Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / Reclaiming Physician Mental Health: Stand Up for Doctors with Kim Downey
Transcript
- Santina Wheat: Welcome back to the hidden load. I am your host, Dr Santina or Tina Wheat. And today ⁓ we are doing something a little bit different. I am welcoming Kim Downey the podcast today. Kim Downey is the founder of Stand Up for Doctors and she is a fierce advocate for physician wellbeing. Thank you so much for coming on today, Kim. Kim Downey: Well thank you, very honored for the opportunity. I appreciate it. Santina Wheat: Absolutely. Do you mind telling us a little bit about you, Kim? Tell me how you started Up for Doctors and what we should know about you. Kim Downey: Sure. So very briefly, I'm a pediatric physical therapist by training and I was working in a local elementary school when I was diagnosed with thyroid cancer in the fall of 2020. And I had a complication from that surgery that resulted in more doctors and tests and issues and complications. And then I left my job 2021 in November amidst some of my health challenges. And when I thought I'd finally be moving forward, I was diagnosed with breast cancer. So I had surgery. Santina Wheat: Today, we are going to talk a little bit about physician mental health and physician suicide. And so if you are suffering, I hope that you will reach out to your own behavioral health clinician to make sure that you are getting the support that you need. Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. Kim Downey: and radiation for that. And then when I finished treatment for that, I was diagnosed with breast cancer on the other side. So I had surgery and radiation for that. And amidst this time, I seen many doctors and some of them really stood out to me and I developed, you know, very caring relationships towards them. And one of them being my radiologist. So after two years of constant medical issues, I finally thought I would be moving forward for real. Santina Wheat: Okay, let's go ahead and get started. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. Kim Downey: and I showed up for what I hope to be a routine imaging visit and my doctor wasn't there and when I asked where he was, they said he died a month ago and I couldn't even believe it. I said, are you joking? And they said, no. And I asked what happened and they said they didn't know. And in my heart, I just like, I knew that he had by suicide and I came to find out. That was the case and I felt a calling to support doctors and and that's what I do. my friend Dr. Michael Hirsch was coaching me and he helped me process and accept a lot of things and move forward. He connected me on LinkedIn. I started speaking with physicians because I wanted to find out ways I could help my own doctors ⁓ and then that into a podcast and then I started pairing people up. Santina Wheat: You can find information on how to reach me in the show notes. don't forget to hit subscribe so that never miss an episode ⁓ and leave me a rating so that others can find too. and take care of yourself because you deserve to be held up too. And I'll see you next time. Kim Downey: And then I was sending my own doctors monthly messages so they know that I was trying to find ways to support them. And that turned into a substack newsletter. And then a year ago, January, we reached out to the first 15 doctors who were guests and we wrote a book together, White Coats, Courageous Hearts, and Kevin M.D. writes the endorsement on the back. And there's many more stories to tell. And I don't just interview doctors. It's mostly physicians. but we came out with another book just in February. the first was, White Coats Courageous Hearts, and this is White Coats Human Hearts. ⁓ And this one features physicians, two physician spouses, ⁓ and two patients. ⁓ we'll keep going there's still more stories to tell. And I'm also planning a physician retreat just north of New York City this year, October 9th to 12th. Santina Wheat: Oh my gosh, what an amazing journey. And I am so impressed that you've been able to take something that is so painful and turn it into such a force for good. I am absolutely in awe. ⁓ Can you share with me a little bit about how it feels to be on this journey? ⁓ I like to talk a lot about the hidden load and so I am sure many like me are in awe of you, but are there challenges or downsides about this that we don't know that you're facing as you go through this? Kim Downey: Well, ⁓ I didn't plan on doing any of it. So that's a challenge in itself. And then I keep trying to keep up with myself because it gets to be, you know, more and more and more. And I'm just one person. So last spring I needed to employ the services of a virtual assistant to help me with my own podcast episodes. And now that we have the books and the retreat, the tiles and, those kinds of things, and I have not monetized my work. So I do it pretty much seven days a week, almost from the time I wake up till the time I go to bed, unless I'm doing something else, which like I try to take a walk every day. And to do all that and not have monetized it, to have it cost money every week, like that's not sustainable long-term. But so far, like I haven't gotten burnt out and I haven't given up because... It feels like my life's purpose. So I feel like that's what I'm in the process now somehow during this year figuring out how to