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I'm currently my seventh year of pediatric training on I'm working in the neonatal register are currently working Eat London in Homer should in the hospital. And I also alongside my pediatric training work with the London School of Pediatrics Trainees Committee on Dive. A special interest in recruitment, retention, um, which is how I became, uh, how I got in touch with Emily and how she asked me to come and speak today. Um, so thank you very much for having me, Emily a nice river for coming along on this Tuesday night. Um, because there's, um I'm trying to make this is, uh, public and to try and make this talk is interactive as we can. And I'm going to use the chapped function. I assume so. Hopefully people who were accessing on their phones and stuff will be able to express it as well. And so just there's about 20 of us here Now. I think you want to just pop into the chat, and I can see your names already, But just what year of medical school urine? Um, if you just want to put that in there, just I can have an idea of where your or less, um, in your training. Oh, fax. So I can see they're just just just have Oh, great. So really good mix too. Crust, your second year, 50 year, fourth year on a student midwife and surgery. Hello here, Grace. So hopefully and oh, my medical science treasure. Oh, hello. Welcome. Great mix. Well, thank you so much for joining, and hopefully you can see my sides. And I just moved them along now on said with confidence didn't There we go. And so what we're going to talk about today, and is it kind of is it Tuesday evening and we won't make it too serious. Um, you're coming here in your free time, and so it's more of a talk than kind of a strict lecture. But what would be talking about is how babies adapter extra, usually in life. And what happens is this process goes awry. And what we do about just, um how did I end up here So a little bit about, uh, if you're interested in following a career in pediatrics or working in pediatrics in the future. And of course, that's a cute babies, uh, as well. Oh, sorry. My sides of looking and lots of taking pictures of babies as well. Um, And so at the first question that I'm just gonna ask you all to get involved in is what should I watch next on Netflix? And so I'm currently watching a a Swedish drama about unexpected, um, unexpected murderer. But I've seen a bit too into the truth crime recently. So what are you guys watching or much? Should be the next thing we watch. So just pop into the chat, taking your watch, Netflix that you've enjoyed recently. Oh, five. Reflection of you, The office, Good workers. He's a great picky blinders brilliance. These are all sounded. Joyce is, and not to crime heavy. So that's good. I can get away from my unexpected murderers. So thank you very much for popping those into the trash. And the next thing we'll just talk about this, how babies adapt to extremes. Sure, I life. So when we're thinking about what happens when babies are born, we first need to think about what's going on in usual. And so this is just a picture of the baby before they're born and and the main things we think about is this is a baby just floating in amniotic fluid there, not breathing on other gas exchange. And all the nutrition is coming from the presidential on the gas exchange is occurring via the placenta. Um, and so because they're not breathing and older gas exchange is happening by this person to here, they need some special mechanisms. Just citate that happening. Um, which we'll talk about now. So just before we get into, um, fetal a nasty, we'll just quickly remind ourselves that the anatomy of us as adults, um or, uh, blood in the world. So this is the anatomy of the heart, which hopefully won't be true surprising for you and on the way the blood flows, as you all probably know. But just a quick reminder is that you have the inferior vena cave in the super superior vena cavor that bring blood from the head around the head and neck, and also from the rest of the body and the oxygenation blood into the right atrium. That then flows through the tricuspid valve into the right ventricle. And that then pop says into the excessive here, which I'm gonna ask you in a second. Well, It's called into the lungs where the blood becomes oxygenated. And then it comes back in through these vessels here, inch the left atrium, the left ventricle, and then goes the oxygenation. Blood goes ash around the body through the aorta. So in the chest, if you guys can remember in adults, so we're talking about others briefly before we move onto fetuses and deoxygenated blood travels from the right ventricle into the lung. So it gets to the right ventricle here and then goes into the lungs by this vessel here, or these two vessels here. What's the name of them? Uh, are they a pulmonary veins? Be pulmonary actuaries. See the aorta? D the superior being a cable, we're not sure. So if you hop in the shower, what do you think the answer is might be? Don't worry, if you're not sure is absolutely fine. Yes, of a few votes for three votes for B or pulmonary actuaries. Be fantastic. Great. So that's really good dimension. That's exactly right. So in, um, adults or older Children who are out in the world, your deoxygenated blood goes inch inch from your right ventricle into your lungs by your Clemon re arteries. But as we said, um, infusions is gas exchange doesn't occur in the lungs that their circulation is different, so we'll just move on to that now. Um, and so during fetal life, only 10% of, um, a baby's cardiac and ghost the nose, Um, and so, as a result of the lungs being full of fluid compressed down, not full of air there quite solid. So there's the professors in the lungs are quite high resistance, and there's very low flow