In this Season 2 opener, Revitalize Women Physician Circle co-founder and host of the podcast, Dr. Andrea Austin previews what is on the horizon for our company and podcast. She starts with a discussion of her personal journey through COVID-19, shares a recent health setback, and how this has pushed her to radically rest and prepare for the next phase of her career. Andrea talks about her recent experience with Functional Medicine, and how Dr. Danielle Douglas is helping her improve her health.
She talks about her experience processing emotional trauma. She recommends the following books for learning more about emotional trauma:
What Happened to You by Oprah and Dr. Bruce Perry
How to Unfuck your Brain by Faith Harper
Buy Yourself the F*cking Lilies by Tara Schuester Family Trauma
Body Keeps the Score by Bressel van der Kolk
Wounded Healer by Dr. Omar Reda
Andrea mentions how before leaving for her sabbatical, she left going "horizontal," a term Brené Brown uses on her
MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.
In this Season 2 opener, Revitalize Women Physician Circle co-founder and host of the podcast, Dr. Andrea Austin previews what is on the horizon for our company and podcast. She starts with a discussion of her personal journey through COVID-19, shares a recent health setback, and how this has pushed her to radically rest and prepare for the next phase of her career. Andrea talks about her recent experience with Functional Medicine, and how Dr. Danielle Douglas is helping her improve her health.
She talks about her experience processing emotional trauma. She recommends the following books for learning more about emotional trauma:
What Happened to You by Oprah and Dr. Bruce Perry
How to Unfuck your Brain by Faith Harper
Buy Yourself the F*cking Lilies by Tara Schuester Family Trauma
Body Keeps the Score by Bressel van der Kolk
Wounded Healer by Dr. Omar Reda
Andrea mentions how before leaving for her sabbatical, she left going "horizontal," a term Brené Brown uses on her
MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.
Trauma, Healing & Getting Ready to Rumble
SUMMARY KEYWORDS
trauma, physician, medicine, pandemic, cortisol, emergency medicine, emotional trauma,
SPEAKERS
Andrea Austin
Andrea Austin 00:00
Welcome to The Revitalizing Doctor podcast, we explore with our guests how you can move from surviving to thriving as a physician. We know that when you connect with your values and authenticity, you can live a life that is fulfilling, and not only good for you, but drives the necessary transformation in health care to take better care of our physicians, which means better care for our patients. Hi, everyone, this is your host, Dr. Andrea Austin, I am so excited to be opening season two, and tell you about what we're going to be doing and share about some of the updates with Revitalize. So this is going to be a different episode than normal, I don't have a guest, I'm just going to be talking to you. This is going to be a vulnerable and hard conversation. And it was encouraged by a friend that's been listening to the podcast and said, you ask other people a lot of questions, but we don't really hear about you and your story. So I'm going to try to let you all in a little bit today. I also have a new microphone, and I'm learning how to use it. So the sound quality may not be amazing today, but I will continue to get better with it. So I appreciate your patience with my novel podcasting skills. And lastly, I want to say this will be a difficult podcast to listen to not one for small ears. So if you're listening to this in the car with your kids, I would turn it off and listen another time, I am going to be talking about trauma and not the kind maybe we're more comfortable with in the trauma bay, but more about emotional trauma. I'm going to talk about some of my experiences and my own journey with mental and physical health. I am sharing my own experiences. These are not meant to be physical or psychological advice. So I'd encourage you all to reach out to your own medical and mental health professionals. So if you've been listening to the podcast, you've heard me referenced several times that spring of 2021 was a real nadir. For me as far as my physical and mental health, I was very exhausted at that phase of the pandemic and feeling very unfulfilled professionally. And considering leaving emergency medicine. Essentially, I was burned out. So I took a pretty long, in my opinion about a three month break from clinical emergency medicine. And I took that summer off, slept a lot, normalised my sleeping pattern and worked mainly doing veteran disability work and a little bit of online teaching, but really no clinical work for about three months. And during that time, I read a lot of different books. And I think it's helpful to share my journey through books. And for those of you that know me, well, I love to read and these books have been incredibly eye opening. And I hope they're helpful to you as well. There's been a lot of discussion about how traumatic the pandemic has been on us as individuals, us as collectively as a society. And while I'm not going to minimize anyone's experience, I can only share what my experience has been and what I've witnessed. And my perspective is obviously from the physician from the healthcare worker being at each point, and that's who I spend the most time with, and then I know their experiences best. And to say the last three years has been challenging is an understatement. And