get like sponsors for the YouTube for my ⁓ podcast for the retreat and things like that. So yes, it's challenging, but I feel like there's a lot of people who would help me if I asked. Santina Wheat: Absolutely. It's hard to ask sometimes though, too. I feel like that that is a difficult thing for many of us. Kim, tell me a little bit about this, your new book. Tell me what these stories are about. What can ⁓ readers find when they dig in? Kim Downey: Sure. this this white coats human hearts. The subtitle is true stories of healing belonging in the courage to stay human in medicine. So our two stories from patients include ⁓ Pat Dunstan. She was a nurse who became a lawyer and had to leave because she developed Parkinson's and she had the deep brain simulation surgery and it really changed her life. And she's so grateful to doctors and doctors need to hear that gratitude. So she writes a beautiful And then we also hear from Dr. Mark McLaughlin, who is a neurosurgeon. And they both happen to be in the state of New Jersey, although they have not met yet. And he shares a poignant story about a patient named Anthony, who was a child at the time. He's still alive, but there was a complication. And... ⁓ Dr. Mark McLaughlin suffered in silence for about 15 years until he had a reunion with this family. And it changed instantaneously the way he saw it because it turns out they were so grateful to him for saving their child's life where he felt it had been the worst case was actually the case that taught him most in the most grief. So they're just powerful, beautiful, honest stories we hear from again, two physician spouses. which you know medicine is a life of sacrifice not only for the physician but for the physician's family and people aren't walking around oftentimes you know thinking about doctors let alone thinking about the sacrifices of physician family so i'm very proud that we've included the voices of them Santina Wheat: Mm-hmm. Kim Downey: And we hear stories from ⁓ doctors losing, like becoming numb to it all and how reclaiming their sense of awe or feeling like they went into medicine to feel a sense of belonging and that wasn't the case and how they found that. And ⁓ there's just so many, ⁓ one doctor was crying in the bathroom stall thinking, this isn't what I signed up to take care of patients, but I didn't sign up for. ⁓ know, 10 hours of paperwork every day and then how she found a path forward. So what I love is that there's hope in the stories. You know, they're honest stories, but also share paths forward both in and outside of medicine. Santina Wheat: I absolutely love that. I do think that that is... is so important. think that so many of us think that we're having some of these struggles that we're feeling this way and that maybe we're the only ones feeling that. And that is part of why I'm doing this podcast is because I want people to remember or to know for the first time that they're not the only ones that feel this way, that there's others that are going through this. think there's so much that comes with shared experience and even just knowing that it goes through. in the similar way. ⁓ How does it feel for you? You were on the other side of healthcare as well. ⁓ You said that you were a pediatric physical therapist. know you were in a school, but that's still healthcare. I was recently learning that there's physical therapists at my daughter's school and I didn't know it. ⁓ How does it feel sort of supporting on the other side? Kim Downey: Yeah, so ⁓ through all the changes in healthcare over the years, because I'm seasoned, you could say, and there's been a lot of changes. And when they introduced the EMR, I was for about seven years working in some local nursing homes. And that's when they introduced that. I feel like overnight, I feel like in general, therapy ⁓ teams are really our teams. know, PTOT speech, really, you know, we... work with the patients in the gym together, we co-treat, and we would eat lunch together at the table and talk about everything from our weekends to so-and-so needs a walk or does the social worker need to see so-and-so, like in the best interest of the patient and it was that time. But once the EMR came in the computer and there was so much more, it was the biggest lie ever that they said more time with your patient and less time on paperwork. And I literally started changing what I brought to eat for lunch. I'd pick something so I could eat with one hand and type with the other hand. And we didn't eat lunch together anymore. Everybody just had their like head and faces in the computer. So I experienced, you know, once I got involved in these spaces and her doctor's talking about burnout and moral injury, and I feel like I experienced both and now I understand the difference. So that's why I feel like I have such a holistic perspective because I lived some of it as a healthcare professional, but also understanding deeper challenges that physicians face. Just one example I would use is that you generally don't need a physical therapist in the middle of the night. So like I had a, I never had to, you know, like take call or work all night and then try to perform a surgery, right? So I also understand the layers of obligation and responsibility that doctors have on. on top of what physical therapists do. So we share some of the same challenges and there's some excess