through. It's only about 10% of the blood that comes from the heart goes belongs because it's so hard for the blood to go that direction because the lungs there, full of fluid and small market um so from the percentage er and which is down here, hopefully you can see my pointer touch from the present of blood comes into the vicious by this vessel here with the number 80 written on it. Let me know in the chart. If you can't see my pointer, I'm trying makers. Uh huh. This is somehow oh, he could see fat. And so we have to present to hear attached to the move. These vessels coming in and the blood interest If you just buy this best of here and now another question for you. So the oxygenation blood travels from the travels from the percentages. He's just fire. What? This vessel here, what's this called? Is that the only, like a vein younger, like a large Cherie, or you're not sure? Don't worry if you're not sure, I'm asking this because it's a tricky question that people often get a bit confused by. Yeah, so we have a few answers coming in, and it is a really tricky question, actually, because in, um, an ash me were used to veins carrying deoxygenated blood. And, um, we used to, um, arteries, herring, oxygenated blood. But with the fish is is a bit different. So from the percent, you have the oxygenation blood coming from the mom in the underlying occult vein. So answer a and there's only one number like a vein. This dagger makes it Looks like there's truth. I'm not entirely sure where that is. Um, Bush. Very er. So there's one I'm like a they, which travels from the percent of bringing out straight a blood into the newborn. Um, and then the blood travels into the travels into the liver. Some of the blood goes by the hepatic, um, fame here into the liver. But the majority of it goes across this special structure called the Doctor stenosis, Um, which enables blown to pass from this number, like a vein into the inferior vena Cavor. And so remember that this is oxygen oxygenation, blood passing into the IV sneak. Uh, on this theater of this is that the oxygenated blood can then travel up into the right atrium from the right atrium. It goes to a second special structure that fetuses have that we don't have as adults. And that's the foramen ovale e. So this is just a little hole between the two Atria of the harsh on the blood, from the oxygen blood from the inferior vena cava travels across this into the left atrium. The advantage of this is that the feet circulation is kind of designed to prioritize the brain and the harsh for oxygenation bloated. So this enables the blood to travel from the right atrium. Directly into the race is the left atrium down into the left ventricle and then into the aorta, where it supplies the car reactor ease from just at the bottom of the order here and then also the brain, um, is well, so that's 100 little system that the features has in situ and the other place the rash and a blood comes from. And the rest of us. It's only about a third off the blood that comes from the IV. C goes this direction to the foramen ovale e. The rest of us joins with the blood from the SPCA in the right atrium and travels down into the right ventricle. And then it goes up into what he goes correctly. President, right is the pulmonary arteries. But we've just said that in usual, the baby's lungs or prolapse and they're hard to the blood can't find it very difficult to go into the common revascular a church. Is it so high resistance, so baby, to have an additional, um, connection here, um, called the doctor's arteriosus that allows the blood passed directly from the coronary arteries into the descending aorta, and that blood goes to the rest of the body. Um, and then the look, which has come from the head and the neck, also joins in and travels down this descending aorta here and then back into the only, like, a lot of trees and then back into remember, like, luxuries in them back into the percent into and mother is well, I'm So the advantage of this system is one that the baby gets oxygenated blood without involving the lungs. And two is that the gets extras. Blood was involving the lungs. And the second thing is that it prioritizes the oxygenation blood for the head and the harsh and any questions about that I'm happy to go through it again. Are you okay on? For those of you who are worrying that you haven't seen a cute baby in a while, there's a cute baby. I'm just to lighten the load of a national. I see a national there. So, um so what happens of birth? Um, so here's the baby has just been born, and they're busy wondering what's just happened. What's this cold right place that they've been brought to? Haven't been nicely warm swimming around inside their current, um, on ah, what happens? The birth, essentially, is that a baby has to transition from the primary case of there. Gas transfer happening in the presenter to it happening in the lung fields. And so a number of changes take place for this to happen. So the first thing is that the baby takes a big breath. Oh, sorry. That's just a question there. Um, how does the mother cope with the babies? Deoxygenated blood. I'm so that gets a So they, um the blood goes back into the capillary beds, which is in the presenter, and then gas exchange occurs. And so the, um so to gets cleared into the mother circulation. And then the baby receives us well received the oxygen from the mother's let's high, inaccurate bed. And so that's how that happens. I don't know if that answered your question exactly. And then the mother fears the carbon dioxide violent circulation be so as I was saying, the majority of babies will do this on their own. So 95% of babies will just transition themselves from FIFA circulation to need an extra circulation that they needed in the outside world. So this and the result of