Hi! I'm Mark Shrime. I work as a surgeon on a hospital ship in Africa, and I competed on American Ninja Warrior three times. AMA!

Hi Mark! How'd you become a doctor when you didn't want to be one?

Basically, it boils dow to being the first-born son of an immigrant family! As a first-born son of an immigrant family, I kind of only had four options: Take over the family business, become a doctor, become a lawyer, or become a failure.

I'd been majoring in biology (much to my chagrin—I wanted to major in music or linguistics), so doctoring was the logical next step

It must be difficult having that pressure on you. I know a few people who have had similar experiences with family pressuring them into approved career paths. It's awful.

Have you considered changing careers now that you've proven yourself? With a resume like that you could probably do anything you like now.

My career is already pretty non-traditional. I haven't seen patients in the US, for example, since 2018, focusing all my clinical work in Africa. I do a lot of research, teaching, writing, and advocacy these days.

I can't say I know what the next ten years will look like, but, ten years ago, I wouldn't have predicted today. And I'm ok with that. As long as I'm working toward my own why, then I'm where I'm supposed to be.

Dang, engineer wasn't even an option?

Well, the family business was engineering!

Oh hi Mark. Are you able to effectively train for such a highly specialized sporting event while on board a ship? I know most large civilian ships have some kind of exercise equipment or something, but are you just doing mad parkour all over the deck or what?

I'm so glad to have you as a best friend

And yes! I can train. How effective it is, though, is a bit questionable. It's a lot of hanging off things, pulling up stairs backwards, and the like.

On the Africa Mercy, there's a gym but it's fairly small. Mercy Ships has built a second, larger ship that I haven't personally seen yet. The gym looks a lot bigger there!

What specific African countries have you been to (assuming you are allowed to get off the boat?)

Do you have a favorite?

In Africa so far: Morocco, Senegal, Guinea, Sierra Leone, Liberia, Ghana, Benin, Togo, Zambia, South Africa, Congo-Brazzaville, and Madagascar.

Liberia was the first country I worked in with Mercy Ships, so it's got a special place in my heart. In terms of sheer natural beauty, it's hard to beat Madagascar!

Hi Mark, I work in a hematology-oncology cellular therapy program. With your hospital being on a ship, are you mostly dealing with acute issues, or is there long-term care available for chronic diseases? You say you do surgery, I am curious what the extent of your resources are in treating cancers. Is chemotherapy also available, for instance? What about outpatient medications? Diagnostic equipment?

I love reading about global and public health (Paul Farmer is one of my personal heroes) and I will put your book on my reading list!

Hey thanks! I'd love to hear what you think of the book.

The ship I work on focuses almost exclusively on "cold" surgical conditions—in other words, we aren't a trauma center, and we don't provide exclusively non-surgical medical care. We primarily treat things like large, disfiguring tumors of the head and neck, burn contractures, obstetric fistulas, facial clefting, etc.

The question of malignancy is a very good one. As you know there is a cure rate for malignancies with surgery alone, but it's not nearly as high as it would be with the ideal multimodal therapy. To a large degree, then, we only treat malignancies that can be approached with surgery without adjuvant therapy.

There are pros and cons to this approach, for sure. It's one of the bigger ethical questions (I believe) that a ship like this can face.

How has the pandemic affected Mercy Ships?

Well, the short answer is: the ship hasn't done surgery since early 2020. Because early in the pandemic it became clear that ships and covid don't mix.

We've learned a lot since then about covid (we, surgeons on Mercy Ships, and also we, the scientific community as a whole). We've instituted a lot of safety protocols, so, fingers crossed, we can get "back in the water" soon!

Hi Mark, any advice for medical students or early career physicians looking to make global health part of their medical career/journey but unsure of what that might look like (or where to even begin)?

Such a great question. I'd answer differently for medical students than for early career physicians

For medical students and trainees, be the best medical student / trainee that you can be! In other words, for a while you might have to de-prioritize global health. Two reasons I say this: first, in countries without well-developed preventative systems, and in which access is difficult, you're likely to see patients with disease you've never seen in your home country. You want to be the best doctor that you can be for the patients you'll see.

Second, there's (unfortunately still) a presupposition among some members of the medical establishment that global health is something of a vacation—that people who are interested in global health aren't "serious" doctors. It's on us to dispel that notion.