I think it's been challenging because our jobs were hard pre pandemic. And the burnout and the trauma that we were experiencing before was very high. And now what's happening with the pandemic. It's just gotten to such a level that most of us feel individually at a breaking point or we're seeing our healthcare systems be at that breaking point. And what really helped me understand what's happening is learning more about emotional trauma. I've spent a lot of my career specially the last five years heavily involved in the care of trauma patients, from gunshot wounds to stabbing wounds. So when you say trauma, that's what I think of first. And honestly, what I feel really comfortable taking care of. What I fail to understand is the emotional trauma that us as caregivers, and our patients are experiencing, that we have to be more attuned to that and take better care of ourselves and our patients. The book that really opened my eyes about what is trauma is, the first one that I read was, What Happened To You by Oprah Winfrey, and Dr. Bruce Perry. It's a very fast read. And I would highly recommend that everyone read this book. Essentially, the premise is that everyone goes through trauma in their life, I mean, all of us experience the death of family members and friends, things happen to us our mental and physical health. So living on this earth is a traumatic experience. And another book I read, is how to Un-F your brain by Faith Harper. And I really like her definition of trauma, which is, it's something that kicked your ass. I really liked that definition, because you get to decide what kicked your ass. And I know a lot of people have talked about that we're over utilizing the word trauma. Well, we've been under utilizing it for a really long time. So in the short term, I'm okay with us over utilizing it a bit until more of us understand what we're even talking about. And when I talk to most of my physician colleagues, and you say the word trauma, they still don't understand the emotional meaning of trauma. And if they do have some sense of what it is, they're very quick to be dismissive of it. And I'm speaking from the type of physicians I spend the most time with, which are the people that unfortunately likely experience the most trauma, emergency medicine, critical care, other frontline specialties. So going back to Faith Harper's definition, it's something that kicked your ass, you get to decide what kicked your ass. And there's things that happen to us as children, that may seem like not very big deal. And let me tell you, physicians are really good at comparing their trauma. Well, you know, I didn't experience being a refugee. So how bad could my you know, relative abandonment had been in my childhood, or, you know, my molestation, and childhood wasn't as bad as something I read about in a book or patient I took care of, so it's not a big deal. So I would highly encourage you to stop comparing your traumas to other people in your patients. And if you need data on why you should not be comparing your trauma for there's very good evidence, and there's a book that I hope many of you have heard of called the Body Keeps the Score by Bessel Vander Kolk, that essentially says that our bodies don't really have this gradient that our minds have about trauma, whether something was small, medium, or big. Our bodies, hold on to trauma and respond to it, sometimes something small, like it's something big, and certainly for people that are experiencing Post Traumatic Stress Disorder, post traumatic stress symptoms, you can have that hyper vigilance and heightened response to very minor things. So I'm going to use an easy example. To start with some of you know my last week of medical school, a drunk driver T boned my car and totaled my car. I was able to get out of the car. I didn't go to the hospital because I was going into emergency medicine and I said if I can self extricate okay, I'm fine, which in retrospect, was not smart and just more of this machismo persona that we often have in medicine, especially emergency medicine. So I didn't really appreciate the effect that that incident had on me. And since then I have a lot of hyper vigilance when cars are coming towards me, especially if I'm the passenger, and something's coming towards my left hand side, I have a lot of anxiety about that. And it was worsened after I did a couple of years doing mainly trauma care and taking care of really injured trauma patients from motor vehicle accidents. So I've experienced how something that quote wasn't that bad a car accident that I walked away from, then has caused some post traumatic stress symptoms that have been exacerbated by my job taking care of really severely injured trauma patients. So that's just one example of you know, how our personal lives intersect with our professional life. And what I'm happy to tell you is that you don't have to go at it alone. And I've had a lot of improvement with cognitive behavioral therapy. And I'm also doing some EMDR to help me process those, those traumas, and EMDR stands for eye movement, desensitization and reprocessing. So I just want to give a shout out to Anna Rainville, who's the founder of grounded roots therapy in San Diego, for sharing with me about EMDR. And how it's been very helpful for people with PTSD, and then PTSS, post traumatic stress symptoms, which I would say a lot of us in medicine, at least have PTSS if not PTSD. So that's been really, really helpful. The other thing