this is that the main duties of pediatricians at most deliveries is to do absolutely nothing. So you just have to look calm and composed. We're lowering at the back of the delivery room and avoid making faces such as this when you see deliveries happening. Um, because the miracle of birth is lovely, but can also be shocking. And so you're looking common composed. You're drying the baby and keeping them warm. Your congratulations, Family. On the new arrival, you're there to take photos. Hope of the baby with their family on. Of course, you're there to hold the baby. I left in the air while singing circle of life. That's the most important part of the job. Yeah. Um, so that's how babies adapter extrauterine life. The second part is what happens if this process goes right and what we need to do about it? Um, So, um, this is a baby looking worried because the process is going to write. And so if this doesn't eh? So if the baby doesn't transition themselves between introduce right and extrauterine life, I said the duties of a pediatrician, but actually also midwifes were in attendance is well, or anyone, um, like an advanced me in a nursing practitioner who's there to, um, look after the baby when they're born, and your job is still Teo. Dry the baby and keep them warm him. But some babies who don't breathe on their own with need extra support and the way that forms is. Unsurprisingly, as you guys have probably realized in your training following an ABC approach, Um, but because we're dealing with neonate, it's a bit different to the basic life support you guys may have learned in your training. And, for example, one big difference between a newborn babies and adults. Um, is that a newborn babies air born soaking west? Um, and completely naked? So that's why it's really important to dry them and keep them warm. The other thing is that we focus so much on airway and breathing with newborn babies. Um, because these this tends to be the problem. I went comes to transitioning between the truth circulation's, so I keep them warm. The next step that you would do is to try and stimulate the baby, and and it just tells your fantastic for stimulation babies, because there like sandpaper and there's no fabric suffer involved. So they often with just some stimulation, babies will cry and inflate their lungs over some babies won't do that. So then you have to go to the next step, which is insuring that the airways open to make sure that there's nothing blocking the airway prevention the baby from breathing such as, Um, sometimes babies can, uh, past meconium in usual. So they have their first poop before they're born, and that can lunch in their airway and stop them breathing. And sometimes babies are quite frumpy, and so the stuffiness of their airway stops breathing. So with airway maneuvers you can open their airway, then a small proportion. Babies, despite all this won't breathe on do. That's when you become involved to inflate the lungs. And the aim of in placing the lungs, as we said, is to help the circulation transition from what's needed inside to what's needed in the outside world. The things we used to do this it might be familiar to some of you if you've ever Bina on a delivery swisher on the birthing center and this machine here is there a cyst, a tear we use So it has a heater book because keeping babies warm is really important and and leads to better. It comes for them and this is the bed where you resuscitate them. And then here you have a section on this one. And then, um, gas is that you can use to inflate the lungs here. This is how we inflate the lungs. Usually in, um, kind of a UK healthcare session. We have this attached the resistant tear on you. Use this little mask to deliver breaths which inflate the lungs like this and some babies. Despite, um, okay, our best efforts to get them start breathing. They don't start breathing when we under continuing this mask ventilation for a while. At which point means we consider doing something like intubation, which is where we use it. During the scope on you put a tube down into the windpipe to breathe for them. Um, a very small portion of babies, the mid vast majority. Once you inflate their lungs, they will improve. A very small portion of babies won't improve despite that. And then they would need chest compressions and emergency medications and things like that. But that, as I say, the vast majority of babies will improve themselves without rash him. And then, of course, don't forget the most important step of any neonatal care holding the baby up and singing circle of life. Um, so the reason that Indian nation care we focus so much on every and breathing is old to do with the circulation that we went through. So if the baby is born and their cord is caution, they're no longer having gas exchange occurring at the placenta. So they're reliant on their lungs. But if their lungs aren't inflated, you just get deoxygenated blood circulating around. So this has been, um, crushed. The cord is being close here, So the doctor spinosus is kind of starting to close itself. You're deoxygenated blood coming up the ivc at the way it ordinarily would. An adult circulation on deoxygenated blood coming from the superior vena Cavor. Now, that's all mixing in the right atrium. Some of it is still going across the foramen ovale E because the pressure on the right side of the heart is still high because the lungs are still collapsed and west. So you've deoxygenated blood going across to the left atrium left ventricle on up into the aorta, which leads to detox situation. We're going to head into the harsh. Then you have deoxygenated blood. Also going into the pulmonary arteries across the dumps just arteriosus, which has been closed because, um, the extra never hasn't gone up. And And so all the detox trace