demands even on top of that for physicians. And then as a patient, I had all kinds of experiences from wonderful to traumatic, know, like I'd say even at the hands of doctors. So, but now I wonder, ⁓ you know, what were they carrying and were they hanging on or they hanging on by a thread? So trying to get to the root of it because most doctors do go in. to help other patients. what is, how have they become numb to it all? Are they so burdened just to make it through the day? Or are these some of the strategies that they had to come up with just to put one foot in front of the other? Santina Wheat: Sure. Thank you so much for sharing that. And then tell me a little bit, as you've collected stories, if you have talked through so many things, what do you feel like is the most prevalent theme that you've seen as you've talked To physicians, to teammates, to spouses, what are the threads that you have pulled out? Kim Downey: Well, I think with physicians, think it could really, lot of it can fall under two buckets of loss of autonomy and moral injury. And under loss of autonomy, there's like real loss of autonomy, which I experienced also as a physical therapist over the years. And then there's perceived loss of autonomy because also with coaching, people can come to know that you always have more power than you think you do. But then there's also the excessive demands, right? So that's, I feel like all falls in the like autonomy bucket. And then just that moral injury, you know, being either prevented from doing what you want to do. or doing things that you don't want to do, like things that are dictated to you. So I feel like a lot of it falls in those buckets. Santina Wheat: Well, and you could probably argue that sometimes that moral injury comes in part because of the loss of autonomy too, because you're making these decisions because the insurance company is saying that you have to or your health system is saying that you have to, and this is not exactly what you want to be doing for your patient. ⁓ Are there... Kim Downey: Right, yep. Santina Wheat: Are there things that you have found yourself advocating for as, let's say in particular with the loss of autonomy that you have found that have been successful or that you think we need to do a better job at advocating for? Kim Downey: Well, with advocating in general, I'm proud to be an ambassador for the Dr. Lorna Breen Heroes Foundation. And they've made incredible strides in just a few years as far as removing intrusive questions on the back of licenses. And I feel like that's so important because I bet every doctor doesn't know that. And every physician and healthcare professional needs to be able to access ⁓ confidential mental health support. when and how they need it. So I feel like the Dr. Laura Breed and the Heroes Foundation is a wonderful advocacy for that policy changes and people can get involved in different ways. They have different buckets again, even with their. So I'm very proud to be an ambassador. I feel like that's one way that I've been advocating. And then I've been involved with Medicine Forward and their mission is to improve like the, catalyze positive change so physician-patient relationships can flourish. And I've worked with them on ⁓ some things related to that. And then I've also become involved with the Healthcare Reinvention Collaborative. And they say we aren't gonna change healthcare, but we're gonna connect the people that do. Santina Wheat: Mm-hmm. Kim Downey: and they like to spotlight and amplify ⁓ even people like me and like what I'm doing. So lots of times they'll amplify my posts and say, you know, check this out. The comments are thoughtful, add your voice. And then I've also become involved with the Clinician Burnout Foundation, you know, with Jody Green and everything. So those are a few as far as other organizations I've collaborated with. And as far as like individual like strategies or practices or supports, ⁓ I feel like that some of the things we talk about in the chapters of these books really ⁓ spotlight some of that and also spotlight some action steps and solutions. One of them being connection mitigates trauma and doctors can be walking around like surrounded by people all day yet feel alone. So the importance of community can't be underestimated and that's going to be one power. thing about our physician retreat is just like a true sense of community. They can be themselves for a week and a safe space for doctors. And then another one would be like learning about vulnerability and boundaries. And like Dr. Michael Hirsch will say, you know, being vulnerable doesn't mean I have to tell you everything, but letting little pieces of yourself show is that Dr. Mark McLaughlin found, you know, when he had an honest conversation. it just changed his whole perspective. So sharing little bits that every doctor needs a safe person. I feel like they should have like the buddy system like in the army. So whether it's a doctor, a friend, a coach, a colleague, a pastor, a therapist, every doctor needs someone to talk to, a partner, spouse, someone. And setting boundaries because I know when you're all in medical training, Santina Wheat: Hmm. Kim Downey: you're told not to say yo, to say no, say yes to every opportunity and just learning. And that also that that means sometimes saying no to good things. It could be positive