I would just encourage listeners is just like healthcare right now is going through a staffing shortage. So is the mental health community. And I jokingly say, if you're going to have a breakdown three months from now, make sure you're working on finding a therapist now. And that's joking, like, and also not joking, because I tried to go through my insurance to find a therapist, and I had to wait, it took me about 12 to 15 phone calls, and about six to eight weeks for my initial appointment and then find out it wasn't a good fit. And I'm going to also give a shout out to the Vet Center, which was founded by Vietnam vets that were dissatisfied with the care that they are getting at VA health care. And they founded the Vet Center for Mental Health for veterans. And many of you know, I am a veteran. So I qualified to be seen at the Vet Center. And they actually do offer EMDR and they've been phenomenal to work with and very supportive, receptive, and also work very well with my schedule, much better than, quite frankly, the therapists that I was trying to work with through my insurance company. So if you're a veteran, I would highly encourage you to work with the Vet Center and, and or the VA, whatever works best for you. So the next thing I just want to touch on was a book called by yourself the F*ing Lilies by Tara Schuster. And Tara's book really helped me come to terms with some family trauma that had happened to me, and that some of the things that happened to us in childhood can be reactivated by working with patients, and that these early traumas that I didn't think were that big of a deal, actually did need to be processed. And I'm really happy that I've been able to do that work. It's been very challenging. You know, I leave my therapist appointment usually, with a lot of tissues and I've usually cried at least 30 minutes out of the hour, but it's been incredibly effective. And the last book I want to mention about trauma that I hope you'll consider reading is the wounded healer by Dr. Omar Reda. And I had the distinct pleasure of participating in a book club by my dear friend and colleague, Sharee Johnson. And if you listen to the pod, you know, Sharee. So Sharee is actually going to be our next episode. In the interview with her, which I'm so excited about. She also runs an international book club, and it's only for physicians. And in our book club. We read Omar Reda's book, The wounded healer. And essentially, the premise of the book is caregiving involves being wounded. And we're all wounded. Some of us talk about it more than others. Many of us build up really high walls and to use Brene, Brené Brown's language, many of us are extremely armored up when we go into work, and we think we're not letting those traumas in. But the thing that really came to a head for me in 2021, is before I left for deployment in 2016, I was a crier. Like, I actually liked crying. Like, I thought it was cathartic. And, you know, I'm the type of person that I would put on a movie like Steel Magnolias or Terms of Endearment, just when I needed to, like get a good cry in. And when I left for deployment, I joked that I cried all the tears that I had. And for that experience, I actually, I stopped crying, I don't actually remember crying on deployment at all, despite, like many times wanting to, but I just, I couldn't get the tears to come. And then when I came home, they didn't really come either. And it got a little bit better. But then I moved many of you know, I moved up to Los Angeles, and I lived by myself up there. And obviously, you guys know, I'm married. And we still had our house in San Diego, but it was an isolating experience. And I really didn't cry very much, even though I was taking care of some really horrific cases, the type of cases that should cause you to cry if you're healthy. So Omar Reda just reminded me that what we do impacts us. And that's not a bad thing. And that we are more whole, when we are in touch with that vulnerability and the hard parts about caregiving. And the last concept I want to leave you with before we move on to another subject is when you go in armored up to your shifts, and you are like nothing's going to touch me. And I'm not going to cry. And when I get home, I'm not going to think about what just happened there. And I'm going to put on some Netflix, maybe pour myself some wine and eat a bag of chocolate, you are numbing. And that seems okay. But when you do that, over years, 5 or 10 or more years, those traumas are still in your body in your mind. And there's a term that was introduced to me by the Mission Critical Teams, which friends of pod know Dan Dworkis, who's part of Mission Critical Teams and their team introduced me to that concept that what we experience, leaves residue on us. And I essentially had 10 years of residue that I had built up on me in 2021. And I had to stop in a very profound way and process that over that three month sabbatical. I just listened to Brené Brown's first episode back on Unlocking Us, and she talks about her sabbatical. And it really resonated with me because she uses this phrase I left going out horizontally instead of vertically And that's how I felt about 2021, I left going out horizontally, there was no choice but to stop and get healthy before coming back. So my, my call to action for you is to go out vertically, when you need breaks, whether it's a small break, or a big break, do it standing up, don't wait till you get to the point that you're so