Transcripts For CSPAN3 Dr. 20240705

Challenge. Thats why we are working around the clock to keep you connected. Were doing our part so its easier for you to do yours. Spark light supports cspan 2 as a public service. Munro carol jr. Hospital at vanderbilt. Pediatrics, Plastic Surgery and radiology. The vice chair of the department of neurosurgery. He has served on the editorial board, journal of pediatrics. Chair of the Host Committee of the cns section on pediatric neurosurgery in 2018. Serves on the executive committee of the American Society of pediatric nurse surgeons. In addition to scientific writing he has been a contributor to the New York Times sunday review. Garden and gone magazine. His scientific writing focuses on pediatric neurosurgery. Also the broader field of medicine and profound Lessons Learned of children and parents he cared for over the last 30 years. He will tell us all about it. Were looking forward to that. First, lets dive in. For those who have not read it, tell us about it. We meet a lot of children that i have cared for. Sophia. Little girl who came in the midst of the pandemic with a rupture in her brain. We met delilah, a sixyearold child with a brain tumor. We took out acutely and her vision came back and we had to navigate the fact that it was malignant. We met luke who was involved with a terrible motorcycle accident. Alyssa was involved in a self inflicted gunshot wound because of social media. We met so many children who have gone through challenging times. Who have, on the other and most of the time. With the phenomenal resilience and it was difficult for me to not see the grace within that. The shared moments of joy and cheryl. For me, the book really is about the children. There is something about my father who was a important figure in my life who passed away when i was a young resident. It is a little bit about my mentors who had impact on me and a little bit about the mentee residents who i worked with who still have an impact on me. Its a little bit about my other members of family, too. It started out to be a series of stories about patients. You unzip yourself and pour yourself out on the pages. You cant help it. You find a lot of commonalities between them and you. Lets talk more about that. Lets go behind the story and talk about your purpose. What was your purpose writing this book . Where did the idea come from and how long did it take to write . Two in 2017, i was going mach 5. I was a Program Director. I was in charge of the residency program. I had a couple other leadership positions at vanderbilt. I filled my day up 26 hours a day with things to do. All of a sudden, i found myself as opposed to sitting with the family, i used to look at xrays , now im working on a computer screen. Often times i would say that i could see the tumor and heres what to do. My chairman, thompson, i have taken this from him, but i still give him credit for, he has this study talks about being a piece of the plan. One of the things that you give people when there is chaos, when there is a issue like a brain tumor or a congenital issue, this is what it is. This is what we are going to do. This is when we are going to do it. A little bit of what we were talking about before, trying to get the sense of use. There are risks. This is how we will move through this. Instead of me saying those words, it was me hearing those words. It was another doctor showing me a tumor in my pelvis. That just hit me like a ton of bricks. I had surgery to have it taken out. I had a repeat surgery. I was basically on bed rest for 2 1 2 months. Not to be a star trek geek, i went to impulse power, maybe . I was stuck. There is only so much netflix that you can watch, i promise. My sister, sarah, is the ultimate enabler, in a good way. She said, why dont you write down some of the stories you tell us after and during dinner . I would not tell that many stories during dinner but it was a good idea. I wrote a story that was funny. I sent it to the New York Times and it was printed. It turns out that my editor there, peter, his stick is to take new writers and help them write more into themselves and write more. It does not matter if you are 50 or 22. He said this is a funny piece. Your pediatric neurosurgeon, why dont you write a serious piece . I did. I wrote a piece about a girl who was basically saved by a blackhawk helicopter who got her to the hospital in birmingham. At the end, many years later, she has recovered. We did surgery. I will get letters from her parents. One day i get a letter from her and they tell me that shes getting married and i was invited to her wedding. She told me how grateful she was for the blackhawk pilots and for the er doctor at that hospital. For me, all i could think of was how grateful i was to her. It was my first year of practice. That piece went out. The first piece i had emails from friends who said that was funny. That i was a funny writer. The second piece i literally had almost 1000 emails from people around the world about how much hope it gave them. When i realized, the pandemic was starting to raise its head. It was moving from wuhan to italy. There was a lot of anxiety in society. I realize that maybe there was a place for all of the things that these children have taught me about grace and resilience, grief, joy, how they go together in your hands. There is Khalil Gibran who wrote about