The Rural American Surgeon

E38: The Colonoscopy Chronicles with Dr. Dan Margo

What happens when you're the only surgeon for hundreds of miles and every decision matters?
 
Host Dr. Randy Lehman welcomes Dr. Dan Margo, a seasoned rural surgeon from northern Minnesota, who has spent decades mastering the art of surgical practice in isolation. Dr. Margo shares hard-won insights from his years serving remote communities, including the unique challenges of being a visiting surgeon and the critical importance of collegiality in rural practice. 
 
They dive deep into colonoscopy techniques–including abdominal pressure maneuvers and advanced lesion removal strategies–while exploring everything from Miralax prep protocols to pre-anesthesia evaluation timing. Dr. Margo demonstrates why rural surgeons must be master diagnosticians, skilled technicians, and compassionate caregivers all rolled into one.
 
Tune in for an inspiring episode filled with practical surgical wisdom from the frontlines of rural healthcare, where innovation is born from necessity and every patient interaction truly counts.
 
0:00 Introduction
2:58 Dr. Margo's Background
5:22 Why Rural Surgery Is Special to You
23:52 How I Do It: The Colonoscopy
1:35:40 Financial Corner
1:37:06 Resources for the Busy Rural Surgeon
Resources Mentioned:
🌐 Foregut Disease Foundation course: https://foregutdiseasefoundation.org/2025-course
🌐 North American Rural Surgical Society: https://www.northamericanrss.org/
🌐 American Society for Gastrointestinal Endoscopy (ASGE) Guidelines: https://www.asge.org/home/resources/publications/guidelines
🌐 Cologuard test (alternative screening method for colorectal cancer): https://www.cologuardtest.com/

E37: Money Miniseries 1: What's the Point? Why Money Means Nothing Without Purpose

Introducing a new miniseries on money—starting with the question beneath the dollars: What’s the point?
 
Before we talk finance, we’re digging into foundations. In this episode, Dr. Randy Lehman shares an unexpected conversation with ChatGPT about evolution, intelligent design, and the meaning of existence—revealing why, for him, the evidence points to faith over chance.
 
But this isn’t just about science. It’s about worldview—how what you believe about life shapes how you handle money.
 
Dr. Lehman pushes back on the pursuit of wealth for its own sake, arguing that without a higher purpose, money is meaningless. He challenges listeners to redefine what it truly means to be “rich”—and why, in the end, the means are the ends.
 
This episode sets the stage for the entire series: exploring money as a tool for freedom, purpose, and lasting impact.
 
0:00 Introduction
2:15 The Most Important Question
3:30 A Conversation with ChatGPT About Evolution and Design
15:40 Why Darwin's Finches Don't Prove Macroevolution
18:55 The Cultural Fallout of Teaching We're Cosmic Accidents
25:30 ChatGPT's Stunning Response
31:20 From Utilitarian Thinking to Faith-Based Purpose
34:10 Money as Freedom vs. Monument Building
36:05 Redefining “Rich”
 

E36: Saving a Dying Hospital with Dr. Manu Kaushik

What happens when a rural hospital loses its only surgeon and faces closure?
 
Host Dr. Randy Lehman welcomes Dr. Manu Kaushik, who stepped in to save a dying critical access hospital in Greenville, Alabama. After 40 years of service, the hospital's longtime surgeon retired, COVID hit, and the OR shut down completely - threatening the entire community's access to care. 
 
Dr. Kaushik shares his incredible journey of rebuilding surgical services from scratch, training staff, fixing broken equipment, and literally buying his own instruments to keep patients from having to travel hours for basic care. 
 
They dive deep into his innovative modified Smead-Jones hernia repair technique, discuss IPOM and component separation procedures, explore the transition from laparoscopic to robotic surgery, and cover everything from inguinal repairs to emergency trauma management.
 
Tune in for an inspiring episode filled with practical surgical techniques and unforgettable stories from the frontlines of rural healthcare.
 
0:00 Intro
1:54 Dr. Kaushik's Background
6:43 Why Rural Surgery Is Special to You
11:00 How I Do It: Ventral Hernia Repair
20:22 How I Do It: Smead-Jones Stitch
28:23 How I Do It: IPOM Technique
35:13 How I Do It: Robotic Inguinal Focus
43:51 How I Do It: Mesh Placement in Hernia Repair
55:48 Financial corner
1:06:06 Classic Rural Surgery Stories
1:23:18 Resources for the Busy Rural Surgeon
Resources Mentioned
 
🌐 American College of Surgeons (ACS) Rural Trauma Development Course: https://www.facs.org/quality-programs/trauma/education/
 
🌐 ACS Stop the Bleed Program: https://www.stopthebleed.org/
 
🌐 ACS Rural Surgery Resources: https://www.facs.org/for-medical-professionals/education/programs/so-you-want-to-be-a-surgeon/section-iii-surgical-specialties/rural-surgery-program/
 
🌐 MGMA (Medical Group Management Association) Data: https://www.mgma.com/mgmadata

E35: Carotid Endarterectomy Mastery with Dr. Michael Roskos

How do you perform a carotid endarterectomy with confidence while ensuring patient safety in a rural setting?
 