blood comes around uh huh. Through the descending aorta, into the tissues and then just circles back around into the venous system the way you'd expect for extra, usually high. Yeah. Oh, that's very good question. So, um, it doesn't happen immediately. It does take a few hours, and there's different steps, but the May can take about 24 hours. But once you have the lungs inflated, the baby Kennedy start oxygenating the blood by the lungs, the pressure and so the doctor stenosis. It can take about seven days to close the doctor Surgery assist aches about 90% of babies of clothes and 12 hours on the frame. And overly should close as soon as the pressure on the left side of the heart is greater than the pressure on the right side of the harsh. And that is usually kind of within the 1st 12 hours of life. And if a baby is hypoc sick and so they're not getting enough oxygen, it takes longer for this circulation to transition. Um, and so in, for example, really own, well, babies. We can see that this circulation persists for sometimes days, with them needing a support from urination, intensive care and in preterm babies as well. You can find that elements of their circulation, because they weren't expecting to be born, just just persist for even longer. So we have some babies. When doctors arteriosus that air still paid into it a month of life and two months of life. That's because their circulation, um, it's kind of still expecting to be faithful circulation. But because they have, um, inflation, their lungs, or we've been facing their lungs for them, in some cases, there for a minute or valley is closed on. They do have a blood flow oxidation, blood flowing around barely. They can get a problem with blood actually back flowing. So when the pressure on the left at the heart increases, blood can go the wrong way through the doctor's arteriosclerosis. Going wrong the aorta into the pulmonary arteries in into the lungs, and that causes a stone kind of problems. But that might be a topic for another day, and but a really good question. How do you think some of them? Yeah. Oh, so that's and just the portion of the truck. And that was talking all about, um, kind of the adaptations that happened around life in babies and what to do when it goes awry and things I flash. Um, did anyone have any questions about this kind of changes that happen to a baby when they're first born? On what we kind of do? Budget? I kind of just given you a brief overview without going into too much detail. If there's no questions about that elastic again at the end, So don't worry. And I was just gonna Oh, and she's asked, What's the prognosis like of the baby that require intubation? Um, so the minority of babies do require intubation. I suppose it depends a bit about, um, why the baby required intubation in the first place because there's a range of reasons that a baby would need information. And one maybe that the airway itself, um, is, ah, floppy. Or there's a problem with the airway. Like it congenital anomaly. They might need you information for that. Second reason might be to do with the lungs themselves. So sometimes babies do breathe, and but they're breathing is not effective enough to, um, to oxygenation ventilation and examples of that will be. Sometimes babies are born with pneumonia or babies who have a poop who have passed meconium inside their first food. They can then swallow that down into the lungs, and that can create irritation and blockage. Um, and then another reason that babies might need information of birth is that if they don't have adequate respect to drive, the most common um, sign of that is suppose is babies who are preterm or the most common time. We see that his babies, who are pre term but also babies who have had a reduced blood supply in usual and so babies have been hypoxic before delivery because they've been starved of oxygen. They sometimes don't breathe at birth, and it's not because there's necessarily anything wrong with their lungs or they're harsh or anything like that. It's purely because they haven't. They have become and careful pathic because they haven't had oxygen and usual. So they're all the types of babies who would need intubation of birth, but they're prognosis will be quite different, depending on the pathology that's causing them to require intubation. And so sometimes there any information for 24 48 hours. Some of the preterm babies air inch patient for, um, kind of weeks or months, depending on the stage of their or the the development of their lungs and how developed they are. So it's kind of in a case by case basis in terms of what the prognosis is like for them, uh, depending on why they needed information. So stuff have antennae to kind of give you a mixed answer, but it depends a bit on why they need information in the first place. Um, and higher dose the fluid. Get uh, could you explain how the fluid gets forced out of the lungs again, please? Yes. So when the baby, um, takes their first breath, the baby's congenital Asian massive negative pressure in their chest on dash causes the fluid to reabsorb. And so it's purely just by the act of their first cry, they inflate the lungs and increasing the pressure within the lung fields, forces the fluid out of the lungs into the airways and also into the tissues as well, and then with each breath big clearish more. You also get increased blood flow into the area via computer events, which also helps to reabsorb the fluid in that way. And but the rate of wish they clear fluid is remarkable. Um, so they can clear the majority of the fluid. And if they if they cry, um, spontaneously. That can clear the vast majority of fluids kind of within the first minute or two of life. Um, but obviously, if there's any difficulty with them having that first choir starting breathing, it