things, but even positive things you just can't do at all. So a lot of doctors now say if it's not a H yes, it's a H no. And so I feel like, yeah. And then just two other ones I would add is self-compassion. Santina Wheat: Absolutely. Kim Downey: is critical and also resourcing yourself again outside of medicine, having an identity outside of it, whether it's know hobbies, interests, relationships. Santina Wheat: Thank you so much for sharing those. think that those are all so important. I want to go back to what you said about the work that the Dr. Lorna Breen Foundation has been able to do with the questions, the sensitive questions, because I don't think everybody knows that. I was practicing for several years before I even knew that this was a challenge. Can you speak to that a little bit about ⁓ what the questions and how some of ⁓ the changes have ⁓ Kim Downey: Yeah, sure. So there's one thing that I still feel like it gets me in the gut is Dr. Lorna Breen was an emergency room physician during the pandemic and she was working tirelessly hours in horrible, you know, circumstances and she developed COVID herself. So she had to be out for the seven or 10 days, whatever it was. So then she went back to be on the front lines really before she was physically and emotionally ready, you know, from COVID. it ⁓ just didn't go well. You know, she was doing these really long shifts. So one day she woke up and I think she pretty much couldn't get out of bed. She was in pretty bad shape. So she called her sister and they were in Virginia and the sister and her brother-in-law is Corey Fice. They managed to get her there to Virginia and she received inpatient treatment, but she was afraid that everything she worked for would go down the drain that because she sought treatment for her mental health, that it would affect her career. So my understanding is that she didn't know that ⁓ New York had already even removed those intrusive questions because like on the back of my physical therapy license, only says like, you been convicted of a felony in the last year? you complete your continuing education? things like that where with physicians, it's like if you, sometimes it says like if you ever sought ⁓ support for mental health, which now what they're fighting too is it should just be like today and is it impacting your performance as a physician? Because there are many, like doctors are human. Like that's why this book is called White Coats Human Hearts. And any problem that. Regular people have, doctors have too because they're people, right? They're regular people. And so many of them have just like people walking around on the streets, have a mental illness. They might have anxiety, depression, bipolar, but they can be successfully treated. So if they've known about this for a long time and they're successfully treated, it's not impacting their performance. So sometimes they can feel shame or fear and sometimes again, real or perceived. Santina Wheat: Right. Kim Downey: who are both. So now their goal is for Dr. Laura B. Hirons Foundation to remove those intrusive questions in all 50 states and many states have already done so. Santina Wheat: And that work is absolutely amazing. It is so important to be able to know that those are are going away because ⁓ do know of people who ⁓ have chosen not to seek care or have been worried about seeking care themselves because of how they might have to answer those questions. And so as a physician, I think that's a huge relief that that isn't changing. And it's something that, as I have been an educator, it's been nice to able to share differently with my learners that when I first started. practicing it, we did have to this conversation of we, might have to disclose this at some point. We don't think that should stop you, but you have to know that this is a thing. And today we can now say in many states that's not the case anymore and are able to talk about that transition. ⁓ Kim Downey: you Santina Wheat: ⁓ The other thing that you really, that you mentioned that I think is so important is that loneliness. think so many people really do feel like they are walking next to other people and not sharing what's happening and they are feeling that loneliness. I think that that... Kim Downey: Cough Santina Wheat: that really speaks to ⁓ conversations that I have with my learners and my team all the time. It's sometimes you feel like you're not supposed to feel this way. You're supposed to feel like that you're successful. And sometimes you don't even feel like you can share it with your partner because they're not going through the same thing if they're not in medicine. And so ⁓ I those as two of the things that you have highlighted. Kim Downey: times say every time a doctor shares their story another doctor feels less alone So we're just chipping away at all is we know when every doctor comes on my podcast whatever they share you know, because some Recently I had an episode where one physician shared that he ⁓ even later in career Had a challenge at work ⁓ and he had know suffered like mental, you know discomfort ⁓ and he saw Santina Wheat: Yeah. Kim Downey: help so the fact that now doctors are willing to come out and share these things to support their colleagues, it's really critical. And then the other physician shared that he had experienced ⁓ a lawsuit and he shared about that and how