For early-career physicians, I'd ask how much of your career do you want to devote to global health? 5%? 10%? 80%? As a colleague of mine says often, "Start with the end in mind." If you know you want 80% of your career to be devoted to global health, then that should influence everything from what you specialize in to what you negotiate into your contract, to even what kind of practice you join / mortgage you apply for / etc

How long does it take from when you get the call to when you do the taping for a Ninja Warrior episode?

When I was actively competing, it was only 3-4 weeks. Things have changed with covid (and I haven't applied during the covid years). Calls are going out earlier this year than ever before!

Hey, Mark ! Is it more difficult to work on hospital ships ? (didn't even know it existed, but we learn something everyday, don't we ?) Have a good day !

It's not necessarily more difficult. It's just different.

Mercy Ships is quite well-equipped. It's rare that there's an instrument I need that I can't find.

Sometimes, though, the operating room lights will swing away from me!

I was wondering about this too. Is your operation table like those pool tables on ships? Where they balance out so it's a stable surface?

Happy cake day!

Sadly, no. I wish they were stabilized!

Hi, Mark, which do you prefer, Depeche Mode or The Smashing Pumpkins?

Depeche Mode. Like any good Gen Xer

Why did you want to be an ENT surgeon?

I kind of fell into ENT.

I initially thought I'd be a nephrologist or an ID doctor, but I didn't enjoy my internal medicine rotations. Surgery was more compelling.

Since I never wanted to be a doctor anyway, though, I didn't want the life of a trauma surgeon. I wanted a specialty that would give me enough free time to pursue the other things I wanted to do with my life. ENT seemed to fit.

(Side note: I also learned an important lesson. Don't pick a speciality because you want to get away from it as much as possible! Not the wisest way to choose what you'll do for the rest of your life)

What would you like to promote on this AMA?

My book!

In all seriousness, I truly believe in the message in the book: after years of trying to figure out what the heck I wanted to be when I grow up, I've realized that unless we're living right in the center of our own why, we're never truly content.

Hey Dr. Mark...

What is your reason of not wanting to be a doctor?

Also how has it changed your perspective once you became one?

I wish I knew why I didn't want to be a doctor. All I know is that my handwriting is terrible, so my parents would joke that I was of course going to be a doctor. And I'd react viscerally—"No! I don't want to be a doctor. I want to be a rock star."

I'm glad I'm a physician now. And at the same time, I'm glad I've gotten lucky enough not to follow the traditional doctor path

You are a physician now? Am confused??? Thought you were a surgeon?

Oh, hey, this may be an Americanism I'm using.

You're right that there's a distinction between the two. In the US, however, "physician" often encompasses everyone who's a doctor. I'm not sure where you're writing from but, for example, we don't have the distinction that the UK system has between "Dr." for medical physician and "Mr. / Ms." for surgeon

Does your last name rhyme with rhyme?

All the time.

Hi Mark,

Has your experience working in Africa in any way changed how you would practice medicine state side or anything that kind of challenged things you were taught in medical school? Great work btw!

Absolutely! In fact, I love bringing residents with me to the ship, because the breadth of the pathology we see challenges us to think about the anatomy a lot more deeply.

There are definitely techniques I've learned from my African colleagues that I brought back to the operating room at home.

What can the average American do to help facilitate wellness in Africa?

Advocate! Aside from getting involved with the direct care, advocate advocate advocate.

The COVID pandemic has (among other things) really exposed the inequities in access to healthcare. There are over 60 surgeons per 100,000 people in the US, and 0.8 in some African countries. The high-income-country population is something like 5x more likely to have been vaccinated against COVID. These things didn't happen by chance.

They happened through what Paul Farmer calls the "historically given and economically driven" structures that underpin poverty. As people who have won the birth lottery, I believe it's incumbent on us to work to reverse those structures.

Hi Dr. Shrime! How do you find the time to succeed in all of your various pursuits? Impressed with all you’ve accomplished and congratulations on your upcoming book!

Hey, thank you! I hope you like the book!

Thanks for the AMA. I’ve always been curious about the surgery ship and what that practice experience must look like. A few questions.

What does your triage process for the OR look like? What happens when the determination is made that surgery is not an appropriate option?

