Good evening, all. Thank you for joining us this evening for our presentation, the plight of pedestal physician, frustration and my path to resilience. Our speaker this evening is Dr. Nora Acana. Before I turn it over to Dr. Acana, I want to go over some housekeeping. Next slide. All participants are muted. So if you do have a question, which we certainly hope you do, please type them into the Q&A box and Dr. Acana will answer them following her presentation. If you are here and wish to obtain CMB credit for this webinar, you must have taken the pretest prior to the webinar. So make sure you do that or have done that. The slides will be available in the AOA online learning course, as will the recording for this. That's also where you will find the post-test and the post-evaluation, which is required to obtain your CME. And then the next slide basically is just a disclaimer, letting you know that this webinar is for educational purposes only and that Dr. Acana is going to share her experiences with us. That's okay. She has nothing to disclose. And then briefly what Dr. Acana is going to discuss is the social history of the practice of medicine, the impact of capitalism and the recent COVID-19 pandemic, and tips for physicians of this new era. She will share her personal experiences with mental health crises and her mental health crises and her path to healing and sustained resilience. This is the second webinar in our regaining the joy of practicing medicine series. And we are thrilled to have Dr. Acana here and I'll turn it over to you, doctor, and let you go over the objectives. Okay. Thank you for the introduction. Yeah. So I am honored to be giving this presentation as a psychiatrist, as a DO, and as someone who has dealt with their own mental health struggles. It's something that I'm very passionate about. So yes, like she said, the learning objectives will be a brief, very brief review of the history and perception of medical professionals in the U.S. and sort of how that tied into capitalism and sort of the struggle with professionalism, burnout and COVID and resilience. Okay. So the history of American medical practice. Now, this is a very brief history. There's lots of things I'm not going to go over, which are the creation of the osteopathy and the integration of women and minorities in medical practice. So just know it's a glazing over. Okay. So the early American practitioners, when we think of colonial times, first were settlers, European educated settlers. So at that time, medical education could take up to 13 years to complete. It was often expensive and really was relegated to upper class of society. So there's really no incentive for people to come over to the colonies, except for refugees. So those early physician settlers were often refugees. Then below them, there are what they called irregulars. First of them being the barber surgeons. So they were low class tradesmen in England, but during times of war, they aided with amputations, dental extractions, and through that gained higher status in the colonies. That red and white pole that you see outside of barber shops signify the history of barbers wrapping bloody bandages around poles. Then we have midwives, very obvious there. And then priests who not only offer spiritual guidance, but they often prescribed herbs as well. Apothecaries, who we now think of as pharmacists. So not only did they, you know, prescribe medications, they often diagnosed illnesses, they made house calls, and some of them performed surgeries too. Apprentices, which were including, but not limited to enslaved African Americans. And then there were other irregulars. So Thomassonians who relied on baths, emetics, diuretics. There are homeopaths who relied on diluted pharmaceuticals and eclectics who mostly used botanicals. Okay. So the creation of the first American medical school. So this is a picture of the College of Philadelphia, which was opened in 1765. And today this is University of Pennsylvania's Perlman School of Medicine. So now we get into perceptions of physicians and the iconography of healing. All right. So the role of symbolism in medicine. Okay. So what we see here is the rod of Asclepius. So Asclepius was the son of Greek God Apollo, and he was known to be able to heal the ill while they slept. Okay. Asclepius is often depicted with his walking stick and snakes and snakes are a symbol of rejuvenation because they are, have the ability to shed their skin. In 1910, the American medical association adopted the rod as its professional symbol. And a lot of other medical associations have also adopted that symbol as well. And it's important because this use of mythological iconography, it really subconsciously reinforces the idea that healers are godly or can foster this unrealistic expectation. In fact, the Hippocratic oath that we pledge is to Asclepius's daughters, Hygieia, the goddess of cleanliness and hygiene, and Panacea, the goddess of universal remedy. So you can kind of see that, you know, it's, the trails are there. Okay. So we talk about respect. Okay. So in a 2021 survey, I tried to use something a little bit more recent, a survey of 22,000 people in 16 countries, scientists and doctors were the most respected professions in the U.S. Doctors ranked above scientists as the most respected profession. And in that same survey, nurses ranked fourth in the U.S. behind