emotionally and physically exhausted, that you have no choice but to go. But if you're at that point, I've been there too. And I really hope that you'll honor yourself and know that it's going to be okay. So if it's a financial thing, I promise you, it's going to be okay. Whatever barrier you're setting up in your mind about why you can't take a break, and give yourself the time to heal. I promise you that you can overcome it through support from your friends, from your colleagues, from mental health professionals, from coaches, there's a lot of different people out there that can help you. So I hope you'll take the time. The next thing I want to talk about is the toll that our jobs and the pandemic have taken on us physically. And it really intersects with what we were just talking about. And those of you that know me, I'm really interested in this mind body interface of how do we live fulfilling lives, be great physicians have great performance and outcomes for our patients, but stay mentally and physically healthy. So 2021 was really getting my mind healthy again. And 2022 has been more focused on my body, but the two are very connected. So not unlike many people, I gained some weight during the pandemic. And I was doing a myriad of things to try to lose the weight and having some difficulty with that. And I mentioned it to one of my colleagues in the emergency department. And she began telling me about how you know, this is very common, especially for women and people in these really high stress professions that we have excess cortisol production, I'm sure many of you have heard this, that contributes to weight gain. And I asked her, she had a lot more to say about it in a much more intelligent way than I'm articulating right now. And I was like, Wow, you really know a lot about this, like, tell me more like how do you know so much about cortisol and hormones and food and mind and body? And she said, Well, I've done this functional medicine fellowship. And I actually have my own practice, and I take patients if you'd be interested. So I did the typical thing I procrastinated for a couple of months, but I eventually reached out. And her website is drdaniellemd.com. I set up my appointment, and she explained how functional medicine works. And we're going to have a couple of different functional medicine doctors on early this season. I hope to have Dr. Danielle on as well. But you know, the rooftops view of it is it's really focused on personalized, optimized health and how do we get our gut healthy? How do we ensure that we've got the proper detoxification pathways in place? And initially, there's often some supplements that are involved but really moving towards lifestyle modifications, with diet and meditation and exercise to be more healthy. So I think most of us understand that a lot of our physical and mental ailments come back to not taking care of ourselves. So her approach seemed to make sense to me. And I was also really excited by the focus on science and that there'd be labs involved. And you know, I'm always really interested in data. So that appealed to me as a physician. So I go through the process, and part of it involved a 24 hour salivary cortisol test. And for some of you that maybe were better, better medical students than me remember that our cortisol levels change throughout the day. And you have to do like samples at various times which involves spitting into a tube which is kind of gross and weird. But you know, I did it. I got my results back, we met on Zoom. And she showed me my cortisol curve, which honestly looked pretty good. It looks like a normal curve with one problem. It was microscopic. I am well, I was at that time producing about 1% of cortisol expected for somebody my age and gender. Or sex, sorry, I want to use the correct term. So for female my age, I was producing approximately 1% of the normal amount of cortisol, which is really jarring, and weird and scary. And I actually started crying when she gave me the results, because it was a physical reminder of how much stress were under and that it takes a toll. And essentially what had happened is, I suspect from residency deployment, coming back working mostly trauma for two years, and then a pandemic. And having a lot of instability around where I was living and like what was going on in my life. I had a lot of stress. And essentially, I burned out my adrenal glands. My adrenal glands eventually were like, Nope, we're done. We're shutting down. We can't keep up with you. And what else helped that happens when you're running low on cortisol is your sex hormones have the same precursors as cortisol. So I didn't realize this, but I was also having all these various gynecological things that were happening, that I think in retrospect, are related to a lot of those hormones being shunted over to try to keep up with my cortisol production. So I've been on this journey for the last approximately two months of trying to change my lifestyle. I was told by her that I need to really focus on recovery, I had wanted to sign up for a half marathon. And she said, she did not recommend that that essentially, my body is not in any shape to be doing such a intense high endurance activity. And instead, she would recommend meditation, yoga, light strength training, no interval training for right now, until I'm stronger and healthier. And I need to make some diet modifications because I am a what I like to call lazy eater. I don't like spending time on food