Imagine if your BFF was a doctor: Medical Mentorship
Kara Wada, MD: Welcome back, everyone to this week's episode of the Becoming Immune Confident Podcast. My name is Dr. Kara Wada. I'm a board- certified pediatric and adult allergy immunology lifestyle medicine doc and Systemic Sjogren's patient. We love to have episodes where we welcome some of my friends and colleagues to talk about the awesome things they are doing in the world and today, I am super duper excited and honored to have Dr. Tracy Shevell join us.
Dr. Tracy is a classically trained high-risk OBGYN. She's not only used to dealing with coordinating care between multiple physicians, subspecialists in the care of her patients, but she's also a woman and a mom who personally has dealt with complex mystery illness as well in learning how to self-advocate after already advocating tirelessly for her patients, she now helps coordinate medical care for women across the reproductive careers and life after that. She really hopes to be part of the changing paradigm of how women are cared for by others by improving the overall medical experience. Thank you so much for joining me today, Dr. Tracy.
Tracy Shevell, MD: Thank you. It's been a pleasure getting to know you and work with you, and I'm really psyched to be here with you today.
Kara Wada, MD: Can you share a little bit more about your story with our audience?
The birth of Blue Moon Perinatal
Tracy Shevell, MD: Sure. Of course. I'll tell you more than you wanna know, probably. No, I'm just kidding.
I followed a very traditional path to medicine. Always wanted to be a doctor when I was little, always very idealistic and really have always felt most comfortable helping other people.
After medical school, I did my training in OBGYN in the city, Mount Sinai, and then I did a fellowship in maternal fetal medicine or high-risk ob at Columbia. And right out of training, I got a great job, we moved out from the city to the suburbs and I worked for about 17 years at our local community hospital here in Connecticut.
And it really was literally the perfect work-life balance for many years and I kind of very quietly would go home and be like, "Oh my God. It's the perfect work-life balance. It's so great". I was not used to having the luxury in a city hospital. You see 70 patients a day but I didn't have that here.
I had the luxury of spending time with women and talking through because we were a referral center, I did tend to see patients who already were at higher risk. And so, super emotionally laid in issues, whether that be maternal health issues or something, we found on ultrasound with the baby. But really got to spend a tremendous amount of time and resource on seeing all of my patients and really had an amazingly wide population base from different socioeconomic backgrounds. And it was wonderful. It was really great.
I went down to working part-time to be a mom to my kids and was like living the dream for quite a while. And then, about seven years ago, I think we talked about this. Everything started changing. Women who had intimate relationships with their OBGYNs, because they were one or two in a group, turned into one in four, first to cover call for doctors who were burned out. Then became one in eight, then became part of a 12 person group, and then that group became part of a multi-specialty group. And a lot of that was not because the doctors didn't wanna spend time with their patients, but because there was a slow trickle of an influence of business into medicine.
And the more clout you have as a group, the more doctors that are in your group, the more power you have to negotiate with insurance companies for reimbursement. Again, not something that the doctors were really happy about either, but for me, especially where I'm talking about such intense things with women, it became so challenging.
I'd walk into a room, do an ultrasound, and it'd be a woman who was there with her six week fetus and all these hopes and dreams and there wasn't a heartbeat, right? And I went from being able to spend half an hour with that woman and then she'd call her doctor, who she'd known since she was 21 and be taken care of to teaching her how to hack the medical system to get seen earlier because you call a call center and you know someone's in Idaho and you don't even know your doctor's name.
So that really started to become profoundly difficult for me. I'd have an hour consult and I'd spend 40 minutes scheduling appointments and kind of giving insider secrets. The second thing that really kind of pushed me over the edge was the real crisis in maternal mental health. A lot of, even my partners, the immediate response was, "Well, your patient's on medication or she has anxiety, she should see Tracy". And it really was devastating to me that even in the community that I was in of doctors who really cared about patients, the other people in my group really didn't wanna deal with it. It wasn't just that like I was specializing in this, I wasn't, I love prenatal diagnosis but someone had to be there for those women. I myself had tucked two high risk pregnancies and the anxiety that comes along with that, and being a mother and having a concurrent sort of medical thing.
