if you have insulin-dependent diabetes.

David Salko: I pushed myself to the limit, and the limit of that was the lack of sleep. And I guess the idea of maintaining that, for me, was important. It was also important, I think, for me to share that with people around me, which is what I encourage patients to do a lot. When you make a goal or you're going to make yourself a health challenge, tell as many people as possible. Don't fear the failure of it, because you'll still learn something. People that attempt to quit smoking, I don't know, it might be ten times they need to attempt. So those are lessons that I can take from my own experience and share with patients. And I think it does take time to do that. I don't know that people would want to do that right off, or how they feel comfortable doing that, but I think it's something that probably should ease its way into medical education, that we are normal, vulnerable humans, and we go through some of the same things that our patients do. In doing that, we can actually better serve them, no matter what our outcomes are. Sharing those challenges with patients, I think, can bring them down a path of better health. We might not always see the outcome, and I think that's part of the bummer, but you never know exactly when you're going to influence someone. So I think you always have to be ready to do it, whether it has an impact or not, the first time or the tenth time.

Lisa Belisle: I agree with all the things that you just said. And I also think that there's this interesting thing that we forget about, and that is that we're modeling behavior. So when we bring something to the table and we say, I think it makes sense for you to explore these as options for your life, but then we're not doing those things ourselves, that doesn't really make us very trustworthy as far as caring for patients.

David Salko: I'm finding it's the same as being a parent. So you aspire your children to do the best of all things, and we always want the best for our family, especially our children. And I wouldn't want one of my kids to trip over the same thing that I did with sleep. But yet today's environment pushes kids pretty hard, whether it's school or college or sports or something else, it does push them. And the end game, I don't think, is necessarily just being the most productive, or the most patients, or have the highest volume or revenue. The end game that I think I enjoy the most is, people will remember how you treated them. People will remember how it felt when you were with them, more so than most of the stuff that we say. So we can share, I'm sure you'll share with patients, sometimes, here's a journal article, and that might not be where they're at, but we can share it through another way. We can share it through a personal experience, and patients will remember that. It'll become memorable for them and stick a little bit more than just some static statistic that you can share.

Lisa Belisle: And I love this idea of the story, because when you're trying to convince somebody of something, sure, a statistic is very striking. If you are age 50 and you are a male, your opportunity for having a fatal heart attack is significantly increased over when you were 30, and whatever statistic that is, please don't be able to pull that up automatically because I'll feel embarrassed. But that is striking. And also when you say, and I was in a scenario recently where there was a person, and this actually happened, it impacted this person's family. I think there is the understanding that it's not just people's rational minds we're dealing with, it's people's emotions, and that as any sort of clinician, you actually have to understand how to communicate with people in order to help them move through a change, if that's what needs to happen.

David Salko: I do think, as I mentioned earlier, there is an art to communication, just in listening to a patient. Sometimes when I see another conversation happening, or I'm mentoring somebody, I can tell that they're thinking about their response. So they may not be listening to necessarily understand, but they may be listening to reply, which isn't always wrong, but if you are really in the conversation, you're listening, you're absorbing, and then you can understand their perspective and better reply. So I think there's things that come. I feel very lucky. I mean, I get to have 20 to 25 conversations a day with different people. It's someone different every turn of the door, but you learn some from each of those, and you sort of perfect your art of how you approach each person, knowing them, knowing what they expect, what you expect. And over time it really becomes fun. It really becomes rewarding.

Lisa Belisle: And I love that, because some people are more numbers, some people, you're talking to their emotions, and I think you're right. Until you actually spend time with somebody, you may not know that. And what I've found is that over the years, of many years now, of sitting with many people in many conversations, I can start to recognize patterns. I'm not going to pigeonhole them and say, oh, I know this person immediately just by this pattern that I'm seeing. But it's more like, oh, there's a kind of a conversational thing that I've noticed before. So how can I meet that person in a way that feels comfortable to them, and actually utilize these years and years of experience having conversations?

David Salko: I think it's really awesome. And I'm sure you've been to this stage too, where now you can make some of those implicit things explicit. You can explain to someone, well, I sat that time and didn't look at the computer because, and you had a sense of that, and a real ability to articulate that early on. And I know I didn't have that. I just walked in the room and hi. And then people would judge based on how I came in, I would judge based on what I saw. And now it's different. You can break down some of those stereotypes and really approach the conversation fresh, but also with this more expert experience of playing the sport of conversation.