Host Dr. Randy Lehman welcomes Dr. Michael Roskos, his former program director for the rural surgery track at Mayo Clinic, to dive deep into this critical procedure. They explore patient selection criteria, detailed surgical techniques, and the evolution of vascular surgery practice over the decades. 
 
Dr. Roskos shares his experience practicing in La Crosse, Wisconsin, and his weekly surgeries in the small town of Arcadia, where he operated on patients whose families he'd known for generations.
 
Tune in for an in-depth discussion where technical mastery intersects with the unique demands of rural healthcare.
 
0:00 Introduction
1:52 Dr. Roskos’ Background and Path to Rural Surgery
4:11 Why Rural Surgery Is Special to You
6:08 How I Do It: Carotid Endarterectomy
29:30 Financial Corner
33:49 Classic Rural Surgery Story
39:30 Finding The Right Surgical Volume Balance
43:21 Resources for The Busy Rural Surgeon
45:03 Outro
Resources Mentioned
 
🌐 Rural surgery listserv: https://gaggle.email/join/distribution-list@rural-surgery.ca
🌐 National Comprehensive Cancer Network Guidelines (NCCN): https://www.nccn.org/guidelines/
🌐 UpToDate - Medical Resource recommended by Dr. Rosko: https://www.uptodate.com/

E34: Rural Surgery on the Cutting Edge with Dr. Greg Gerrish

What does it take to bring advanced foregut surgery to a rural hospital?
Host Dr. Randy Lehman sits down with Dr. Greg Gerrish, a third-generation surgeon practicing in South Dakota, to talk shop on the real-world challenges and wins of rural surgical care. From Barrett’s esophagus to emergency thoracotomies, Dr. Gerrish brings both technical depth and day-to-day experience to the conversation.
They cover Dr. Gerrish’s approach to laparoscopic hiatal hernia repair, his reasons for avoiding bougie-assisted intubation, and how he selects patients for LINX procedures. He also walks through a high-stakes trauma case that required fast thinking and decisive action. 
 
This episode offers a look into the kind of surgical work being done far from academic centers—but with no less precision or purpose.
 
0:00 Intro
3:23 Dr. Gerrish's Background
10:25 Why Rural Surgery Is Special To You
13:46 How I Do It: Laparoscopic Foregut
1:03:48 Financial Corner
1:04:49 Classic Rural Surgery Story
1:12:21 Closing Thoughts
 
Resources Mentioned:
🌐 Foregut Disease Foundation course: https://www.forgutdiseasefoundation.org/
🌐 Comprehensive General Surgery Review Course (Mayo Clinic): https://ce.mayo.edu/surgery/content/comprehensive-general-surgery-review-course-2024

E33: Bariatric Breakthroughs in Rural America with Dr. Kabir Mehta

What happens when Mayo Clinic precision meets small-town grit?
Dr. Randy Lehman sits down with Dr. Kabir Mehta, who never expected to land in Hazard, Kentucky–population 5,000–but now finds deep purpose in bringing advanced bariatric care to a region where patients used to drive hours for a specialist. 
This honest doctor's lounge conversation covers the real stuff: Dr. Mehta’s surgical strategies for handling bariatric emergencies, how he earned trust in a town where everyone knows everyone, and what it takes to not just survive but thrive in rural practice.
They dig into technical hurdles, financial realities, and those 2 AM moments when you’re the only one on call. But it’s not all struggle–there’s something powerful about practicing medicine where you know your patients’ stories and see the difference you're making every day.
0:00 Intro
5:11 Dr. Mehta's Background and Practice
14:42 How I Do It: Bariatric Emergencies
26:28 Managing Internal Hernias in Bariatric Patients
48:13 Embracing Failure and Learning from It
59:30 Missed Shuttle Story
1:08:48 Closing Thoughts
Resources Mentioned:
🌐 White Coat Investor: https://www.whitecoatinvestor.com/
▶️ Dr. Kabir Mehta's YouTube channel: @KabirMehtaMD