can take longer to here. Hopefully that answers your question in relation stash. I'm just hoping the trash is There was further questions. Bad that I move on to the next part of the talk just talking about working in pediatrics. But if you have questions, you just pop them in, and I'm happy to answer them afterwards. Um, So, uh, I was just going to talk a bit about how you how I ended up working as Indian Nation Register or how Angela working in pediatrics and just in case sometimes people who are in pediatrics, I it ease, have an interest in pediatrics and might want to work in the area. Sorry to those people who are kind of working in mid with three and things that might be this, um, uh, related to doing kind of medical pediatric training. And but it might be interested in still, um, So this lady here I included the sport because it just made me laugh. So she's a woman. Call Kathleen in. Who's an Irish pediatrician to move? Uh, she was born in the 18 seventies and she was one of the first female doctors in Ireland, Just went into pediatrics and opened kind of her own Children's hospital on It was also kind of a stuff rejection, a bit of a rebel and things like rash. But it makes me laugh, because I'm not really sure what's going on in this picture. It's a bit funny the way she's holding these four babies kind of outside. I don't know. What was medical care in the 18 seventies of this may have been standard care, but also sometimes how I feel at work just wandering around, carrying for babies. Um, obviously we don't do that. I hope that if it is just gives the idea of sometimes have busier if you on, I can relate to her. Um So the way I got it in pediatrics is that I was saying to emanate earlier ages my undergraduate training at the University of South Hampton. Um and then I while I was there, I really enjoyed working with kids and during projects involved kids. So is in, like, 30 bare hospital on, um, skips a pumpkin, which was a student for kids international projects. So that used to work in Madagascar with local communities. Kind of teaching public health messages to Children And so really, like working with Children. And it caught him. I'd be interested in doing pediatrics. So back when you applied foundation trading, we used to get given all the jobs in the country like a big spread sheet of hundreds of thumb and used I look through them and I notice that more it was more pediatric. More f one F two jobs with pediatric rotations in the northwest. So I pride in did my training. Um, if one f two up in Wigan and I started working and I was kind of working away and then at the start of have to you have to apply for your training. And so I decided, uh, because of the work I've been June and things, and I liked working with my hands and the risk of knowledge and stuff. I decided to apply for anesthetic training on I really Uh oh, yeah, This is great. Got shortlisted. Went for an interview and everything. And then while I was waiting to hear back from my interview, constructed my pediatric girl been if to it was my last job. And then I thought, Oh, sugar, actually, really enjoy this on. I kind of had forgotten about pediatrics that hadn't done it in the previous two years. The previous year and a half, I thought all I had made a mistake. So then I didn't do I didn't It could go into anesthetics. And I took a year old on traveling and also worked in pediatric. You need, um, and then decided to apply into pediatric training in London. Him And that was seven years ago. And I'm still here. No, um, or I just thought I'd quickly show, in case anyone is interest, but I'll only do quickly what pediatric training looks like. Think is you're interested in going interest. So this is what pediatric training looked like for me, but actually yours, if you go into pediatric training, might look of it different. Um, so this diagram is a bit messy, but essentially you do your S h o years. So three years working as an S h O where you do kind of general pediatrics knee and eighths on, Then you do subspecialties as well. So I was lucky to do infectious diseases and a oncology, both of which were absolutely lovely jobs on. I really enjoyed that. The experience. And then everyone goes into level to training where you just do a bit of general pediatrics, neonatal and community pediatrics. And throughout these years, I realized that actually are quite enjoyed near Lakes on day. So I am ST seven now. So 67 a shins, your level three. And so I've spent six and I will spend seven journey and it's it's Well, um, it's eight years training all together, But actually, I think one of the reservations a lot of people have about do pediatric training is that it is so long, Um, especially after you've already done quite a long degree and then foundation training and things like that. So they have, um, they're going to change the shape of training from I think it's from 2023 to make it seven years on. It's essentially putting a bit more flexibility into suits, your core pediatrics or you're in a schedule for one or two years and then your register for two or three years, depending, and then you go into specialty pediatrics. So whatever you're interested in, you go into then. So they're taking a year. Actually, the training, which I think would be good because I do think the length of training sometimes puts people off. Um, and then just how did I end up here? Um so I think when you're thinking about what you want to do with your life ahead in terms of medical training, but also maybe if you decide that you don't want to work a doctor once you finish medicine and that's absolutely fine as well. And it's always have to kind of think about these four questions. I think eso kind of where do you want to work? And so if you're staying in medicine, do you want to work in a