Lisa Belisle: So there's two things that I give you so much credit for, Dave, and one of them is that, like my father in his generations of bringing people along in family medicine, essentially you've been a teacher for, again, decades now. Yikes. Which I saw in you, because I think you were a year behind me in residency, maybe two. So we were in residency at the same time. But even as a fairly young doctor, straight out of medical school, you always had that gift. You were always a teacher. But I know that you've just continued that all the way through, and it's so powerful that you have done that for people who are coming along. And also part two is that you are so great at reaching out to colleagues. You're so great at it. And I regularly, we'll just be like, oh, you free? Okay, let's take ten minutes. Let's talk about this. How are you doing? How are things? And I think right now in medicine in particular, it's so challenging, because we've lost a little bit of that professional journey idea, as learners early on and then as professionals in leadership, mid-career, whatever we call it. And you've managed to create this continuity, which I think is really admirable.

David Salko: Thanks. I always get embarrassed by compliments, and maybe that's something that keeps me going. I don't necessarily think so much about what I do or how many students I've had. I think fondly about most of the ones I've had, because I've had some great students, and there's the benefit of teaching, I get a lot out of it. So there's something there for me. Sometimes I'll say, maybe it's the ten-thousandth time I've seen someone with strep throat, okay, here's your antibiotic, out the door, but it's not an urgent care. You can use that to dance around the conversation with the patient, and there's an enjoyment in that. Maybe that's a little too selfish, but it's fun. I enjoy doing it. Not every situation is as easy as strep throat, but it's still an evolution of time with these patients. It's really enjoyable. So I wouldn't keep doing it, these things that you say I do so well, if I wasn't having fun doing it. Finding ways to have students find fun in it, I think, is sort of my, I'm feeling drawn more to that. How are we creative in our jobs when our jobs are becoming maybe less flexible? You've got the EMR, you've got restrictions on time. There are many rough spots in primary care, but where can you find space for creativity? I've tried to find space for that in myself, and I'm hoping that over time, that's something that I do more. So reaching out to colleagues, to me, is always exciting. I like to hear what other people are doing. What's going on? How do you run a podcast? This is something I dream about. I'm having my dream right now. Anyway, it's something fun and exciting. I think that people pursue their passions, and when you see it happening, it is joyful for me and joyful for them.

Lisa Belisle: I'm glad you were able to accept the compliment. I'm not great at accepting compliments myself, but also I know you to be a very humble individual, so I'm sure it is hard to hear a compliment. But it requires additional energy on top of being a doctor, a father, a husband, a brother, a son, to actually continue to do these things, to connect, to remain dedicated to being a teacher, to continue to work on. So I think the community building that you've done, it's very meaningful. So if you can accept that compliment as well, I want to make sure that you hear that from me.

David Salko: Thank you.

Lisa Belisle: So switching gears a little bit, I had the opportunity to interview your daughter. I think she was early on in her art career at Ringling College of Art and Design.

David Salko: That's right.

Lisa Belisle: Which I'm sure you're very familiar with the naming of, because you've paid probably some money towards them over the years.

David Salko: Yes, we've support education.

Lisa Belisle: You support education, support education for everybody. Yes, exactly. So I'm interested to hear how she's doing. And I know you have a daughter also who went into nursing.

David Salko: Nursing. Yep, yep.

Lisa Belisle: And you have a couple of other?

David Salko: Two boys that are hockey stars.

Lisa Belisle: Yeah. Great. So these are all good things, but I am interested, when you talk about creativity, you're clearly fostering creativity in your own children, and in really different ways. So I'd like to hear how they're doing, if you don't mind.