I basically set out to create a mental health and wellness center at my hospital, and everybody was very gung-ho about it, all the way up to the highest levels of administration. And then they realized that it didn't involve doing any procedures. So the funding didn't so much come through and COVID had hit, my kids were out of school, the world was locking down and right at that same time, I myself was finally, after years of seeking a diagnosis, was given a diagnosis. I had mast cell activation syndrome and was told by my immunologist about the importance of PPE and keeping myself safe and it wasn't happening so much for me at work at the time, so I was like, "You know what? Like this isn't working". So long story short, fast forward, I actually had unrelated surgery, became a patient myself, saw the inside of the medical system again as a patient, was very dismayed to say the least. And everybody's just working and doing their best and pulled in a million different directions and on an electronic medical record and everybody's trying to provide care, but there's so many other things that get in the way. So I decided for the first time in my life to be an adventurer and I tried to make a career out of connecting the dots.
I launched Blue Moon Perinatal in December of 21 and it's a service that provides the support, the explaining all the stuff that I used to be able to do in a hospital setting for women going through complications or difficulties from pre-pregnancy through postpartum. And just this year I realized that I had a lot of clients who wanted to stay on once they had young families and so now I've expanded to offer this concierge navigational support for young and growing families who can stay with me on a yearly basis because a lot of what I do isn't just about fertility and pregnancy, it's about just caretaking. So here we are today.
Why Filling Your Own Cup First Is Key to Helping Others: Insights from a Perinatal Health Expert
Kara Wada, MD: I know. there's so much to that we could talk about and dig into more. One thing that stood out to me so much is at a certain point you made this realization that you couldn't pour from an empty cup anymore. That you yourself needed to take care of you, which I think takes us a long time sometimes to get to that point.
Tracy Shevell, MD: Yeah. No, you're a hundred percent right. I look back and I think about like I spent a lot of my career also living in like the sandwich generation when I had a lot going on with my kids and I had a mom who was struggling with dementia, and I remember one night being, in my unit, it was 6:00 PM covering for somebody that was away and my kids were calling about dinner and this issue and that issue, and my mom got rushed into the emergency room. So I ran to the emergency room and then the car dealer called, because the loaner car had to be traded back. I'm like, we just do it, do it, and do it, and do it.
I realized, especially with my own medical issues, It took me so long to get my own diagnosis and part of pouring, like you said, is filling that cup and sometimes it requires really tough decisions to be made. But I have seen a radical change in my life, taking a risk just in my interactions with my family. And I think really overall in my mental and physical health, we all have to pay attention to ourselves and again, I think so much of navigating this world of complex illness where everything's interrelated, the gut, the brain, the, the nervous system and the way that our bodies manifest stress, right?
How Medical Mentorship Provides a Sense of Safety and Advocacy in Complex Health Situations
Kara Wada, MD: Yes. Yeah, absolutely. I was thinking back, so this week is the 13th anniversary of our med school graduation. Like my class' graduation. Some friends had posted pictures, the throwback pictures and everything. I think about how much has changed over that period of time. And I was reflecting a bit more this week on my physical health and how that has changed over time too and how my body was also manifesting stress.
At that time, my now husband and I, we had been dating all through medical school. We started dating like about a month in but he was very non-committal. I think he will own up to that for a long time. And so we ended up getting engaged a couple weeks after graduation. And I was talking with someone I said, " I realized at a certain point a lot of the stomachaches and headaches I was getting, they didn't like totally go away, but they decreased pretty considerably once I had that certainty. So I was just like kind of exploring this idea, this thought of how important is feeling safe and secure in our relationships and in different ways, really can make a difference or impact us in ways that we may not fully comprehend until maybe in hindsight.
Tracy Shevell, MD: That's so interesting. I think that you bring up such an important point too, as it relates to this whole journey of trying to patch up the medical system. A lot of the questions I get asked, and we are all really looking for safety in some way, right? Like the most common question that everybody wants to ask either after medical school or after having kids like, "I have a headache. Do I have a brain tumor?" I think the majority of us don't really think we have a brain tumor, but we want safety, right? We want to know everything's okay.
And I think that, to your point. That's why I feel that it's so important to add the background, what seems like the background, right? I'm not doing the ultrasound anymore. I'm not doing the EKG and making the diagnosis, but I am offering some sense of safety and security that someone's gonna have the time to take and to go through things with and to advocate for you.
So you're so spot on because I do think that, and again, it's not that the doctors aren't caring anymore or it's a new generation, they care, right? Like they care. But it's hard to express when you've got to solve a medical problem or deal with a blood pressure medication or that's what you have to solve. And then the caring piece, that takes time. And that time is hard to find. It's hard to come by.