traumatizing that was and that even though they quote unquote won, in the end there's no winners because the other three physicians all left practice and we lost the really good doctors. Santina Wheat: Absolutely. So mentioned that ⁓ people can advocate in different ways. How do they get involved in this? If they want to do some of the things that you are doing, ⁓ can they join in? How can they help support physicians across the country? Kim Downey: So we're actually working on that and trying to figure it out even more. So one, like I said, is the Dr. Lorne Breen Heroes Foundation. Anyone can become an ambassador. Like you fill out a form there and there's quarterly meetings. So there's many physicians on the calls, but there's also other people that intersect with healthcare on the calls. And then again, they have different. Like advocacy buckets that you can join like steering committees for if you're passionate about Policy or about removing these intrusive questions. So really if your concern is at all mental health, you know for physicians There's a place for you in the dr. Lorna breed heroes foundation and I'm also meeting with a couple physicians in ⁓ someone else next week to talk about ⁓ Like doctors have solutions, right? Like we know that the system needs to change, but we also know doctors are very smart and lots of times they have the ideas, they have the solutions, they have innovations and we need to be able to connect to them with each other so they can share their ideas and if something works so then we can amplify it and let a lot of other doctors know, hey, this is what's happening, this is what works. So there's that innovation bucket. And then there's also though, some doctors, if they're struggling and just trying to keep their head above water, they aren't in a position to be thinking about innovating. They're the one, if they're struggling, they need support and it's just as critical to, because it's totally understanding. Any doctor's struggling, you're not alone and it's totally understandable and ⁓ we need to figure out ways to support you. So we're trying, so in my conversation with a couple doctors next week and someone else, we're gonna start to try to figure that out ⁓ so people can reach out to me and if they wanna get involved, we can keep you in the loop as we try to make progress with these things because what we'll be trying to figure out is you don't wanna reinvent the wheel and then some doctors don't have the bandwidth for another community, right? Or another Facebook group or Slack or something. But some wouldn't want to be on WhatsApp because they wouldn't want to use their phone number. But even if we share resources, figure out how to make them widely available so we know when we know what other doctors and healthcare leaders and people are doing that's working so we can have a way to share those resources with other people. Santina Wheat: Great. And then, ⁓ so I'm primarily speaking with this podcast to the leaders and the educators in medicine because truly believe that we hold an extra load because we have to be a little bit, we have to look out for other people at the same time and sometimes that causes the loneliness even to be a little bit worse. ⁓ there lessons that you've learned that... ⁓ you would like to share with folks who are in those roles, the leaders and the educators, not that it's always totally different, but are there specific things that we should be thinking about or modeling for our teams and our learners? Kim Downey: Mm-hmm. Sure, so I've learned a lot in the last year or so about trauma and trauma-informed care, right, for doctors and patients and healthcare leaders. And so many people are walking around with their own trauma. And some people... healthcare leaders might not identify it even as trauma or they may think, well, I went through something that was a lot worse, suck it up and get over it and move on. So I feel like it's very important when they all say, right, it starts with you, right? When everything starts with you. So you need to be, we need our healthcare leaders to be mentally healthy as well. So you need to shore your own self up. So all those things that we talked about, connection mitigates trauma, vulnerability and boundary, self-compassion, resourcing yourself outside of work, that would also apply to healthcare leaders. So if you're a healthcare leader, you have to think to yourself, like, how are you doing? And do you need help? Do you need support? And then it's incredible, like, if you do and you're willing to model that, and actually next week I'm interviewing, He was a healthcare leader for Kaiser and he struggled for 15 years and it was his boss that caught him in one day who had taken a ⁓ mental health first aid training at his church and recognized some of the signs and in those five minutes changed the trajectory of this gentleman's life. ⁓ So I feel like it's the most important thing. Santina Wheat: Mm-hmm. Kim Downey: is to start out and look at yourself and are you doing okay and get help for yourself and then support your team. Santina Wheat: Absolutely. Absolutely. It is nearly impossible to support other people if you're not taking care of yourself. It's the whole on the flight, the oxygen mask, right? You have to put it on yourself before you help anyone else. ⁓ And I do think that we need to hear that over and over and