E32: The Art of Adaptability in Rural Surgery with Dr. P.J. Reddy

What does it take to thrive as a rural surgeon for over four decades? 
Host Dr. Randy Lehman welcomes Dr. P.J. Reddy, a most adaptable and resourceful rural surgeon who shares his journey from India to settling in Kansas, where he practiced for 41 years. 
Dr. Reddy discusses his experience with colonoscopies, offers financial insight for medical students, and emphasizes the importance of a broad skill set for rural surgeons.
Tune in for an episode packed with wisdom and inspiration for every medical professional committed to excellence in rural healthcare.
0:00 Intro
5:11 Dr. Reddy's Background 
12:32 Why Rural Surgery Is Special to Dr. Reddy  
14:47 How I Do It: Colonoscopy  
25:12 Financial Corner
32:24 Classic Rural Surgery Stories
35:44 Resources for the Busy Rural Surgeon
39:16 Closing Thoughts
 
Resources Mentioned:
🌐 Rural surgery listserv: https://gaggle.email/join/distribution-list@rural-surgery.ca
📚 Atlas of Color Human Anatomy by McMinn and Hutchings

E31: The Privilege of Practicing Back at Home with Dr. Gary Timmerman

What makes rural surgery uniquely rewarding and challenging? 
Host Dr. Randy Lehman welcomes one of the greats–Dr. Gary Timmerman, a distinguished surgeon from South Dakota–to share his journey and insights into rural surgical practice. 
Dr. Timmerman discusses his career path, the role his faith has played throughout his many years of surgery, and offers a detailed exploration of esophagectomy techniques and feeding tube placement.
Tune in for an episode packed with wisdom and inspiration for every medical professional committed to excellence in rural healthcare.
0:00 Intro
5:57 Dr. Timmerman's Background 
9:19 Why Rural Surgery Is Special to Dr. Timmerman
12:46 How I Do It: Esophagectomy Techniques
24:02 Tips for Diagnosing Esophageal Cancer
38:45 Colonic Conduit and Anastomosis Techniques
53:24 Financial Corner
55:45 Faith's Role in Dr. Timmerman's Practice
58:33 Classic Rural Surgery Stories
1:02:40 Resources for the Busy Rural Surgeon
1:07:34 Sanford Health Residency Programs
 
Resources Mentioned:
🌐 American College of Surgeons (ACS): https://www.facs.org/ 
🌐 North American Rural Surgical Society: https://www.northamericanrss.org/
🌐 Sanford Health: https://www.sanfordhealth.org/
🌐 Sanford Medical Education division: https://www.sanfordhealth.org/initiatives/medical-education
🌐 South Dakota and North Dakota Chapter of the American College of Surgeons: https://www.sdsma.org/event-5616925

E30: Innovations in Rural Surgery with Dr. Eugene Shively

How can rural surgeons navigate the complexities of modern surgical techniques while maintaining financial stability? 
Host Dr. Randy Lehman welcomes back Dr. Eugene Shively, a retired general surgeon from Campbellsville, Kentucky, to explore this question. They discuss the critical role of rural surgery, delve into common bile duct exploration techniques, and examine the growing presence of robotic surgery in rural hospitals. Dr. Shively also brings up the debate about government-subsidized insurance and recounts a memorable case from his career. 
Tune in for a compelling episode packed with practical notes and inspiring stories for every medical professional.
0:00 Intro
5:18 Why Rural Surgery is Special to You
16:44 How I Do It: Laparoscopic common bile duct exploration
24:09 Volumes and equipment for common bile duct exploration
29:45 Open common bile duct exploration techniques
32:03 Dr. Shively's thoughts on robotic surgery in rural locations
38:11 Case discussion: Sigmoid colon polyp management
49:27 Financial Corner: Hospital employment for surgeons
51:17 Classic Rural Surgery Story: 1989 case
54:17 Resources for the Busy Rural Surgeon
56:12 Outro

E29: The Case That Changed Me

A family emergency gave Dr. Randy Lehman an unexpected perspective—from the waiting room instead of the operating room.
In this episode, he shares the story of his grandfather’s emergency gallbladder surgery and how that experience reshaped his approach to rural surgical care.
From the weight of urgent decisions to the strain of limited resources, Dr. Lehman reflects on how these events transformed his approach to pre-op communication and deepened his commitment to compassionate, patient-centered care.
0:00 Intro
5:28 Grandpa's emergency
11:26 Resource limitations in small hospitals
18:30 Unexpected turn of events post-surgery
24:38 Lessons learned
38:13 Importance of rural surgeons