this. Christian wrote about this. Buddhist, they have wrote about this. Phenomenal. If you are standing with joy, do not forget sorrow is laying on your bed waiting for you. For me, it was really the opportunity to say that i think i am going i have so many experiences with these children that are about joy and sorrow, i want to put them together in a book . Did you ever think you would write . I was a english major at the university of mississippi. I decided after doing both the premed track and english major track, i would go to medical school and be a Family Medicine dr. And i would write and get paid by patients about tomatoes and chicken. Thats really what i thought i would do. I remembered that every part of medical school is a anatomy lab. I went to the university of mississippi medical center. It really is a great medical center. I am proud of my time there. We really learned the anatomy. We really learned the physiology. When it was time to take care of patients, we were the ones taking care of patients. The time i got to duke, i had done more procedures and been involved with direct patient care than many other people. I say all of that to say that the anatomy lab, i remember dissecting this beautiful macrami series of nerves that come out of the spinal cord. That was it. I laid down the thought about being a family medical doctor and all the sudden i was in the brain and that was it. It took me 25 years to write it. Lets back up a bit. Pediatric neurosurgery is quite a specialty. How does one become one . How did you . A lot of my life is about the people i am exposed to. When i was on the pediatric rotation as a student, i fed the babies. My chief resident at the time said, no, if you feed the babies you will become a pediatrician. I can still remember this one baby and i wrote about this baby in the prologue. A lot of the other children had parents come see them but this one did not. This one was born addicted to crack. Had gotten through it but i did not feel like that child had any love in their life. I remember coming in early and i would feed the baby and hold the baby and i could look down and see the little sutures of where the bones come together. The little ridge. I remember feeling like i had so much love in my own life, i wanted to share some with that baby. I was already drawn to children. I tried to talk myself out of neurosurgery. I cannot tell you, hundreds of times. I love cardiology. I love vascular surgery. I had a hard time admitting to myself that i wanted to be a neurosurgeon. Every time i would walk by or 16, thats where neurosurgery did their work, i would look up through the window and see what they were doing. Not once, not twice, every single time. Finally i accepted a position at duke and went there. I had a great residency. A lot of it is a blur, i wish i took more notes, because that was a time that the metronomic existence were you go between joy and grief so quickly i meant toward, the second africanamerican neurosurgeon in our community, i wanted to be like him. He was a good person. A great surgeon. I remember saying to myself, if i could live a life like that where i help people, that would make me happy. As a pediatric neurosurgeon you approach lifeanddeath on a regular basis. How do you cope knowing that the patients lives are in your hands . I would like to say that we follow sir William Michael bevan asked. You keep the mass between yourself and the patients. This calm mask. I can tell you that i remember vividly my daughter being six years old, me being called in to operate on a sixyearold girl that had a brain tumor. Im sitting with that family and we are looking at the films. Were talking about the surgery i will do and trying to come up with the plan, its impossible for me not to connect with that person. Its impossible. Somehow it changes from the insufferable neurosurgeon looming over the patient and telling them that their child has a brain tumor and has to be taken out. Somehow it changed for me to one person sitting across from another person. To just talk about what we would do and sharing that moment and helping them understand that we would do the best we could do to help their child. That affected me early enough on, i think that i tried as much as i can to repeat that over and over again. The piece in garden and gun, was about it an eightyearold child who had a brain tumor that was similar to where i had to sit down with the family to talk to them about the end of an eight hour operation, im not back there with a tie on and telling them there was no bleeding and everything went fine. You are just three human beings sharing a moment where you are doing your best for the other group of people. We have all been in situations i have been frightening and stressful. Being in a few myself and from my time in healthcare, we take our cues from the doctor in the room. We talked about that a bit before this session. You are tell me about how you introduce yourselves to your young patients. Tell us about that . I like to introduce myself to the children first. As long as they are old enough. I do not do that to an infant. Hello, little infant. How are you . But, i do do that to any child over the age of five. I feel like five is the age they can communicate and understand that you are being a jokester. Do you go by, james . I am dr. Jay. Nice to meet you. Who do you have here with you . Who is