Kara Wada, MD: Absolutely. And it's interesting when you were talking about how certain patients would magically find their way onto your schedule through your colleagues and what have you, that happens with me as well. There are some of those things and thankfully I really enjoy, for instance helping my patients coming in that maybe think they have food allergies. In hindsight, it's not true allergy by definition as an allergist, but they're eating food that are having physiologic consequences, related to them.
They're having symptoms that they attribute to foods, and so helping them work through that to the best of my ability. But the reality is in that 30 or maybe 60 minute visit, which I am incredibly lucky to have, it still isn't enough time to really dig into everything that is necessary to help teach and help people unlearn all of the bonker stuff that we have learned over the years.
Tracy Shevell, MD: Oh, absolutely. Thinking you have a food allergy or reading something, it can really impact your whole lifestyle, right? And then a lot of women, and I see this happen all the time, you wind up medicalizing yourself in a way where maybe you don't even need to be medicalized and then you start to see yourself as a patient and how am I going to get better and what do I have to do? What do I have to keep away from?
Everything becomes geared toward figuring out what's wrong with me when sometimes it's not much. Sometimes it's life is what's wrong with us, or we're not sleeping enough and I am very guilty of this, or we're on our phones too late at night and restricting food. I mean, I know that I am like one of the most annoying people to go out to dinner with, right? I'm like, hold to this, put that on the side. Some of it's because I have an allergic slash autoimmune thing. Yeah. But I've had to really be very mindful of doing it in a light way, and it's been really hard for me for a long time.
Kara Wada, MD: Yeah. Especially when I would say our generation's, we grew up immersed in this culture of diets and now it's called wellness. And unlearning some of those behaviors is really hard, especially when our brains go in thinking of, " We're doing this to help our health". It's with good intentions, sometimes goes amiss. I also think it's really hard too to navigate this piece of wanting to medicalize because you maybe don't feel like you're being taken seriously within the system, or you've had experiences like so many people being gas lit and at the same rate also realizing that there is in many instances a significant component of how stress in life and all these things can impact us physically as well.
Tracy Shevell, MD: A hundred percent. And it's so interesting you just mentioned being gaslit. It's one of the things people want to know when they're self advocating, but also don't wanna know, is I think that doctors are by and large with all good intent. They're afraid when they don't know something or they don't understand something and that's a normal reaction. We go to school and success is knowing what's wrong with someone and how to fix it, right? But when you have a patient that is struggling with a complex illness, this is a place where patients really do have to not make themselves like a victim, but really start seeing themselves as empowered. And that's part of, especially with autoimmune illness, especially with mystery illness, you have to be empowered and understand that, you've gotta really fight for yourself.
I've had a lot of patients cared for by doctors who understood their condition better than the doctors. Right? And there's a super fine line in navigating that. And if you're not a physician or you don't have a physician with you, one of the things that I love doing, honestly, and I'm able to do it because I'm a physician, is help in situations where a patient knows more about their illness than their doctor who's amazing but to say, "Hey, wait a minute, like this is a thing this patient understands". Like these symptoms have to be taken at face value, they're real. Just because we don't understand something, doesn't mean it can't be.
How a Medical Mentor Can Help You Advocate for Your Health: The Benefits of Having a Doctor as Your Best Friend
Kara Wada, MD: So how does that show up with your clients? Can you walk us through what that would look like?
Tracy Shevell, MD: Sure, yeah, sure.
Kara Wada, MD: I'd love to hear like that this is a thing.
Tracy Shevell, MD: Yeah. I'm really hoping that it becomes a thing. When I started this, it was so funny. I worked with someone to get my practice out there and he's like, "Okay, Google, what are your SEO terms?" I'm like, "There aren't any, I'm like the doctor helper".
So basically, the way that it works is, let's say I have a client who comes to me and she got mystery symptoms or a complex illness, I'm gonna do an individual first just 'cause it's easy, right? So patient has an autoimmune illness and is pregnant and has three different specialists and is struggling to be seen and heard or having symptoms that nobody knows what they are. I'll typically go through a real whole comprehensive.