How many surgeons of various specialties work on the ship, and how do you handle assistants? Do you have your own people, or are there some Uber-skilled assists who help with whatever comes?

Could you give us an example of something typically considered disposable that you’ve figured out a repurpose for?

Thanks for doing the work. And the AMA!

These are great questions!

There is a screening team, composed of nurses who've worked on the ship for a while, who are the first line of triage. They see potential patients, both in the port cities and up-country. They know what we treat and what we don't, so they screen out the ones whom they know we don't treat.

Then, every two weeks, these patients are seen by the surgeons who make the final decision for surgery.

At any one time, there's usually 1-2 surgeons per specialty on the ship, working alongside surgeons from local hospitals. I can sometimes bring a resident with me, and sometimes not. The OR team we work with is super skilled. Honestly, the OR team lead I work with is one of the most skilled person I've ever worked with.

And that disposable question is great. My favorite story is when we had to do some telesurgery, dialing in a neurosurgeon from the UK. We strapped a phone to the anaesthetic machine, angled it into the field, and did surgery over whatsapp. It went super well!

mark what the actual fuck? are you just out here doing all the sidequests in life

What can I say? I'm a completionist.

On the ship, how many surgeries do you do on average in a day?

It depends on the specialty! Ophthalmology can do 20-30. Head and neck, we're more like 1-3.

Hey Mark,

Such a fascinating story you have! What are some of the beauties and wonders of sub-Saharan Africa that nobody really hears about?

Also, how do you actually get on the show? Do you have to do some sort of fitness test before being chosen to appear on the show? Thanks!

Oh gosh, I love traveling through sub-Saharan Africa. Every country has its beauties. The Volta region in Ghana. Robertsport in Liberia.

If I had to pick one, however, it would be the Tsingy De Bemaraha park in Madagascar.

Getting on ninja warrior is just a matter of applying. The application is about 8 pages of questions you fill out online, and a 3-minute application video. There's no fit test, per se, but our videos usually showcase something athletic. Applications are already closed for the 2022 season, but keep an eye on the ninja warrior social media accounts for when 2023 applications open. It's usually late fall / early winter!

Do you think obstacle courses would make for a good Olympic sport?

YES! And also not yet.

The sport is still nascent. We have a few leagues, all of which operate under slightly different rules and scoring systems. There isn't an internationally recognized ninja body (although some are trying). And also there's the question of whether we're different enough from the obstacle course racing world (think Spartan, Savage, Tough Mudder).

Also—someone correct me if I'm wrong here—the IOC has rules regarding how many countries a sport must be represented in before it can be considered an Olympic sport. I don't believe ninja meets that criterion yet.

I love this! I have a friend joining Mercy Ships in a few weeks. Any advice you'd give her?

Oh that's great! I'm sure she'll love it. Do you know what she'll be working as?

If this is her first time, the best advice I'd give her is to meet as many people as she can! Mercy Ships draws absolutely fascinating people. Some of the best friends I have in my life, I've made on the ship.

Dr Shrime,

One of my mentors in residency would work with Mercy ship every year (with the exception of COVID). Without giving away too much identifying info and what not, any fun stories about a great guy Roy you may have worked with (Feel free to DM me)?

Ha! Tell the good doctor hi for me. We never really worked together, but he's great

Hey Mark, what was your's study tips to become the best student ?

Everyone studies differently! I'm a very visual learner, so I made heavy, heavy use of index cards.

I'd write everything I needed to know for the exam on individual index cards. One side would say something like, "Branches of the facial nerve" and the other would have all five branches on it.

I then would flip those cards every day. I would only take a card out of the stack if I could repeat everything that was on the back. If not, it stayed in rotation until I could.

Thank you very much.

Just one question your book is available in France ?

Yes! The Kindle version will release in France tomorrow!

Broad question but do you see a future where surgical interventions be combined with stem cell therapy? Love your work :)

Absolutely! There's a lot of work being done in this area.

Have you ever had an urgent surgery you needed to perform during a storm at sea... if so how do you counter the boat rocking?

Thankfully no. The ship docks for 1-2 years at a time in-country. If we do have to put out to sea (a risk sometimes with large storms), we don't do surgery

How fast can you run a mile at the moment?