architects. But if you look at other surveys, nurses ranked directly below doctors, which comes into play a little bit later. So we talk about the changes in physician practice in the 20th and 21st century health insurance. All right. Until, you know, the popularization of health insurance, most physicians practice either solo or in small groups. And we really decided, you know, how we were, how we feed for our services, our hours and how much, you know, continuing medical education we needed. So the fee-for-service model, but in the 1920s, hospitals began offering prepaid hospitalization plans, and this kind of fed into employer-sponsored plans. Now with World War II, saw the dramatic increase in private employer-sponsored plans, because, you know, because of the limitations, employers needed to attract workers. So that's kind of how it got started. And with that, drove up the demand for healthcare services, which drove up prices and eventually led to, you know, federally sponsored plans, Medicare and Medicaid, for people who were priced out of the market. So capitalism, right? Now we are entering a space where, you know, people are paying to a plan who subsequently pays the doctor. But this is a conflict for us, right? You talk about professionalism. So the aspects of professionalism that are important are not only the specialized knowledge, the specialized knowledge, but also the code of ethics. This clashes, right? Because, you know, capitalism, those, you know, it's an economic theory. It governs social interactions with the parts being capital, wage labor, and raw materials. For healthcare settings, the capital is everything that we need as doctors to practice. So the hospital beds, the medications, the electronic medical records, we are the wage laborers, but the raw materials are sick people, you know, so we need sick people. On top of that, dealing with capitalism, having this background of being this respected profession, yet having limited control, we're also dealing with scope creep, okay? I'm just touching on it. But scope creep, the AMA defines as the expansion of medical services and procedures to non-physician health professionals. So that includes, you know, physician assistants, nurse practitioners, etc. So the capitalistic incentive is there, right? Because with less training means less pay. So for hospital systems, you know, in a capitalistic society, that makes sense. You, you know, if you can have someone treat your raw materials, a wage labor that treats your raw materials for cheaper, you know, it can be better. But there are a lot of medical decentives, you know, because of the real lack of, you know, specialized training, you know, a lot of these non-physician health professionals order more tests, prescribe more medications, and in that also make more mistakes. And with this all, you know, dealing with capitalism, while trying to maintain professionalism, dealing with scope creep, and dealing with the pandemic, we kind of come upon physician burnout, okay? So what is burnout? It's a long-term stress reaction, which includes emotional exhaustion, depersonalization, and just feeling, not, not feeling personal achievement. And it leads to a lot of negatives, you know, we spend less time with patients, we make more errors, and eventually just leads to a lot of staffing shortages. People call out more, people just don't, aren't really invested in their jobs as much. So the causes of burnout, these are pretty obvious to most doctors, right? It's having a lot of paperwork, the administrative tasks, working excessively long hours, you know, working under disorderly conditions, working in a negative work condition, and the corporate consolidation within sectors. I can say personally, I work on an inpatient unit, and there are multiple companies hiring doctors to see patients on the same unit. So while I could be passing by a patient, and I see them every day, you know, when they ask me a question, it is kind of weird to have to say, no, you have to wait for your doctor who works for a completely different health system in the same space, so. And then we talk about the pandemic. I'm not going to kind of go into it all, because we all went through it, but there are numbers to kind of, that, you know, substantiate the fact that we did experience a lot of burnout with the pandemic, COVID-19 pandemic. So for a while, we were, you know, tracking downward with burnout rates. You know, you see 2014, Mayo Clinic lists the burnout rate as 54.4%. We go down to the 30% range, but then 2021, it spikes upward. You know, this is a year into the pandemic, and only now we're starting to trend back downward. And I didn't know that they had any inventory scales, but the scales used for the Mayo Clinic, by the Mayo Clinic, or the Copenhagen burnout inventory, and the single item burnout scales, which is very interesting that they're tracking this. So getting into, like, resilience before I get into my own story. What does physician resilience entail? Okay, so the first part of it is awareness, kind of knowing what's going on, recognizing how you're feeling, recognizing, you know, your perspective on things, having that balance, being able to rejuvenate, prioritizing self, having a little bit of autonomy in your management style, you know, which includes working in a well-run facility, and allowing more efficient use of physician