My clients, I hope they don't hate it, but like they probably get very annoyed. It's a nice big four page questionnaire when I get to know someone about medical, physical, spiritual, emotional, like all of it, so that I have a picture of who they are, where they get the support from and then we go through, and really, I like to think of it as like detective work, right? So go through who are their specialists, I look at records occasionally, if patients want me to look at things, I pull out questions to ask. We make a framework as to putting all the pieces together.
My goal is to then have them be able to come to their OBGYN, let's say in this example and say, " Here's a list of my conditions. Here's a list of my doctors", so that the busy work is presented in doctor-speak to a doctor. So this way, the patient not only is correlating information in a way that a doctor seeing them can digest it most quickly and most easily, but it's clear that they've got a medical advocate on their side.
I never imagined this would extend out beyond pregnancy, but this is something that applies to anything. I was always that person that people called, right? They're like, "oh, I broke my foot, or I have a terrible pain in my back, or I'm struggling with anxiety". And if someone doesn't have that team, I'll find you who you need to see. As a doctor, I have the ability to call the office and say, this is Dr. Shevell, can I talk to Dr, right?
Sadly, patients can't really do that easily.
Sometimes I'll call and I'm like, "Okay, please. I know the doctor is sitting like two feet away from you. Can you just put them on the phone, please?"
Kara Wada, MD: This will take like so much less time.
Tracy Shevell, MD: Exactly. Exactly. I do think that I've been fortunate and that I have a pretty easy time explaining things to people in a non-medical way that are medical. So once patients have a good understanding of what they're dealing with, I think it's easier for them to then interact with their own physicians. And I also try really hard to find ways to get patients comfortable asking what they want the real answer to.
So many times I will have clients who are intelligent, powerful women, men, whatever, they'll go to the doctor and they'll just be tied up in knots. I'm like, "Okay, this is your real concern. This is what I'm hearing out of the office. These are the three questions you've got to ask and get an answer to because that's how you're gonna build a relationship and that's how your doctor's gonna understand that even if they don't understand what you're struggling with, it's okay that they don't because other people might".
So I try to connect those dots in that way and match-make, and I think we used to be really almost luckier. In a way our technology expands, but our connection doesn't. People used to have a family doctor that was their coordinator, right? Basically like a personal medical affairs manager, right? Like all things medical, you call me and I, the part of the reason I have on my pregnancy website " What if your best friend was a doctor?", that's what everybody needs, right? They need a medical best friend to tell them, "This is what happened, this is what's going on, this is the test you need". It's often the filler that is just as important as what's being filled.
Kara Wada, MD: There's so much we could dig in. Oh my gosh. I mean really in your explaining a lot of like medical mentorship, right? Helping and coaching and elements of this all coming together. With that body of knowledge and the inner working of this cluster, what we're working within. Those questions are that I get the most out of in asking my patients. " What are you most worried about?"
And I think that comes back to where you're helping guide them, right? Because not every doc's gonna ask that. But if you can help, just like some of those fears however valid or medically from my training may seem kind of ridiculous, it's not ridiculous to that person. It's something that's keeping them up at night, and if I can help at least take that or minimize that and help them sleep better, that's so huge.
Tracy Shevell, MD: I think that is incredibly wonderful and amazing, and I think that should be on everybody's door walking in, right? The problem is, and this is where things become complicated, what do you do if you don't have the time to get the answer to that question? I always say, for all the time that I practice, I can't do a test unless I'm prepared to act on the answer. I can't do a medical test just looking for a no. What if there's a yes? So that's always been something medically that's been incredibly important to me. To your point, this is exactly what happened with the maternal mental health piece for me, right? Yeah.
It became imperative a while ago that all moms be screened for postpartum depression. And I was practicing in the state of Connecticut and for the first six months that edict went into place. It was pediatricians who were the ones that were doing the screening, the pediatricians who don't know the parents, who are the baby's doctor and yes, the dyad of mother and baby coming in. Of course you have to worry about the whole picture, but it was insane to me. Women had just spent nine months with an OBGYN in their most intimate situations and all kinds of like you have a baby and you don't care who walks in the room, you've made a, connection to someone, right?
Then it became mandated, rightfully so that it fall to the OBGYN. But what does an OBGYN office look like for so many women? I was practicing in a wonderful private hospital but in a private office, you have 35 patients sitting outside and you have someone come in for their postpartum visit, right? Babies out, everybody's safe. You do a screen for depression. What do you do with that? You have 10 minutes. And by the way, if you do refer them somewhere, chances are they have a new baby at home, they won't have the time to get there, they don't have the resources.