David Salko: Sure. I think that having the group of kids that we have is incredibly amazing. We're very blessed. Jen and I, all the time, have many conversations about our kids, creative and otherwise. Children are challenging, and you have your own, and they have to find their own path and their own passion. I think one of the biggest challenges for my eldest was what Covid did to create relationships through college. And that environment is incredibly challenging for kids now, to create relationships, and maybe this is why I am taking this year to create conversations. I called and talked to her, in fact I talked to her just before I got in here, and I said, hey, guess where I'm going? And she said, oh, I was there. So it was exciting for us to share that. So right now she has moved to Nebraska, and she's pursuing other jobs and other interests. She's been very interested in tattooing, and using that art and design. And I think initially, and this is me being vulnerable, initially I was like, what? Tattooing? Oh, no. But her reasoning for wanting to be creative in that environment was also something that I share, is being close to a person. It's a very personal thing to pick out and have a tattoo, and for the person to give it to you is kind of like in the office. I'm giving someone their first vaccine. You're explaining it, you're talking to them, you're designing it with them. So I think she will continue to develop herself with her creativity and also working with people. And you probably know this with your kids, you feel like you know them better because you've seen their trajectory. You're like, oh, I knew you when you were little and you've always done this. And they take that little encapsulated person to themselves and they grow it in some way that you didn't expect. So I know she has passion. I know she has drive, and I know she's a very strong individual, so similar to myself. She will want to do it her way. She will want to achieve her success her way, and I think that's probably the most important thing one of any of our kids can do, is to seek something out for themselves. The worst thing I would want them to do is what I said. So hopefully they're not listening to this podcast. James, Nate, clean your room. So that same parenting style that Jen and I share goes to all the kids. And you probably realize this as your kids get older, you go from being sort of the commanding type, it's time to do this, it's a schedule of that, to a coaching type, which is a little bit natural from what I do in medicine, that I can listen to them, I can hear them out. Sometimes I have to hold my breath, but then we talk about what their need is and what they're experiencing, and I sometimes share my experience, and sometimes I might intentionally hold back because there's a lesson that they have to figure out on their own. Julie, my second daughter, is now in nursing school at URI, and this is pretty special because she's sharing medicine. So she did the first couple months at URI, the first semester and a half, and enjoyed it, but it was a challenge. It was just the academic piece. Then she had the milestone of getting through organic chemistry, which everybody fights, and she did it, and she said, wow, I made it over that hill, I can do this. And now that she's doing more nursing-related courses, she's excited, an excitement that she didn't have maybe studying math or English. I feel like she's in a good spot, and she's going to find her passion. My boys, their passion is hockey. That's it. They love it. I'm so happy that we have hockey. I never played hockey, that came from Jen's family. Her dad always loved the Rangers, and she loves the Rangers. Sorry for all the Boston fans that are listening, but if I favored Boston, I would be kicked out of my house. So we watch as many Rangers games as we can, and we go to every one of the boys' games that we can. It's challenging when they start playing more, but watching your kid grow through a sport physically, to go from barely being able to skate to now scoring goals and feeling very confident with their play, it's really cool to watch that spectrum. I don't know that my boys appreciate how much they've improved over time, but you get to see it as a parent now, because everybody has video from when they were two. You can demonstrate it if you have to. There's lots of blessings that I'm thrilled to see, and that's the drive. I think that may be my balance in life, that you can't work all the time, you can't apply yourself to work. You have to spend some time being creative for yourself. Having a family is another balance point for me. If I did not have the challenges of having a family, the joy of having a family, the trips that we've taken, it would be a lot more dull for me, and I probably would not be as successful in the work that I do.

Lisa Belisle: I, for one, have always enjoyed having a front-row seat to your family. And in particular, your children are wonderful and Jen is fantastic.

David Salko: They wouldn't be here if it wasn't for her.

Lisa Belisle: You got to have that. I think you're absolutely right. And I actually think, in particular in a profession like medicine, you actually really do need to have other people in your family who have decided, okay, we're all in this together, we're all going to support this. Because if it were just me showing up and being a doctor, I don't know that I would have the, I guess, resilience that I have had as a result of having family support.