this lady . Did she come with you . That is my mom, of course. Oh, your mom. Nice to meet you. Inevitably, that will turn to looking at what the child has. I am giving you clinic. It is calm. In that scenario, if the child has to be operated on it is typically elective. Its about that child being comfortable with what you will do. Its about the family being comfortable. It is a slower piece of the plan. Is very different when you are in the emergency room. In those scenarios, not only is there angst, but there is angst with a lot of grief. You have to recognize that what you are about to do, it is this persons worst time in their life. You will meet them and be the person, the last person they ever wanted to meet. Over the years i have definitely evolved to feeling like it is a really important time to instill grace into the conversation. That comes from more than just you. That comes from a higher power. Wherever that exists. If you like that is the time where grace is absolutely needed. It is a great time to step into the story a bit more now. Would you read a passage or two that is meaningful to you . I will start on page 1 and go to page 362. Let me see what do i want to read . 174. This is a story about a boy who within a very awful motorcycle accident, he was racing motorcycles i will read from this. Its called, lukes john. I had a lot of opportunities to speak to the family members about what happened at the setting. One of the things when you do a narrative nonfiction, its important to not write about to write about times that you were not there. You could become to start writing fiction if you do that. It is really important if you are writing about a place that you were not there when it first happened, but you get a firsthand account of what it was like. It is called, lukes john. On the third jump of the race, things went to. The dusty cloud, dirt bikes, finally came to a stop in front of the bleachers packed with eager and horrified parents. Giant floodlights dotted by swarming insects in the fall evening. It turned the desk into day. The spotlight chaotic scene in front of them. Slowly, one by one, they set up and waved to the crowd. Parents ran down relieved. Tentative laughter spread across the crowd. One boy, however, did not rise. Still on the truck, he is crumpled form unmoving. A pool of blood began to form under his head. Whose boy is that . Is that luke . The boy in the dust was indeed. He would not sit up again for quite some time. With the father watching from the bleachers, luke, 12, accelerated up the hill after gaining speed during his first and only time around the track. Just as the writers around him are doing. Someones will call another and the chaos began. The first bounce to earth, luke was thrown off the bike and his helmet flew off his head. The second bounce the handle bars pierced his skull and gouged out one inch of his brain on the left side. His dominant hemisphere were the areas of the brain for language and speech. More often than not, this is a nonsurvivable injury. The patient died at the scene. Lukes father rushing to his son side and pushing through the crowd, reflectively lifts the boy off the track and goes into the vehicle for a ride to the hospital. Essentially he had no spine injury, the most common reason for immobilization. After a quick head wrap, they stanched the bleeding. He emergently was sent to the ambulance for the page one out early notifying the teams of his arrival. We were there as the ambulance got him at the trauma bay. His father stepped out of the ambulance and walked briskly. I came down to the ed despite the presence there because i just finished well into the evening. Still in my first year of practice, i was eager to be involved from the beginning. Perhaps some of my residence will stay with me. My wife was a junior medical resident and destined to be chief resident some year later. She was often in the hospital overnight. There was no cozy dinner or interesting conversation beckoning me at home. I felt the familiar rush of adrenaline setting in as i walked to the ed. After i peaked under the hud rep, i quickly realized i would not be going home for the next several hours. I shifted gears. Once i glanced over the scan of the boys had showing the damage to his skull, i brought the father into the emergency consultation room to discuss the impending surgery. I also needed to get consent. The absence of consent to do the surgery when there is a parent present can be construed at battery, as odd as that sounds. It is critical to proceed. Back in the days of my residency, this conversation was way more about the consent of the connection and that would change for me forever on this night. I was standing for the conversation, as was the father. Our eyes the same height. He wore a goatee. His thin blue jean jacket was faded and his baseball hat, with dark hair underneath was matted with sweat. His eyes were red, face creased, concerned intensity began to set in. We found ourselves alone in the room. The lightbox held films showing the devastation to the boys school. I introduced myself by name as the pediatric neurosurgeon on call. As i did, his chin dropped to his chest. His hands covered his eyes. It was early in my career. I want to say that i reached out and put a hand on his shoulder to comfort him. Thats what i would do now. Its what 95 of pediatric neurosurgeons would