By the way, if you want to go to a psycho-pharmacologist who could prescribe medication if you need it. Sometimes that is $600 out of pocket. And again, I'm not bashing, it's not that psycho-pharmacologist, like they need to earn a living and they're not driving Maseratis either. But what are you doing with those answers? That's a problem and it's a problem that is bigger than one doctor or two doctors. It's a system issue that we're gonna have to analyze and we're gonna have to start coming up with things, right, because this applies not just to women in pregnancy, right? This applies to all of us.
Kara Wada, MD: Absolutely. I mention every week, I'm very fortunate that I do have access to the help of a social worker from time to time. But I really could benefit from having someone, like a therapist, someone to help connect especially my patients who are dealing with these complex mystery illnesses.
Tracy Shevell, MD: Absolutely. And especially, when you think about autoimmunity and how everything is intertwined and stress plays a role and again, I think that we are going to have to look for other resources to help connect the dots. It's just impractical to think that it can all be done in eight minutes in a doctor's office.
Kara Wada, MD: And there's simultaneously charting and billing,
Empathy and Burnout: Navigating the Challenges of Modern Medicine
Tracy Shevell, MD: I mean, there was like a horrifying study that came out about ChatGPT this week. I don't know if you saw it, but it was a study taking a cohort of patients and having them ask a doctor questions and having ChatGPT answer questions and 80% of the time ChatGPT was more empathetic, not just more correct, more empathetic. And I am telling you, I know for a fact that is not because doctors don't care. And I think that's only compounding issue, doctors are so burnt out. I'm in a bunch of physician groups on Facebook and it's just, it's so...
Kara Wada, MD: it's heartbreaking and I think we already have a shortage of physicians, especially in a lot of places, and I think the reality is this problem's only going to grow before it gets better.
Tracy Shevell, MD: I think you're absolutely right and I do think that. To get back to your comment about the doctor shortage, it's a hard time I have young students that I interact with on occasion, that I mentor, that wanna go to medical school and that have all the right ideals. And I just worry so much for our profession, right? I think it is gonna get worse before it gets better. And again, it's not that doctors are lacking empathy, like that study was so upsetting to me because the takeaway is going to be that a machine is more sensitive than my doctor. That's not the case.
Kara Wada, MD: Rather than looking at the system that literally beats empathy out of humanity, out of the healers.
Tracy Shevell, MD: Absolutely. And I will say I am a rare person who managed to be in my obstetrical career and never lose the ability to cry at a delivery. But when you are having the most intimate moment of your life and your doctor is getting paged from the clinic is present in this beautiful moment, right? It's truly like this miraculous moment and then has to go out and fill out literally 45 minutes of electronic medical record about that beautiful experience.
There were times when I knew I was in a consult with a patient, right? And I was like in it, and I was really in it, and I. And I realized, almost a subconscious thought, "Oh my God, I'm not gonna have time to write this note. When am I gonna write this note? So you wind up writing it at 11 o'clock at night and then you're too tired the next day. And so maybe you don't have the same level of empathy on Friday as you did on Tuesday.
Beyond the Electronic Record: How the Shift to Digital Medicine Impacts Patient Care
Tracy Shevell, MD: One thing I do not hesitate to speak out about is I do feel that at least for myself, I do feel that most people practice better medicine when there are paper charts and you could just write a note down.
Kara Wada, MD: And I will say, I graduated med school kind of right at that cusp of the turning point between a little bit of electronic records, like that's how you ordered a few or you could check labs. But the majority of things were written. And then from graduation to starting intern year, we went into Epic like shortly thereafter. It is this really interesting duality. You talked about being kind of the sandwich generation. I think increasingly, the elder millennials are being considered this bridge generation because we had this analog childhood, and even for me in my medical training, kind of this more analog training, but now in this very digital existence that we live in, and what a fascinating experiment we're all living within.
Tracy Shevell, MD: It is absolutely true. One of the most interesting conversations that I've had in the last, couple of months was with a woman who trains doulas and was talking about how the vision, this concept, or conceptually how wonderful it would be if the nurses that were at the birth could be doing some of that or understand some that, but the nurses are even having to sit and chart and find the right box to put the cursor in.
Kara Wada, MD: All of it to bill, essentially to bill and to cover our you-know-whats.
