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

For Dr. Randy Lehman, “rushing to surgery” sometimes means taking to the skies.

In this episode, he shares how aviation became an unexpected solution to some of rural healthcare’s biggest hurdles: time, distance, and access.

From unforgettable landings to the real-world logistics of owning and flying a helicopter, Dr. Lehman gives us a front-row seat to how this unconventional approach is transforming his surgical practice in Indiana.

...and let’s be honest, flying is just plain awesome!

0:00 Introduction

1:58 Family Aviation Roots and Grandpa's Flying Legacy

12:47 Trading Long Drives for Short Flights During Residency

19:51 The Real Economics of Maintaining Three Aircraft

25:31 Robinson R44 Operations and Beating the Air into Submission

29:23 Why a Helicopter Provides Crucial Direct Hospital Access

34:03 Getting a Helicopter License in Just 54 Days

38:17 Landing at Hospitals, Schools and Family Farms

41:53 Transforming Friends Through Rural Peace After City Chaos

47:03 Weather Limitations and Always Having a Safety Plan B

52:24 When $400 Per Hour Flying Actually Makes Financial Sense

54:08 Small Minds vs. Creative Rural Transportation Solutions

59:09 Designing an Intentional Rural Surgical Practice

Resources Mentioned:

Cleveland Helicopters https://clevelandhelicopters.com/

One Six Right https://www.onesixright.com/

Join host Dr. Randy Lehman as he welcomes Dr. Rebekah Wever, a passionate young rural surgeon who returned to her Appalachia, Ohio roots after training in South Dakota.

In this episode, Dr. Wever shares candid reflections on her first independent cases while delivering a masterclass on the innovative Transversus Abdominis Release (TAR) technique for complex hernia repairs. She reveals how her dedication to building healthcare resilience in her underserved Appalachian hometown means the difference between life-threatening transfers and keeping critical care local.

Whether you're a healthcare provider considering rural practice or simply curious about delivering exceptional surgical care in underserved communities, discover why Dr. Wever believes returning home might be the most rewarding decision a surgeon can make.

0:00 Introduction

1:26 Dr. Wever's Background

7:01 Why Rural Surgery is Special to You

8:49 How I Do It: Ventral Hernia Repair - Transversus Abdominis Release

37:55 Resources for the Busy Rural Surgeon

39:27 Financial Corner

42:01 Classic Rural Surgery Story

Resources Mentioned:

Book: Hernia Surgery: Current Principles by Yuri W. Novitsky

After a week of medical missions in rural Honduras, host Dr. Randy Lehman sits down with Dr. John Haeberlin to reflect on their experience and discuss laparoscopic cholecystectomy techniques.

Dr. Haeberlin shares insights on robotics and breaks down an excellent "How I Do It" segment on a gallbladder case. Dr. Lehman also recounts a compelling case from their time in Honduras, offering a firsthand look at the challenges and decisions they faced in the field.

0:00 Introduction

1:41 Dr. Haeberlin's Background

3:26 Why Rural Surgery Is Special To You

8:10 How I Do It: Laparoscopic Cholecystectomy

38:47 Classic Rural Surgery Story

45:26 Financial Corner

47:04 Resources for the Busy Rural Surgeon

Host Dr. Randy Lehman sits down with Iowa rural surgeon and former Navy doctor, Dr. Dave Kermode, for a gripping deep dive into an emergency C-section case. Together, they explore the key differences between elective and emergency C-sections in a rural setting, offering valuable insights for general surgery residents. Beyond medicine, they also discuss the intersections of finance, marriage, and faith, making this an episode packed with wisdom both in and out of the operating room.

0:00 Introduction

0:48 Dr. Kermode's background

4:08 Why Rural Surgery Is Special To You

7:55 C-Sections as a Rural Surgeon

16:59 OB Department Closures

29:01 How I Do It: Emergency C-Section

52:24 Technical Differences: Elective vs. Emergency C-Sections

1:03:02 Financial Corner

1:11:22 Classic Rural Surgery Stories

1:13:21 Resources for the Busy Rural Surgeon

Resources mentioned:

North American Rural Surgical Society

Really Rural Surgery Podcast

Rural Medical Training Collaborative

Welcome back for this Part Two conversation with host Dr. Randy Lehman and distinguished breast surgeon, Dr. Mel Johnson. Listen for a technical walkthrough on sentinel lymph node biopsy, plus a very unique bonus “How I Do It” section involving surgery on a farm! Stay through the end for Dr. Johnson’s powerful encouragement for the new resident who might wonder what life looks like ahead.

00:00 Introduction

02:39 How I Do It: Sentinel Lymph Node Biopsy

05:43 Ongoing Trials in Breast Cancer Surgery

13:27 How I Do It: Patient Prep

20:54 Resources for the Busy Rural Surgeon

21:57 How I Do It: Piglet Hernia Repair

26:52 Financial Corner

28:43 Classic Rural Surgery Story

Resources Mentioned:

NCCN Guidelines

CoC Guidelines

New England Journal of Medicine article: "Sentinel Lymph Node Biopsy in Early Stage Breast Cancer: Is It Obsolete?" by Monica Morrow (December 2024)

INSEMA trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer

SOUND trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer

Host Dr. Randy Lehman welcomes Dr. Mel Johnson, President of the North American Rural Surgical Society and Program Director at Gundersen Lutheran in La Crosse, Wisconsin. This Part One conversation highlights breast cancer treatment, focusing on sentinel lymph node biopsy and the decision-making process for prophylactic mastectomy. Tune in for Dr. Johnson’s insights into implementing comprehensive breast cancer care in rural settings, emphasizing the importance of multidisciplinary approaches and overcoming barriers.

0:00 Introduction

1:43 Dr. Johnson's Background

8:33 Residency Program Updates

14:54 How I Do It: Sentinel Lymph Node Biopsy (Patient Prep and Anecdotes)

25:40 How I Do It: Sentinel Lymph Node Biopsy (Technical Details)

34:33 Overcoming Obstacles in Rural

In this Part Two episode, host Dr. Randy Lehman returns with PA Dan Leman—who flips the script and takes on the role of interviewer! Together, they explore the balance between technological resources and human connection, the complexities of ethical decision-making, and the role of humility in a surgeon’s journey. Don’t miss this insightful conversation packed with thought-provoking perspectives and real-world experience.

0:00 Intro

5:03 Unexpected rectal cancer during surgery

11:19 Importance of humility in practice

17:41 Culture of humility among rural surgeons

22:37 Critical access dollars and healthcare policy

29:26 Investing in rural communities

Resources mentioned:

UpToDate

Rural American Surgeon Facebook page

Critical Access Hospital program