do now. Strike the balance. Compassionate focus. On to the work. I was yet to experience the lessons. Get the consent, get to the or. Very personal stories. Clearly made a Lasting Impact on you. We talked before about the responsibility going into these situations. They are life and death in some cases. Lets talk more about that. A doctor has to be at his best in all circumstances. The next patient that you operate on may not know that there was a difficult circumstance like that. How do you deal with that . How do you go from one room and into the next, ready to do what you need to do . There is definitely a reset at first. There is something important. I want to read this short piece. Its about as a neurosurgery resident, youre doing a seven year training program, youre not just learning to operate. Your learning to make decisions about taking care of patients. Youre also learning how to handle that existence that we were talking about. I want to read this part. In a single hour of being on call as a neurosurgical resident, you can set with another leak woman to tell her that the rain hemorrhage her husband of 50 years just suffered while shaving is not survivable. No surgery will change that. Just afterward, you could be called to the pediatric icu to give a drain to a fouryearold girl and watches as the child opens her eyes and squeezes her parents hands. In the span of one single hour those things can happen over and over again. In weeks, months, seven years, formal training, that job training, the part that deals with the important human truths forged at the unspoken places we navigate. It is never ending. For me, i have this greenfield that exists outside of my vision to the left. In the greenfield, it is a place i take difficult memories. We wrote about the glorious little girl who passed away, the one who came in behind that ultimately died with the type of tumor that chemotherapy is not good enough for her. Or a set of congenital twins that we separate emergently. One was dying and killing the other. They both died in the operating room. Those are important parts of who i am. I cannot let that blind me to where i need to go. The way i deal with that, i take that memory and i walk off into the green field. I walk past a lot of places where there are bumps in the earth and i go to a new place. I take the grass off the top and put the grass over the side and dig a hole. I take that memory and they put it in a box. I closed the box and i locked the box. I wrap a chain around the box. I locked that and put that in a whole. What did her on it in the grass back on and i put it back down. I stand for a moment with that memory so it is always with me. Then i will walk back in to normal life. I can access it when i need to. When i need to remember the Lessons Learned for that particular individual. I need it to be done in a way that does not paralyze me at times when we have to make decisions in the operating room to get things done to save a life. It was a french surgeon who said that every surgeon has a graveyard that they visit from time to time. That was 150 years ago. I think that this is somber to that. I have some of my yoga friends here. Thank you for coming. There is a great story about being on book tour that i wanted to tell. And patchett,s a wonderful writing sensei. Tt,s and let me just say, you know, its not lost on me that, you is not lost on me that i was Program Director for the residence. We have residents that i had the opportunity to teach. Im always an academic, thats part of who i am. Its not lost on me that the age of 60 i have ann patchett and margaret wrinkle and marie la philippot. These amazing nashville writers who all just descended upon me and helped me in major ways. This whole book, i mean, its just phenomenal to feel that circle, flap and back and and my editor had in my book, he said, do you realize that you write about residents, you write about seven of honor women . Is that important to you . And it is important to me that women get trained in media, neurosurgery and pediatric neurosurgeon in pediatric surgery is almost percent women now. And for all of a sudden to have this this team of women now coming their wisdom on me, i just felt so grateful and so full circle, so and sad. Any time that you go to a town, you should find out if it has an independent bookstore and you should just go and sign their books. Thats a nice thing to do. They love that i can just tell you. And so i done it once before and it was fine, you know, and and so we were in asheville. My son jack is a terrific ultimate frisbee, very proud of him. He just got asked to to try out for the under 20 United States ultimate frisbee team. So i get to say that because im a proud but at the time we had little break we rafted the French Broad River we had this was in between you know book tour issues and i decided to go by malaprop, which is the bookstore there, and asked. So i went to the front and i was like, huh, i dont see the out in the window. Well, thats all right. Thats all right. Maybe theyre inside on the hot nonfiction table, right . So i went inside and i looked at the hot nonfiction table and was like, well, i dont i dont see my anywhere. And so they must be sold, obviously. So obviously i went to the window and i said and want to just happened was the book had i very high in that literally high but i was very high because Jerome