time. And then, on top of that, having good community. That is support from family, having friends, having colleagues and staff that you can talk to. This is all what encompasses resilience. So now we go into my own personal story. So we skipped over my biography, but I'm born of Nigerian immigrant parents. My dad is in the middle, that's me, baby me, but he came over in the early 80s on a student visa to study at Florida A&M University Mechanical Engineering. He had an arranged marriage to my mother and brought her over to the US. She immigrated when she was 17 and had me at 19. Keep in mind, this was an arranged marriage. It did not work out very well. They divorced when I was two years old. And very young, I knew that I wasn't wanted. My mother went through a lot of hardships with my dad, and subsequently, you know, kind of pushed that onto me. I got a lot of the brunt of that sort of like stress and hatred. And, you know, not for nothing, you know, also one of the big issues was my skin color. I was a lot darker than her. And, you know, later years learning that I was a big reminder to my mother of my dad. I had a very tumultuous early childhood. And subsequently, my mother sent me to Nigeria when I was about seven years old. And that was really traumatizing for me. So, you know, just being a young child in America and suddenly being thrown into another culture, even though it is my culture, you know, thrown into another country, thrown into another culture by themselves, I felt very alone and went inward. I survived those two years and they were very formative years of my life, but they were very traumatic being left in another country. But the one thing that kind of got me through is the fact that I always knew I wanted to be a doctor. Like many physicians, I was one of those kids who, you know, at five, you ask what you're going to be when you grow up. And my answer was doctor. I was going to be a doctor. My mother is a nurse and I just always had a love of healthcare, anything healthcare. And that really kind of stabilized me in a way because I was always academically focused no matter what was going on in my personal life, which included being sent to Minnesota to live with my dad for a couple of years. I kept this ID. This is the last school ID I had in Minnesota in seventh grade, that was the school that I went to, Expo for Excellence Middle School, lived in the St. Paul area. But those two years living with my dad were also very traumatic. He was, while my mother was mostly physically and emotionally abusive to me, my father was sexually abusive. And not only that, he just didn't know how to raise a child nor did he want to, it was kind of a struggle between my parents who would be burdened with me. And he was neglectful. And one of the reasons why I kept this ID is because the shirt I'm wearing is one that I stole. My dad never really kept track of my growth spurts or when I needed new clothing. And so when I needed new clothes, I went to the laundromat and snooped through the dryers. And that's one sweater shirt that I stole that I wore pretty much every other day for a year. So yeah, there's that. And then after I went, my dad eventually was caught. He molested one of my friends and he was arrested. He was charged. There was a court case that I had to testify at. And for many years after that, because I think I was 12 when this happened, for many years after that, this consumed me. This consumed me. The fact that my private shame was public and remains online. This is a screenshot that I got two weeks ago. The court case is online. It lives there online forever. It really did consume me for a long time. And now I look back, I know that I was experiencing early signs of PTSD in terms of nightmares and flashbacks and things, but I developed coping skills. I cleaned obsessively. I cleaned obsessively. It was a good distraction for me. And it was something that was reinforced culturally. A girl that cleans, great. So, and that's kind of how I maintained myself until college. I went to the University of Florida for undergrad, go Gators. And this was a really important time in my life. This was the first time that I was able to live on my own, on my terms, as much as you can as a 17 year old. I think I took this picture a couple of months after school started, but it was really a formative time for me in a positive way. I became politically active. I protested. I joined Students for a Democratic Society. And I found my voice in small ways early on. I explored my sexuality. And that was something that was not culturally allowed. And also something that I just never felt comfortable with because I was sort of in this PTSD haze as a young adolescent. And I also got to explore nature in a healthy way. This is a picture of me in the Appalachian Mountains. We were in Asheville on a alternative spring break trip, Florida alternative breaks. So this is a picture of me hiking on a free day that we had as we helped plant blueberries and blackberries. So Asheville holds a special place in my heart. And really the Appalachian Mountains hold a special place in my heart because I was really set on going to Roanoke College for undergrad. I got a flyer in the mail, my senior year in high school, and I fell in love with the mountains. But I could not afford it. So I went to UF, which is a great school, but I'm really glad that I did