over again. Kim, as we get ready to wrap up, are there things that we wish? Kim Downey: Mm-hmm. Santina Wheat: Physicians would learn earlier. Are there things that as you've talked to so many of us that you think, wow, this is something that I keep hearing that people have learned too late in their careers that's really impacted them? Kim Downey: Well a couple one thing we haven't touched on yet is bullying in medicine and what I'm hearing even more recently is about sabotage and Again, I feel like this is so sad and not challenges I faced as a physical therapist like when I went to college we felt like our Professor supported us and we supported each other and we weren't really competing against each other and we could all As long as we kept our own grades up, we'd all be physical therapists at the end of our training. And I felt like we really did, it was a team and we supported each other. But I feel like, and I've had, there's a chapter, Dr. Adam Harrison writes in our first book, a chapter on bullying in medicine. And again, he's ⁓ from the UK and now he's living in New Zealand. So again, that's. Santina Wheat: Absolutely. Kim Downey: something else that's ubiquitous around the world. So to be able to, that's another one that you're not the only one and it's not your fault. And to just understand starting in medical training that that's not okay and to find a safe person to speak with. And also what I'm just starting to hear more about, which I think is horrible, is sabotage. That there's like, Doctors or health care leaders that they're like sabotaging each other and I have to say I was blessed like I never Felt that at all so to recognize it and that it's not you because we tend to think it's that inner critic writer ⁓ I must be doing something wrong or it's not me So I just felt like that was one thing we hadn't touched on that I think is so important if you're experiencing that Find someone safe to talk to about it Santina Wheat: Absolutely. ⁓ My husband likes to say, just because you're paranoid doesn't mean they're out to get you. That means they're not out to get you. So yes, absolutely, it is a real thing. People do sometimes sabotage you, The bullying really real. We have a lot to answer for in the House of Medicine and trying to make it a safer space. ⁓ I feel like we have many conversations right now about how do we make the environment a safe space because we haven't done that this entire time. So trying to make that better. ⁓ Kim, any last thoughts that you really would like listeners or watchers to walk away with from today? Kim Downey: Well, one thing that Dr. Mark McLaughlin said was never worry about a patient alone. Santina Wheat: I love that. Definitely words for to all live by. ⁓ If you would to find your books, how do they find them? Kim Downey: Yes, they're available on Amazon and paperback in Kindle. Santina Wheat: Awesome. And how do people reach out to you and find you? Kim Downey: I'm on LinkedIn a lot. So LinkedIn is a great place. And then my website is standupfordoctors.org. And it's great because we have a Books tab where you can see the faces of all of our authors for both books. And then you can click on the link to order their books from there. And then we have another link that says Inaugural Physician Retreat. And you can see our speakers, topic and activity leaders for the retreat. And then you can click on the registration link to see a detail. agenda so those are a couple ways and then my podcast is available on YouTube, Amazon Music, Apple Podcasts, Spotify and Substack. ⁓ So if you Google Kim Downey or StandupforDoctors.org you'll find me. Santina Wheat: And will try to link some of those things in the show notes as well so that if you're all driving, can come back and find that. ⁓ Thank you so much for joining me today, Kim. Any last words that you wanna share? Kim Downey: Well, I just wanted to thank you and give a shout out to you and Somi Docs. I've had Donna Corial on Stand Up for Doctors to give ⁓ Somi Docs a shout out. And I receive the newsletter every Sunday morning. And I've been reading a lot of the pieces that you wrote. So I love the fact that we connected. And again, we'll give a shout out to Mary Ramone. And I think it was through her post. She might have shared one of my posts. ⁓ made me think to reach out to you and that you reached out to me. So I just love all of these connections. So I would say, know, if you, if, if you read something that interests you by someone, go ahead and reach out. And if they're not responsive, like Dr. Michael Hersch will say, often means more about them than you. You know, they might be shy or not ready. And it doesn't mean, you know, don't go chasing after people either, but then you're open to opportunities. And that's how we're having this conversation today. Santina Wheat: Absolutely. The power of connection in surprising places can be absolutely amazing. Some of my most supportive communities have been virtually or digitally in places that I never expected. That especially started for me during the pandemic when we had to do that, but they have maintained as a way to really stay connected. Kim, thank you so much for joining me today. I am so glad that you were here. This has been a great conversation and I really, really appreciate your perspective. So thank you so much. Kim Downey: Sure, and thank you. I appreciate it.