Well, I basically destroyed my knee a year ago after a bad fall (tibial plateau fracture, ACL tear, medial and lateral meniscal tear). I haven't been cleared to run yet.

So at the moment? Maybe 20 minutes!

I am working hard to be a surgeon and serve on the ship as an ENT surgeon. I don't exactly know if actually want to be that specific surgeon as I want to be that surgeon after finding out about the ship. My only motivation is to work on the ship. But is this okay? Like I want to work on the ship as an ENT surgeon but not on land. Is it okay or right?

Hello, fellow ENT!

Honestly, what matters most is whether you're following your why (excuse the slight book plug). An old friend of mine from Mercy Ships used to say, "your mission is your mission. No organization is your mission" and I think she's right.

I've been working with Mercy Ships for the last 14 years: I clearly deeply believe in the organization and its vision. But what's ok with me doesn't have to be ok with you.

Have you gotten any reality show offers? It seems like following you around with a camera for a year would be very entertaining and educational.

Haha, I haven't. Yet?

How can you perform delicate surgeries when everything is moving?

The ship is docked while we're operating, thankfully. So, while it does move, it's not as bad as if it were in the open ocean

How does one even get there? Do you know if I someone can apply for an internship on the ship?

I don't know of any internships on the ship—but the crew is made up of not only medical people! Out of a crew of about 400, only 1/3 are medical. It takes a lot to run a medical ship: maritime crew, engineering, carpentry, electrical, food, finance, IT. You name it.

Hello,

RN here who is quite interested in getting involved in international relief work. Judging by the fact you've been with Mercy ships for years, I take it you believe strongly in their work. Unfortunately I think I need another year or so experience.

Any idea how competitive the application process is for us nurses, or things that can help make one stand out?

Do you know of other reputable organizations you would recommend? MSF has always been a dream, but my monolingual ass is a long way off from being qualified for them, and Google mostly brings up pay to play type organizations, which I find questionable.

Thanks!

Hello fellow provider!

I do believe strongly in what Mercy Ships does. It's also not the only organization out there! Definitely find an organization that meets your own mission.

The application process is fairly straightforward. Competitiveness depends on the specialty you work in! But Mercy Ships maintains a pool of applicants that they reach out to when positions open. So, it can never hurt to put the application in

Hi Mark, what is the most challenging part of your job? And can you share with us an important lesson that you’ve learned ever since you started to work on a Mercy Ship?

Working on a ship, which is a limited resource, in countries with limited healthcare resources sometimes leads to difficult resource allocation questions.

I think the most important lesson I've ever learned in working in resource-constrained settings is that nobody chooses to be poor. Poverty, as Dr. Paul Farmer says, is due to "historically given and economically driven" factors. It's not like you or I wake up one day and say, "I'd like to be born in the poorest country in the world, and I'd like to develop a tumor."

Taking the tumors out is the easy part. Changing the historically given and economically driven structures of dominance that lead to the tumors is the only way we'll make real change

You "..never wanted to be a doctor." - really? Not even while studying to be one? Were You forced against Your will?

Yes, not even when studying to be one. I tried to quit a lot of times! My poor dean of students!

Was I forced against my will? Not at gunpoint or anything, no. More by the pressures of familial expectation and filial duty

What is your favourite food, Mark?

So, in Lebanese cooking, there's this raw-lamb-and-bulgur dish called kibbeh neyyeh (naked kibbeh). It's amazing.

There is a lot to be said about direct clinical care in resource-limited countries undermining local institutions and governments from enacting their own health system. Does your work or Mercy Ships' role address this in any way? As an IM doc from Afghanistan (now in the US), I'm interested in Global Health, however, I have been put off quite a bit by it the more I dive into it and still want to find a way to contribute.

There absolutely is. I've written about this, as have many others. I wouldn't say that Mercy Ships has it all figured out either.

A lot of what we do is training and infrastructure development (I just am less involved in the latter, so I can't speak to it as well).

Global health has a real colonialism problem, which I'm sure you've sensed. It needs to change, and, as Audre Lorde writes, the master's tools will not dismantle the master's house. We absolutely, 100%, need it to be less and less driven from the Global North

I am looking forward to the book. From the brief summary it sounds like finding purpose for you meant taking quite a different career direction. As we look to address staggering amounts of physician burnout and dissatisfaction, do you think it's possible to find meaning and purpose within our current careers?