not accrue a whole bunch of undergrad debt. But I made a promise to myself that I would go back to the mountains. So when it was time for interview season, I made my decision. I knew I wanted to be a DO. I knew that the philosophy of osteopathy was one that gelled with my own views of medicine. And I got into my first choice, which is VCOM. So I went to VCOM Virginia campus. So this is me on graduation day, excited to finally be realizing my dream because it's not that I didn't experience any of the mental health issues from my early childhood traumas. But the one thing that motivated me was being a doctor, right? It is a respected field. Everyone encouraged me. I was the straight A student. So I was able to keep things together because I had a goal. But things didn't work out the way I wanted it to. This is a picture that I took of myself during my second year, first year going into second year of medical school. I had a break, to say the least. I had a mental break. There was something about being away from my family and friends, being in Virginia, Southwest Virginia, living alone and just the grueling nature of medical school, it all sort of combined. And I found myself feeling more and more depressed. Along with that, something that I kind of left out earlier is that after my dad was charged, arrested, all that stuff, he was deported. And after he was deported, he started stalking me from Nigeria. So starting in college, because I was the only US citizen who could, and only a US citizen could bring him back to the country. So starting in college, he started writing to anybody who was affiliated with me. And as most doctors know, once you start to get into the practice of medicine, and you start hearing, joining groups and things like that, the internet is a wide space. And so he was able to sort of track my activities through the internet and harass me in that way. So he wrote to the president of the University of Florida, and I had to tell them like, no, he is my dad, but I don't have any contact with him, and this is my awful story. And I had to do that multiple times, including in medical school. I think it all just came to a head. I started having horrible nightmares again, having flashbacks again. It's kind of triggered by the stress of medical school and the persistent emails and messages and random people who would come up to me and ask me about my dad. And yeah, I was losing weight. I was losing a lot of weight. This picture that I took of myself, I think I was 115 pounds then. There was a month where I was taking a picture of myself every day. And part of the reason why I was losing so much weight is because I was suicidal, passively. I had reached out to my mom and told her that I was feeling depressed, and I had thoughts of hurting myself. And her response was that, you know, suicide is a sin. And in my mind then, to not sin, I thought that it would be okay to just wither away. You know, I still went to all my classes and I studied and I did everything, but I was okay dying. And I just didn't eat. I did the bare minimum to take care of myself because I just didn't feel that I was worthy. And really, you know, the saving grace for me were having deans who knew the students and noticed the changes. And as my grades started to slip, I'll never forget this. It makes me kind of like tear up thinking about it. You know, Bill King, who I think still works at BCom, you know, reached out and kind of said, are you okay? And I was not okay. And I am really glad that they intervened because they saved my life. I remediated the classes that I essentially failed out of due to my depression. I got into therapy. I started taking medication and started the path of healing, but it was their intervention that really saved me. And another thing that I did was get a cat. And so I wasn't alone anymore. And so this is my beloved Daria who passed away in 2022, but she was my rock during medical school. And this was all part of my healing process. Something that's also really important to me to note is, you know, during this time in medical school, one of the closest friends that I had was Claire. Claire, like I, was, you know, very depressed and we just had divergent paths. So while I had, you know, medical school staff who were able to recognize that I wasn't acting like myself and forced me, honestly, to get help, Claire wanted to, you know, kind of struggle through it. She felt that she deserved to be depressed and that she couldn't fight her way through it. And in June of 2012, she committed suicide. And that was a really big wake up call for me because, you know, we were on that same path and it was just a little change and my friend was gone. And I didn't want to forget that because my experience going through the mental health journey, sitting in front of a board of the medical school and kind of explaining to them that I was depressed and I had PTSD. I was diagnosed with PTSD, major depressive disorder, I had generalized anxiety and OCD. And I had to detail this as a black female medical student, the child of immigrants, the first doctor in my family. So I knew before going to med school, I wanted to be a psychiatrist. That affirmed, that experience going through it, affirmed my drive to be a psychiatrist. And Claire really sealed, Claire's death really sealed the deal for me. And one of the ways that I wanted to commemorate