preparation. And that often leads me to eat things that are readily available and not always the best for me, and certainly not enough fruits and vegetables and other healthy foods. So I'm working to improve my diet. But I just wanted to share with you how important working on our physical health is as well. And that I'd really encourage you in addition to working with your osteopathic or allopathic physician and doing your normal gynecological screenings and colonoscopies and other preventative health, that if you're still having some stumbling blocks, and not really where you need to be, maybe look into working with a functional medicine, physician. And then lastly, you know, big part of what Dr. Danielle talks to me about is my sleep. And sleep is such a really key thing in such a challenge for us in emergency medicine. And this links back, actually to the first part of this podcast, that sleep disturbances interfere with our ability to process trauma, and have meaning making in our life. Sleep is where a lot of cleaning up of those neural pathways and restoration happens. So while you might think you're getting enough sleep, I wonder about the quality of your sleep. Because we're always flipping schedules in emergency medicine. And I would encourage you to use some type of device like a Whoop or an Aura ring that tracks sleep so you can get some objective data about the quality of your sleep. And lastly, I'll just say the first question Dr. Danielle asked me, When we were going through my health inventory was, was I attending to my trauma history, and that essentially, she could not help me with my crazy high then low cortisol levels without addressing the root cause, which is largely related to unprocessed emotional trauma. So that's where she started with first. And thankfully, I had already been down that road for about a year. So it was just really interesting to me that those two intersected so much that, you know, she really didn't think she could get me physically well, until we addressed some of the traumas that had been going on. Alright, so last phase in this podcast Brene Brown uses this term in one of her books, I think it's Dare to Lead, but it may be one of her other ones about being ready to rumble. And I think after the last two and a half years, I've been really mired in like, how hard things have been how hard it was on deployment and coming home and how hard the pandemic was, and how hard emergency medicine and medicine in general is. And, you know, the truth is when, you know, my physical and emotional health was not there. Everything's really hard. So I'm beginning to see glimmers that I'm getting back into fighting shape. And I'm hoping more of you are also going to be back in fighting shape and ready to rumble. Because we have a lot of rumbling to do in health care. It is no secret that things are very messed up right now. Working in the emergency department right now is like the dumpster firing analogy doesn't even get us there. You know, I worked last week. And there was one point where I could barely get to the waiting room because there were so many ambulances in the hallway that it was like physically hard to walk into the waiting room, which by the way, had about 40 people in it and two nurses assigned to it. And patients were so frustrated. And that moral injury that we experience of having to explain to them that they have to wait in the hallway or in the waiting room when they have a cancer diagnosis, and there's people around them coughing, you know, I don't think that's okay. But I don't have a way to fix it. And that really causes despair. And I just finished listening to Brené Brown's Unlocking Us episode with Anand Giridharadas on his book called The Persuaders. It's a two part episode and I still need to read the book. But I thought this was such an amazing episode and resonated with me so much as a doctor, because he talks mainly about how right now in America, there's a lot of despair. There's a lot of concerns about our country, that it's not working and that there's so many divides, and that we have these really big problems that we're not able to affect change. And I feel like medicine is like that right now to that most of us agree that there's these massive problems and inequities. But a lot of us are feeling like the system is too big, and administration and other entities, insurance companies are too powerful, and that there's nothing to be done. So maybe the best thing to do is to leave, maybe the best thing is to start to invest in real estate and get out of medicine, you know, whatever. Whatever. You know, you're thinking about which I honestly if that's what you need to do, you should 100% do it. I'm not minimizing anybody that leaves medicine. But what I am upset about is that we have so much expertise, there's been so much money, time, blood, sweat and tears invested in our medical education in the fact that I had residents coming up to me at my most recent American College of Emergency Physicians meeting telling me that they don't think they're going to be able to practice emergency medicine for more than 10 years because they're already feel burned out. It's really alarming to me. And listening to this episode with Anand Giridharadas on The Persuaders, he essentially said this line that despair is part of the design. And I feel like this is really true in medicine. You know, there's a lot of people making a ton of money with the way that the system is built right