Groopman had just given a positive, really positive review. The new yorker. Right. So i was like i am jay wellons. Ive written a book on the movies. They got a good review in the new yorker, and i just was going to come here and sign it. My buddy and pagets, that was a good idea but i dont see the books and i figured you must have sold out of them or something and so i just maybe have some in the back in a box. Im happy to weigh whatever you guys want me to do. I got pen. You know, i read a sign and the lady in the lady behind counter and they still had the plexiglass there. She was like, whats it cause . And all the moves us cause, all that moves us all that moves us. Shes okay. I know where that is . And she walked me to back of the store and there in the yoga section was my book all the moves that i. So there we go so so that is from my yoga my yoga comrades but they that was the time that i that id kind of established my confidence intervals. You know i texted my partners i said one minute youre in the new yorker and the next minute youre in the yoga section. What does that mean in life . And my partner, who also does yoga he takes it back. He said, no, i must stay you know, i cant make this. Yeah. So were getting to the end of our conversation. And if anyone has a question if you could go ahead and be lining up here at this microphone. I know you have questions that you want to ask so be making your way up. One thing i wanted to ask before we end our conversation, we talked before about this beautiful cover, if cant see it, if youve not held the book in your hand theres a teddy bear. Its got a bandage on its head its its its clearly undergone a medical procedure. It looks like its got an ivy and lets talk about that. Well so, you know, youre a first author with with Penguin Random house. You know, and you realize that theyre actually going to pay you to a book, which i didnt realize, you know. I was like, oh, my gosh, you know, but you get a whole team of people. You get a you know, you get an editor that you work with and man mark warren amazing you get a publicist and she was amazing. You get a social media publicist you get you know, the of nonfiction. And then you also get creative team. And so for for the hardback everybody loved the the picture of the surgeon looking down. And a lot of people think that thats me and thats actually not me but my friend asha whos the chairman of cardiac surgery here, hes indianamerican he looked at the cover i was shown. I said, what you think about this . And he goes, hey, is that atul gawande . And i was like, oh, my gosh, it is. Its a tool gawande day. Theyve a picture of a tool gawande day for the of the book and i freaked out and i called my editor and i called the head of nonfiction and he said is this a stock photo is this atul gawande are you because the four heads exactly the same i the wrinkles theres like three wrinkles if you look at his other books, theres three polls in his book like we cant do this. They were like, its not. Atul gawande. They and they found, you know, its like its a surgeon. Like from pakistan. So i guess the top of my head looks like a surgeon from general surgeon from pakistan. But what was really neat when it came time for the for the paperback, they said, what do you want to do . And we work with terrific people and a childrens hospital, whether its the lucile whos here, whos the scheduler in our clinic. Lucille, where are you . There you are. So, lucille schedules the operations in our clinic. Were very lucky. The room team is amazing. We have a fantastic neuro pediatric neuro team. And i said, you know, they do this really cool thing and. So i just want to read this one piece because its just like a one and a half pager that describes it. Surgery is scary at any age, but particularly for children. They dont want to be separated from mom and dad. They want to be with total strangers down a hall on a gurney into bright room, marked sterile on the door. And they sure dont want to be alone on a bed in the center of that bright room with unfamiliar people milling about them going back and forth to computer screens or instrument trays. Oh, everyone them kindly when they arrive particularly the o. R. , nurses a special group of people with a smile that can be seen around the edges of their mask and their kind eyes gleaming. Our anesthesia colleagues do their best to distract and comfort to the kids. Get to choose what flavor they can smell, and the inhaled anesthetic mask. Strawberry is popular. Banana is not small. Talk about superheroes, their favorite toys or sports teams mixes with the quiet chatter of the o. R. Circulating nurse and scrub tech as they begin to carefully prepare the back tables by laying out sterile blue drapes. Ive watched all play out thousands of times from the side, the room where we as the Surgical Team and await the word from the anesthesia ologist that we may move ahead with and prepping and the surgical itself. But it is what the nurses do after the child goes to sleep is my absolute favorite. And where the new cover for this book comes in. Nearly without fail, the younger kids will be clutching a beloved stuffed animal as they make the journey into the operating room. Teddy smiling foxes, purple elephants, toothy dinosaurs. Ive seen all sorts of stuffed animals on that gurney over the years. I remember a plush scorpion named justin next