that and also her life and not to forget her or the reason why I chose to be a doctor is the tattoo that I got. So Claire's French. And so, yeah, so I have that on my left forearm and so I can never, I never forget Claire. Another thing, you know, along with that tattoo, I started finding ways to express myself, you know, visually, honestly. I started, and this was in medical school, I got, you know, my first tattoos and I got some piercings and granted, everything was very hidden and hush hush. I started to feel comfortable. There's something about coming back from the brink of death, basically, that really, you know, invigorated me and made me feel like I could just, I could do that. You can be a doctor and be yourself because yeah, you can. So this is during medical school. I met my now husband during medical school and we graduated at the same time. So, and kind of figure out where we're going to live and work and kind of the next stage is in life. He's an engineer. We decided on Kansas City. Now, this is me as a doctor. Now, this is me at the beginning of residency. So one of the reasons why we chose Kansas City and one of the reasons why I wanted to go to UMKC in particular is because at that time, Truman Medical Center, which is now University Health, had its own fully functioning, fully standing, you know, separate psychiatric emergency room. And that was a burgeoning interest of mine was emergency psychiatry. I did an internship in my first year of medical school with IRETA, the Institute of Research and Education and the Treatment of Addictions. And one of the small little, you know, rotations we did within that was at a psych emergency room at Pitt and I loved it. So yeah, so I got into my dream residency program. And so the reason why I have a picture of my white coat here is because anybody will notice it's redundant. It says doctor and DO. And I was in this phase of my life where I was expressing myself visually, but not vocally. And I was tired of hearing people ask, you know, like, what's a DO? Like, are you an eye doctor? Like, you know, are you really a doctor? What's going on? And so as an act of defiance, I had them print doctor, my name and DO because I am a doctor. I am a DO. I'm proud of being a DO. And yeah, so that's kind of funny, my redundant white coat. And you know, the picture next to it is how I showed up the first day of residency. Now, I don't have a picture of interview season, but during interview season, I was a Southern Belle. I had, you know, the long dark hair and I hid all my piercings besides my Monroe, but I had a very realistic Monroe then. And I really tried to present myself as like this clean blank slate. You know, I was told that I needed to present in a more sort of American, maybe more Caucasian appearance. And it just wasn't me, right? And once residency was about to start, I kind of just made this decision that, you know what? I'm just gonna do what I want to do. And so I bleached my hair blonde and donned a Mohawk. And yeah, when I showed up, everyone was very surprised, but this was me. This was my way of expressing myself. And at that time as well, we got married. I got married to Frank. It was also something that financially and timing wise was not probably the best, but it felt natural. This is me sort of kind of coming into my own and finding out that I can be myself and be okay. So something that, you know, happened in residency is that residency was the first time for me that I was, you know, an employee and a coworker and not just a student, right? And I had this idea of residency being this, I don't know, because it's a psychiatry residency, I thought it wouldn't have the same office dynamics that, you know, maybe some other specialties, residencies, workplaces have. But the truth is, is that in many ways, medicine is a good old boys club. And so you see those dynamics, you know, I was really shocked at like, sort of the importance of who do you sit next to, you know, this lunch and this thing. And, you know, there's always the jock who's like vying for the chief resident role. And, you know, the female resident who's using their sexual charm to sort of gain privilege and access. And when I noticed all of this, I sort of retreated into myself. I was not a place, I'm not a confrontational person, I'm not a competitive person. And so I really retreated into myself. Something that I had done as a teenager and in, you know, even in college and in medical school is I've always been a writer. Poetry and essay, storytelling, it's something that I'd always done privately, but in residency, I think out of loneliness, I started to do it publicly, you know? And also I was poor, so I needed money. And so I would take these paid gigs to write articles for websites. And I wrote a lot of them just out of, you know, passion and also money, I was broke. But yeah, it was just a way of self-expression. And it kind of snowballed from there. So I, from the articles that I started writing and kind of presenting, I started making more friends in the writing community and I was asked to do some storytelling events. And so in the Black and White was my first storytelling event. And then from there, my friend David Wayne Reid invited me to speak on his storytelling event, Shelf Life. And from there, I transcribed those stories into essays that were eventually published. And that was one of my