Absolutely! I tell the story in my book of my colleague at my first attending-level job. For him, being the best surgeon he could be, doing the best research he could, and providing the best life he could for his family really did seem to be his why. They weren't mine, obviously, but my why isn't yours.

I really hope for this book not to be prescriptive, but, instead, to help us look for the why in our own lives.

Hi Mark, any advice on how to become an American Ninja Warrior? Also what part of the body do you think is essential to train for American Ninja Warrior?

What I love about ninja is that it's an entire-body sport. You've got to have explosive power in your legs and the proprioception for balance and the upper body strength to hang for a long time.

If you have to start somewhere, though, I'd start with grip

Do you have to be smart to be a surgeon? Where you nature smarter? And some tips to study smarter

Look, sometimes I think you could train a well-behaved cat to do what I do.

The way med school is structured in the US, however, the surgical specialties often require higher board scores to get into. And yes, for sure, there's a lot of studying involved. I mentioned in an earlier answer that I relied heavily on index cards for my studying—but everyone learns differently. For me, just drilling the information over and over again until I could recite it cold worked the best.

Aloha, thanks for the AMA! Have you considered trying out for Japanese Ninja Warrior? It seems much harder and more personally rewarding.

I haven't! Maybe one day

Any plans to go to Côté d'Ivoire ?

I haven't heard of any yet!

Mark Shrime is a name I haven't thought of in a very long time. Glad to see all is well with you. Go Hawks!

My question: were your siblings able to pursue career choices of their liking, or did they succumb to the same scope of pressures that you did?

Always strange to see someone who knows you on an anonymous website!

My brother’s in film, so yes!

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I honestly don't remember how many employees my dad's business had. He drove an Oldsmobile (RIP). We didn't have any artwork on the wall. Some rugs that they'd brought over when they fled the war in Lebanon.

I went to university for four years, medical school for five, residency for five, fellowship for two. I got lucky (so to speak) by not getting accepted into the most prestigious (and therefore expensive) medical schools! State school medical tuition was a godsend, even if the rejections hurt. I worked during both my undergraduate and medical degrees. Once you graduate to residency, you start getting paid. Not a lot, mind you.

How were you motivated for 16 years to be a surgon?

A combination of familial pressure, filial duty, and sheer cowardice about what might happen if I got off that path

Hi Mark! I’m the coordinator of a ninja program. Unfortunately my bosses are really trying to gear it towards kids (4-13) with equipment that seems (to me at least) far too dangerous for the lower end of the age range that want it for. Do you have any suggestions about what kids around the lower age range would be able to do with such intense equipment?

Gosh I wish I knew! In my next life, I'll be a professional ninja

Have you ever been to Mercy Ships headquarters in Van, TX? What's it like beyond the gates? I've driven by there and always wondered.

I have, but only a couple of times. It's a nice campus!

Cool. That's for answering . Did you have to go there for training or just a tour? Where do the ships leave from? Are you out for a set about of time? Is it paid or mostly volunteer?

It's all volunteer!

For medical staff, Mercy Ships has a rule that you have to have been out of your training for at least two years (I'm not sure if that rule applies to non-medical crew).

The ships dock in host countries for about 10 months at a time, then two months per year are spent in dry dock. This happens in either South Africa, the Canaries, or Europe.

How long you're on the ship depends on your job. Some people have been living on the ship for over 30 years!

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Oh, that's the thing! I live my life in constant fear. Anxiety is a steady companion on this weird path. I wouldn't give it up for the world—I know I'm where I'm supposed to be right now—but that doesn't take the fear away.

That's honestly one of the biggest lessons ninja taught me. Standing 14 feet off the ground, and leaping for an obstacle you may or may not catch, is objectively stupid. Your brain's all, "No thanks! I'd like to go now." And you could. You could just step back off the obstacle.

Or you can jump.

A couple of days ago, Amanda Gorman wrote a tremendous op-ed in the New York Times in which she talks about almost deciding not to read her poem at the inauguration last year. She wrote,

Maybe being brave enough doesn’t mean lessening my fear, but listening to it.

So, friend, from one stranger to another—the anxiety is real. It's there. Listen to it. And then act according to your values anyway

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Absolutely!