David Salko: I mean, her patience is incredible. When I read a book, I think it might've been in residency or right after, and I can't remember the name of it, it might've been The Power of Two or Medical Marriages or something like that. There are three parties in the medical marriage. There's the husband, the wife, and the job. And it can be intimidating to have that third party. And over time, yes, the job has always been something that has a demand that, frankly, I assumed, because I saw my dad do it, and I never thought much about the impact on my mom, what that meant for him to be out all hours. We went through that. When I worked with him in Pennsylvania, I pretty much modeled him, and I thought, this is not survivable, and it wasn't. So Maine was a breath of fresh air for us, to be able to start over and in that way commit to each other, commit to our life, our family, and having our set of goals. And that's just grown. I've watched, too, Jen, a lot of times when there's medical involved in a relationship, the other person has to take a backseat, and she's given so much of her time, and her career as a mom is incredible. I often tell this to people at work, she may not know this, but some people say, oh, how's your kids? How's everything? I'm like, oh, it's really busy, and it's hard, and it's stressful. And it's like, that's why I'm here in the office, because I can't handle that. The amount of stuff that she does and accomplishes is incredible. It's getting a little easier maybe in some ways, because there's not as many moving parts at home. And I think that's allowed her a little bit of time to stretch herself and decide, who am I? Where am I creative? What do I like to do? Right now, she's gotten into calligraphy, and it's pretty amazing stuff. If I tried to do it, it would be terrible. Doctor's handwriting is not meant to go into calligraphy. But she makes cards and things like that. And they're true expressions of what she loves to do. The detail in it is incredible, the dedication to it. So she's been learning that, and that's something that is original to her, and I hope to be able to provide her some space to expand that. And now, when we see those things in each other, we're like, oh, that's something you might want to grow, that's something you might want to support. And it becomes a little easier for us to make space and slide that third party, the medical career job, over a little bit and say, now we're going to do something else.

Lisa Belisle: Well, Dave, you said there were two reasons you came on this, and one was the ongoing kind of conversation creation, and one was the exploration of creativity. Do you feel like you've accomplished both of those?

David Salko: I think so, yeah. I always think it's fun to have conversations. You don't exactly know where they're going to go. It's like a movie you don't have the ending to.

Lisa Belisle: Well, and that's actually one of the things that I've most valued about connecting with you over the years, since we were residents back at Maine Medical Center in the day, is that neither one of us knew what was going to evolve over time. And some of the people that we keep in touch with who are residents, you mentioned Mike Steadi up at Central Maine, he is one of them for both of us. How could we possibly have known what we would look like a few decades in as doctors?

David Salko: It's pretty amazing. And I think the other piece to that to remember is, you don't know where you're going to be in the future either. So there should be some excitement in that. Not necessarily anxiety, but excitement, anticipation, seeing a trajectory move forward and not exactly precisely knowing what's next. Anticipation, it's a good emotion that I like to have, whether it's going on a vacation or just anticipating a day, what am I going to get to do today? So there was a lot of excitement in getting to the podcast.

Lisa Belisle: Well, I'm so glad to hear that. That makes me very happy. And I will say that you and I now have successfully followed in our fathers' footsteps and now shared conversations around our children that now are being broadcast, successfully, to anybody who's listening. So as much as our fathers did this with us as we were growing up, and shared us with their patients, we have now successfully done this with, I guess, anybody else who's paying attention.

David Salko: That's true. It's out there on the internet forever.

Lisa Belisle: Here we go. Forever. Yeah. And I will say, anything that I ever heard back regarding what my dad would say about me, it was never bad. It was always with a sense of pride. And so I want to just make that very clear. I'm assuming your father was the same way with you, that if there was stuff that was shared that was negative, people didn't come back and necessarily talk to us about it?

David Salko: No, no. It was the good stories. It was the funny stories. It was the awkward situations you got trapped in. And also it was the accomplishments that you made in life, that you knew if you heard that from someone else, and your parent had shared it with someone, they were proud of it. And it felt good to feel that you knew someone was watching and encouraged you along.

Lisa Belisle: Well, I hope that people, when you are doing your Dempsey Challenge, when you reach out to them this year, that they support you to the full extent of their abilities, whatever that looks like.

David Salko: That sounds awesome. I'll be looking for people to ride with. I'll be looking for people to support the Dempsey Center, whatever people feel they can do. Even if it's just the thumbs up on the pictures that I send out, sometimes that feels good, and that little bit of encouragement goes a long way.

Lisa Belisle: Well, very good. I'm sending that out there to the world, support Dr. David Salko with the Dempsey Challenge. And I really appreciate you. I appreciate all that you've put into being a doctor, being a parent, being a friend, being a colleague, and also taking the time and coming in and talking with me today.

David Salko: Thank you. I will say that I'm incredibly happy to have this opportunity. This was a lot of fun.

Lisa Belisle: It was a lot of fun for me too. I'm Dr. Lisa Belisle, and you have been listening to or watching our video podcast called Radio Maine, where we celebrate creativity and the human spirit. We are sponsored by the Portland Art Gallery in Portland, Maine, and today I've been speaking with my friend and colleague, Dr. David Salko. Thanks for coming in today.