more personal, you know, stories, Sense of Touch, was published in Eizell Magazine and subsequently won their inaugural Eizell Prize for nonfiction. So that was a really proud moment for me. So I went from just doing something as an escape from residency to doing it for my own pleasure. Something else that I did, you know, feeding off of this was building community. I wanted community. I wanted to find friends. And Kansas City is a place that is very segregated. Like many places in the Midwest, you know, a lot of people are, you know, grew up with each other and are just not really great at integrating new friends. And so I created a group like Water for Chocolate, which was a semi-support group for women of color to kind of have more in-depth conversations to talk about those difficult topics and to be community for each other. And through that, I made and maintained some friendships that I still have now. So I created the life that I wanted, building on, you know, the steps of sort of, you know, expression, self-expression, you know, going inward, outward. So this is from my residency graduation dinner. It's me and my husband and my son, Theory, who is now turning seven. But, you know, this was a great time for me. I was kind of riding this high of finding myself in a way, you know, expressing myself vocally, right? I went from writing things down and tattooing myself and doing all these very passive gestures to outwardly expressing myself. And I was really riding this high because of my own trauma and my interest in trauma. I took a job. My first job out of residency was at the VA. I worked at the Topeka VA, former medical clinic, and it was a great experience. So that was 2018. Now, 2020 happened. And what became, what was a difficult job as it was, became almost impossible for me. I was very, very much triggered by a lot of events. One, the pandemic itself is just scary, going to work. And, you know, if we all remember the first stages of the pandemic where we didn't really know how COVID was spread, you know, people were speculating, is it, you know, is it in the feces? Is it in urine? You know, I had coworkers who were using the bathroom in their car, like just doing weird stuff. We were just, and there was no masks. There was no supplies. It was, there was a shortage of people, of professionals who could work. And I was being the youngest employee, the youngest psychiatrist in the outpatient clinic at the VA. I was one of the few people, if not, you know, one of two psychiatrists who stayed in office to see veterans. And it was just a lot for me. And not only that, I was still dealing with the issues that come along with working in a veteran population. So I had a stalker and I think that was like my breaking point, feeling unsafe at work in every aspect, not knowing if I was going to catch COVID and bring it home. And then also feeling physically unsafe and having to hide and having to know like when people were coming in and out of the building, it led to an emotional breakdown. And I left the VA and took a job working remotely in community health. So that was my way of doing the thing that I loved, but also taking time to recover, to just, to regain my focus. I got back into therapy. I think therapy is something that I've always, you know, kind of gone in and out of since medical school. I got back into therapy. And with that, I kind of gained the courage, understanding, knowledge that some of my relationships that I had maintained up until then weren't healthy. One of them being with my mother. Like I said, my mother had made it very clear to me at a very early age that she did not want me. You know, she did not like my father. She was unhappy with the marriage. I was just sort of, for a while, you know, I thought I was a happy accident and a happy byproduct. But, you know, I just really, through therapy and kind of revisiting trauma because I was re-experiencing things again, I realized that that wasn't a healthy relationship. And I took this photo the last day that I spoke to my mother. And that was in 2021, I wanna say. Actually 2020, 2020, it was 2020 that I stopped talking to my mother. And that was a really big moment in my life because, you know, my father had died two weeks after my son was born, my older son was born. And so that part of my life, I kind of buried with him. And this was a major step, you know, not talking to and estranging yourself from a living parent is a really hard thing to do. But when I did that, it really empowered me to sort of live freely and do things that, you know, I was always told not to do. One of them being was exploring nature on my own. So I had always gone on trips and done things with other people because I was raised with this idea that, you know, being a black female in the world is just not safe. And I really pushed myself to, you know, think outside of that. I bought a camper, that's Junebug, my camper. And I took trips, I went into nature, I volunteered on farms and rode horses and enjoyed the prairies of Kansas. And along with that, snowballing, right? Because I had done all these storytelling events and was establishing myself as a writer, I made a lot of friends in the creative communities of Kansas City. And one of the things that I sort of branched out into was modeling and using that as a form of creative expression, visual creative expression. So I was gaining