now. And they are totally happy with, or at least okay, I don't know, if they're happy, they're at least okay with the status quo. And that they can keep asking nurses and doctors and other health care professionals to do more with less, because their bank accounts are growing. So I thought what was interesting about this, this book, and this discussion on on Brené's pod is that we actually do have choice, we do have agency, and I would challenge that physicians have a lot more agency than we are owning right now. I mean, at the end of the day, there is nobody else in health care that has the amount and intensity of training that we have, and I think enters medicine with the degree of altruism that a medical student does. And we should be harnessing that for good and working to change the system. But it's really hard to change the system when you're working 40, 50, 60, 80 hours a week. And I think we need to think about how much we're working, and how much that's causing our sleep to suffer, and how it's leaving very little energy to do the important work that we're going to need to do to go forward to transform healthcare. So I want to give you a teaser for episode two. It's going to be with Sharee Johnson, who I've mentioned earlier in this episode. So Sharee is a physician-coach and psychologist and her website is I'm going to bring it up here coaching for doctors, I will have it in the show notes. So Sharee has a really interesting story and, and sad and poignant that we'll talk about in the next episode. But I just want to warn you guys that that is going to be a difficult episode for some of you to listen to because Sharee has the benefit of being an outsider. She's a psychologist. She's an amazing physician advocate. But she also is challenging us. She is challenging physicians to grow, and to gain some of the skills that we didn't develop in medical school that we need to to be more effective persuaders, tying it back to the podcast, on the book, The Persuaders that in order to affect change in healthcare, we do need to be better communicators, and leaders. And that's hard for us to listen to, because I believe everyone listening here is a leader. But I also believe that the changes that are going to be necessary in healthcare are going to require an intensification in our leadership, communication and teamwork skills. And I think Sharee has a really important message and is a key advocate, teacher, coach for us to improve our skills in this way. So what's how does this all fit into Revitalize? Why did I talk about all this today? Also, in 2021 was the founding of Revitalize, which is no no surprise if you've been listening to this, Linda Lawrence and I founded Revitalize Women Physician Circle because we are alarmed and saddened by the exodus of women out of medicine which has been accelerated by COVID. And we truly believe that women physicians are wonderful physicians that have amazing empathy and communication skills. And we have the data to show that women physicians are really actually have some improved patient outcomes in a variety of areas. So we need to empower women to stay in medicine and to transform medicine and to use our voices in the most coordinated and effective way possible. So every program we do at Revitalize, is focused on helping you grow individually. And we know that that is going to inspire change in the healthcare system. So with our renewed focus on leadership, I'm very excited to tell all of you that in February, we're going to launch a leadership mastermind that's geared towards women leaders in medicine. And it'll be a six month program in which you come together with other women, physician leaders, to work together grow, collaborate on how you can really level up your leadership skills to be even more effective, and use the power of the group to get to where you want to go faster. So this has been a very hard conversation for me, it was extremely vulnerable to record this with you and share some of my struggles, what's been going on with me, and what's been so challenging. I really appreciate you listening. I would love your feedback. So please reach out to me via email, on Twitter, on LinkedIn. And I'd love to have you in our leadership mastermind group starting in February. So if you're interested in that, please reach out to us you can send us an email at revitalizemm.info@gmail.com That stands for mastermind, so revitalizemm.info@gmail.com And I can't wait to see you next week. We will be here most Tuesdays except when my plates a little too full and they need a break. But my goal is to have episodes on most Tuesdays for the next few months. So thank you to everyone for your support and for everything that you're doing. And I look forward to rounding out 2022 and the exciting things we can do together in 2023. Thanks for listening to The Revitalizing Doctor podcast. This podcast is brought to you by revitalize women physician circle founded by Dr. Linda Lorenz and Dr. Andrea Austin, your host. You can connect with us on our website at https://www.peoplealwayshcc.com/revitalize tweet at us @RevitalizeWomen. And please connect with us on LinkedIn at Revitalize Women Physician Circle. We look forward to helping you go from surviving to thriving. This podcast represents our opinions and the opinions of our guests. It does not represent any entity that we work for or with including the military, the government or any other institution. Thanks for listening, and we'll see you again soon.