to a little boy as he fell off to sleep as. We prepared to take out a sizable brain tumor that was giving him headaches. After the all the instruments are laid and verified and the checklist completed, its finally time to start the actual. And thats when the o. R. Nurses get to work on the stuffed animals, stealing precious minutes during a break to carefully wrap the childs stuffed animal in its own surgical dressing to match the dressing that the child will find themselves wrapped in when they wake up. And yes, the scorpion fitted with a nifty head wrap when its owner woke up and opened his eyes and became aware of his surroundings. The pediatric icu there was his best buddy, justin. Look in the same way the child, the stuffed animal then heal together in the days after surgery, when its time for the head wrap to come off. Off comes the head wrap on the stuffed animal as well. Better be careful of that stinger dr. Big removal term. Same for the animal. Its a command and simple way to help a child understand what theyre going through and that they are not alone. And isnt that really what helps most of all . Love, kindness and healing together . Like i said, it takes a special person to be a nurse in the pediatric o. R. I love that story and what it tells me when i told you before was that the choice in this cover, it tells so much about not only the book and what you wanted people to understand from the book as soon as they saw it, but also how you approach medicine and how your Team Approaches it. And i think that is something thats just so incredibly important to setting that tone right from the beginning, when you meet your patients, when you ask them to trust you. Yeah, you well, i think now its your turn. Who . A question. If youll just come right up to the microphone. And dont miss your chance to to ask some things of doctor whelans and just hear him talk a bit more about his work and his book and surely be glad to answer any questions you might have. I think we have someone making her way up. All right, here we go. This is my favorite part. Hi, doctor. Well, how are you . Good. Ive heard your name since i was. A little girl. My moms a seal . Yes, ive heard your name since youre sure . Yes, im sure. Hows the car . Is it fixed . Well, we got rid of the crv. Ive got a new one now. Okay, good. So im in my third year of college. Im a classics major. And you mentioned that you had a background in english. Yes. And wanted to know if you felt like that background in the humanities helped you in becoming a doctor. Yeah, absolutely. You know, i think that you know, learning the science medicine is very Building Block based. So for example, you learn biology so that you can learn organic. You know, you learn chemistry. So you can learn organic chemistry and you learn organic chemistry. So you can understand pharmacology. You understand pharmacology so that you can understand how to write prescriptions for patients and how it fits with the pathology that they have right. And of course, important to have the background classes. But to me, theres so much knowledge and you know, just standing in the middle, a bookstore and looking around or in a library, theres so much knowledge about humanity imparted, whether its about love or loss or, you know, happy times, unanswered prayers or miracles. Its just, you. I know, being an english major, you know, the residents make fun of me because occasionally ill quote shakespeare in the operating room. But its a lot its a lot more than that. You know, its its understanding getting a glimpse of the human condition through eyes over the ages. And i just to me would not do i would not go back and do it differently at all. Like im very im very proud of the fact that i was an english major and are very proud of the fact that i at university of mississippi and had some terrific, you know, creative writers. I worked with barry hanna. I worked with alan douglas. You know these are really terrific southern writers and i wouldnt change that for the world. So i do think theres a big role for the humanities. And i think medical schools have learned that because we need to be able to communicate with our patients definitely we need people to be smart enough to come up with vaccines, you know, and definitely we need people to be smart enough to do things where communicate. Its not the most important, but a lot of roles. Now youre you come out way with the patients and frankly, youre expected to be better communicator and to me, being able to draw from massive bank of knowledge that has come from writers from james joyce to william to, you know, hemingway, all points in between is just invaluable for me. Thats exactly what i hope you would say. So yeah, great question. You have another. So im excited to read your book. I havent read it yet. I really loved what you had to say about holding joyce sorrow in grief all at once. And i was wondering if you could give all of us, because thats kind of the human, human condition. We all deal with these extreme moments of joy, mix of sorrow, mix of grief. What would be like a takeaway that you would give of how we can all maybe hold all of those great and difficult things all at once yes. Well, you know, i think an example of that is that scenario were sitting with the family. So ill give you an example and ill give you an answer. So your child has a brain tumor, grief. Your child