Tracy Shevell, MD: Absolutely. And this is why one of the most brilliant things that I've seen in terms of what I think is truly a medical advance, forget like the fancy MRI, some ERs have and some practices have scribes. And I have to be honest, like that is so genius and that's the kind of thing that I mean in envisioning this better way in the future to have interactions
I actually saw an orthopedic surgeon who had a scribe and it was like a little weird, right? But it was just an odd thing that someone's in there typing away. But I had a really meaningful visit that and then he went on and spent those told whatever minutes we spent together, spent the whole time talking to the next patient. So, that's just kind of one of the ways I think if we can be pulled away from the electronic record a little bit more somehow and be able to do the speaking where you're not afraid of the documentation ramifications after, like that's a nice thing and part of one of the greatest joys for me in and having my own practice in this way is that I can write things down by hand and keep folders and that is so, I'm showing my age, but it's so liberating and wonderful. I know where everything is. I don't have to search a program to find the medication tab.
Kara Wada, MD: We know that our brains actually capture that information better too when we physically write things out. That's part of what we learn when I did my training in medical education adult learning, there is something about that kinesthetic movement of using your hand and how that all works, that we do capture more information if you are handwriting. So not only is it more comfortable for you too, but you probably are actually absorbing that information more because you're present more, you have that actual movement aspect as well.
Tracy Shevell, MD: That's so interesting. But you're a hundred percent right, and I don't think that's the same as typing, I just don't. I hope that things like that become more commonplace again, especially with complex illness, right? It takes women sometimes, I'm sure you talk about this all the time too, it can take up to 10 years to get an appropriate diagnosis, right? And once you get the diagnosis doesn't always mean you magically get treated and you're better. It often is the beginning of a separate journey, right?
That's the other thing I always encourage clients to do is after a visit, to take their own notes and have their own record keeping because they will often forget something that's discussed and sometimes they can look back and realize, "oh wow, I should have asked this on their own". They're acquired skills. We're used to writing notes after a visit but patients aren't and even if you don't understand what happened, you can still put down your rendition of what happened and you can often see what was lacking. So that's something that I always say is super helpful.
What does Becoming Immune Confident mean to your BFF doctor?
Kara Wada, MD: Absolutely. When we think of the title of the podcast, which is Becoming Immune Confident how does that show up for you or how does that resonate?
Tracy Shevell, MD: Yeah. Oh my God, that's such a good question. I think that no matter what the condition, I think that no matter what the diagnosis, when you're navigating through the medical system, being immune confident, your immune system is what protects you, right, and what takes care of you and so you have to believe two things. You have to believe in your body, being confident and capable, and competent, and you also have to believe in your ability to advocate for that to continue. So I think it's super important for, anyone dealing with an autoimmune or a mystery illness to not only believe that their body can work for them, but that they can work for their body, right? So part of what I do in the work that I do is teaching people how to become medically confident so that they can advocate for themselves to get the care they need. Especially when you're dealing with any immunity issues. It's having the confidence in yourself too, not just your body, but yourself. It's a very intimate relationship. And it's separate, right? It's separate.
Kara Wada, MD: So if folks want to connect with you, We will post all of these in the show notes, but can you share where
Tracy Shevell, MD: so I'm on Facebook, I'm also really on Instagram. Instagram is something I've learned a lot how to do and I find it's a really super easy way to engage with people. So I spend a lot of my time on Instagram. The arm of my practice that. Deals with women trying to conceive or having issues in pregnancy is @bluemoonperinatal and then the other part of my practice, which deals with everything else is just my name, it's just @tracyshevellmd. So on Instagram, I'm on Facebook. I try to do a lot of Q&As. I have the same website as correlate with the Instagram handle. So I hope I'm easy to find.
Kara Wada, MD: Awesome. Yes. And we'll make sure to have all of those posted. And thank you, thank you, thank you for spending this time sharing your vision, your expertise, I am sure we will be continuing to talk and to collaborate and work together over the years to come. I'm so excited.
Tracy Shevell, MD: Absolutely. Kara. Thank you
Kara Wada, MD: we're part of the change. We'll see it happen.
Tracy Shevell, MD: I love that. It's been a pleasure and thank you so much for having me and you're an inspiration and just keep doing what you're doing and the world's gonna be a better place because of it. So thank you for having me.
Kara Wada, MD: High fives all around.
Tracy Shevell, MD: Okay, perfect.