my voice and also I was allowing people to see me in a way that I wanted to be seen. Keep in mind, while this is all going on, I'm still working as a psychiatrist. I worked in community health and did that remotely. And in this time as well, I got a job in emergency psychiatry remotely, which is something that I never thought would be feasible, but I got a job doing that. And so I was growing and sort of getting more comfortable and going into the places that I wanted professionally because I was feeding myself emotionally. And one of the big things that I did was doing this visual poem, Identity. So this is a project that I worked on in my free time, something that I'm really proud of. And also at the advice of a therapist, because I went back into therapy again, as an advice of a therapist, I wrote a chapbook on some of my childhood traumas as a way to give my childhood self a voice. You know, I literally start the book out with, you know, this is for young Nora, whose words were never listened to, they were never heard. So this is Swallowed Words, my chapbook that I self-published in October of 2022. And then building on top of that, just because I have all these creative friends, I actually recorded an audio book to accompany my chapbook. So this is what I did in my free time. You know, I was not only a psychiatrist, I also was a creative and this sort of fed into my practice. When I was pregnant with my second child, I created another, or, you know, we filmed another short and this was friends of mine, you know, who worked in the film side of things. So the short film is based on a chapter from my chapbook about my cat Daria and how I encountered her, the feelings that were invoked by meeting her and adopting her. And it starred my other cat, I'm a cat lady, my other cat Numbers. So yeah, so this was last year actually. So, and on the day that this premiered, I actually went into early labor with my second child. So this is my family. This is, you know, true, baby true, big brother Theory and my husband Frank. And so, you know, I didn't come from the beginning that most people envision doctors to come from. I had some humble beginnings and had lots of challenges, but I created the life that I wanted. And I think that what pushed me professionally was that I was able to personally grow and overcome challenges. And it led me to where I am now. So now I live in Southern California with my family. I work as a regional medical director for precise behavioral and also a medical director of behavioral health at Antelope Valley Medical Center. And this is not something that I ever imagined for myself because I was always told that doctors have to look and act a certain way and being as unconventional as I am in appearance with my tattoos and piercings and having my unconventional background, I was still able to achieve the things that I wanted because I took care of myself. I used the adversity to push me forward. And it's something that's really helped me in my practice with patients, maybe because I'm a psychiatrist and so I deal with emotions all day, but I think just as a person, you know, the advice that I give is advice that I have taken. I'm not going to recommend therapy if I haven't been in therapy. I'm not going to recommend medication. I don't tell everyone that I did take medication, but it's something that gives me a certain perspective and empathy and makes me human. As doctors, we are human. And we have to remember that, that we have to take care of ourselves, well, care of others in order to take care of our patients. And that's really my message. We are respected and we have this history of this esteemed profession, right? Caregivers, doctors, but with the changes of today, it's getting harder and harder to maintain your own mental health. And so you really have to strive to be healthy. And I hope that everyone does that. So that's the end of my presentation. These are my references. Here are some resources, of course, the physician support line. Yes. Yep, yeah. And then these are the, you can reach us in the physician services department. There's other webinars where you'll be able to see this web recording as well as others. And then the practice medicine webpage, if you need some information on the day-to-day operations in the practice. Member value page is actually for discounts for members. And then the store is where we have some of the books that we sell. So thank you, Dr. Kanya. I mean, your story is, there's the down, the up, it's very emotional. And inspiring to know that you were able to overcome so much that others had not. So, I mean, I think that in itself, the fact that you're willing to share your experience with us, hopefully it helps somebody else know that there's nothing wrong with it. Going for therapy when you're feeling down, you need some help, it's okay to go for help. So, yeah. Thank you so much. It does not look like we have any questions that have come in. If anybody does have a question, please send them into the physician services mailbox. I then will send them on to Dr. Kanya and she will respond to you. But thank you so much for sharing and best of luck to you in the future and keep being you. I will, I have no choice now. Yes, thank you so much. Thank you so much, everyone. Thank you all for joining us. Yes, thank you. Bye.

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