woke up from surgery neurologically intact, moving everything, saying their names asking for mom and dad joy, the mri scan done the next day it looks clean. Theres evidence of tumor joy. The path came back on postop. Day five, benign joy. The path came back on postop. Day five, malignant grief. So its just its just in every thing that approach in medicine and particularly in neurosurgery. You know i think all of medicine you know you know if im insufferable neurosurgeon about anything think its because i do think we deal i mean i love my Orthopedic Surgeon colleagues. I love them. They have helped me have had, you know, hip arthroscopy my son has broken his finger and, you know, he thought this, you know, his ultimate frisbee is over, you know. But ive love orthopedic i mean but but but neurosurgery we we pull people back over the edge. Thats what we do. And so theres a lot of joy and grief in. And so, you know, me reading back with the mystics, you know, finding the poem on joy and sorrow by gibran, i mean, you know, somebody handed me a when i was out, you know, yesterday i got in between the two buildings and i got home last. Open it up and whats in there. But joy sorrow. So i think theres something a theres something than us that its this understanding that life not going to be without sorrow. You know, theres this concept that, you know, to you the sorrow is what hollows out flute. But then the joy is the music that comes once its hollowed. So i think i for me personally, you know, and i dont want to wax too long, but but you know, this last year that ive had has been one of great joy, the opportunity to go and and speak to other people about these children and about this concept of joy and grief and about how to telling stories is important because it makes gives people commonality. And in commonality creates community. And once we create, then we can solve the big problems. But you know ive also had some medical issues come and thats also been grief. And thats just the way the world the world works. And you just hope that have people around you that you work with or people in the clinic or the owner or your partners or their people at the yoga studio. You go to, or people that your friends that you rely on, you know, that you go to to have a beer and decompress or whatever. Its okay to say on cspan. But, you know, the i just like life is about community. And thats how we handle all this together. Thank you. That was beautiful. I think we have time for one last question, joe, step right up. Oh, this going to be big and can we cut the mic off, please . About 2 minutes and then we have a hard stop. Hi, doctor. Thank you. When you when you were talking about taking some of harder memories and putting them underneath the grass and digging the hole and wrapping up that box that sounded like sort of next level, compartmentalizing, you know, way beyond what the average person can do with those things. So i wondering if, one, if you are trained to do Something Like that in your practice to compartmentalize and then to this might seem silly but because youre a neurosurgeon, do you sort of better understand the ability to compartmentalize with your brain . I think and i think that we do that we. We model that for our residents. You know, we really do actively the ability to compartmentalize us. I think thats really important. Theres, you know, this one thing i know we have a hard stop and you know i should i like public in the south and but i will tell you that like this this one paragraph about a kid about a child. Ryan, who had an aneurysm that ruptured that i inherited from my senior partner when i came in on call the next day and he was already the ngo suite and the way that i knew how to treat that was with an aneurysm but the person that was doing it was going to put some glue inside of it which nowadays 20 years later is is no way to do. But back then it was a clear and ultimately that happened and he rewrapped and he died and i know i that i could have put a clip on that and ryan would be 25 years hed be the same age as my son, you know, hed be 18, 19 or 20. And, you know, so i wrote this to this day, i have no idea if he have returned with a rupture. Had i taken him the o. R. That same day as the initial angiogram clipped it . Even now, as i write this the very idea that the same thing would have happened regardless of my actions sounds, like a feeble attempt to assuage my guilt if i had performed the surgery and had re ruptured later, im certain that id have written an essay similar to this one instead of remorse that i did act. It had been remorse because i did. People can die. Kids can die. You can do or not do. You can pray or not pray. You work past the edge of exhaustion, but they still die. Death a part of your daily rhythm. One may become inured to it, but yet to find a way to rid myself of it completely, i desperately want to go on and. Yet for some odd reason, i desperately want it to never let it go without it, theres no final line to hold, without it to struggle against. We become less of who we think we are. So i think we do learn how to compartmentalize. And i do. And i think that we model that our residents and we hope that they it better than us. And then the residents they have do it better than. Thanks. Thank you so much for coming. Oh, thank you. Its been a pleasure. Yeah. Thanks, everybody. Thank you. Thanks, guys