hospital. Do you want working community? You want to work in a lab? Um, for me, I decided that I probably want to work in a hospital. I wanted a bit of experience working in the community. Um, bush at a hospital. Medicine probably solution me a bit better. And on em. Pediatrics, do you get you do majority hospital, ms. Um But there is also the option is used to work in the community as well, in different rules. And and then also, you have to decide where in the world you want to work. You want to stay in the UK or do you want to go work abroad on the handy? Thing about pediatrics is a specialty is that there's Children and babies everywhere. So you have a great opportunity to travel, and same is midwifery. Actually, you have lots of opportunity to do. Experience is a growth or travel abroad and things like that, um, you also need to think about who do you want to work with? So, by that, I mean, what patient group do you like? So I suspect if you request to the pediatric society, you probably quite like working with Children and and that was something that I knew was Well, I am. So I knew that I wanted to work with Children, but it's also worth thinking about, but the other staff, you have to work with us. Well, do you want to work in a team you want to work on your own? What kind of way do you want to work? And I knew I enjoyed working in a team. And also, I find that people who work in pediatrics are generally very friendly people there, people who like working with Children. They're like playing the very approach food. And so that all factored into my decision as well. Um, also working with Children is just hilarious. I really enjoy you asked. Um Oh, hi. Just like, oh, how did you hurt your arm? And you just get these stories back that are just, um, so funny and so crazy that I just really encourage you that if you're down in any tracking, patients always start by asking the child what happened. Because the answer is you get back often. They're no resemblance reality, but they're just so funny. But the things that happened, um, the next thing I always think about. If you're trying to think about what you want to do as a career is what do you want to be doing? Are you someone who likes using their hands? Are you someone who likes using their brain? Do you like using both together? Do you like doing experiments in the lab? Um, do you like seeing patients? You like meeting families? Things like that. So I knew that I really enjoyed using your extra knowledge, Do all the stuff. I had learned that university about physiology and stuff like that. But I also really injury June procedures like information and putting central lines in. So that's why I need an aide some future appeal to me. The other thing that I liked about kneel, eights and pediatrics is that you kind of get to meet her family and follow them through. So, um, you meet someone when they're babies? That message to me in a few minutes and then there with you for sometimes months, is you get to know them, um, until you distrust them home and those parents there, there every day, and then you kind of become part of their family and they come pressure of your family. It's just so rewarding to see these tiny little babies who were 390 grounds and you're not sure if they're survive, be kind of, um, 1.8 kg and discharged home. It's just really rewarding on. I think that's probably my favorite part of the job just to get the people you get to meet and how do you get to be part of their lives? And the other thing that appeared to me, which may not be for everyone, is that some people know exactly what they want to do. They just think, Yeah, the left lobe of the liver is where we want to operate for the rest of my life. I can't get enough of it. I was not one of those people. I'm quite like the variety. I quite like looking at all the systems of the body, how they interact together. So for that reason, pediatrics was quite good for me and if you like that, I would say it's quite good because that doesn't get too narrow too quickly. You get to do lots of different things. Um, funny, I think it's worth thinking about what you're most what you've most enjoyed in your days of your training and at work. What days have made your happiest one of the major feel most with pills on My family and friends have noticed that when I was doing pediatrics, I was just a lot happier. Um, even though the Rochelle was quite demanding, I've enjoyed my work and I was happy to be doing it. And and then I've included this if your diet I'm here, which you guys might have seen before. But I think it's what I just wanted to kind of pass the message on, as I'm sure you know, through life is you kind of think life is relatively straightforward. You know, You start here, you end here. Where is actually life is kind of a lot more messy and than that. And so is that that song? Um, everybody free to wear sunscreen on Don't know if you guys remember that song, and but he there's a line in that that says most interesting people I know I didn't know what they wanted to do. A 22 and a the most interesting 40 year olds I know still don't know, I think people sometimes tell you that you need to know exactly what you want to do with your career from the outset. But don't worry about moving around and trying different things and taking time out on day, especially pediatrics as a specialty, really appreciation skills that you've gained elsewhere. They don't look for you to know that you want to do pediatrics from the outset. If you've gone into GP or surgery and then realize Oh, actually, I don't want to do this. I want to Pediatrics. They did you the skills that you got in those in the pre since and and that you bring to pediatrics and because any skills you gain anywhere is really helps from in going for rich. So I think that's the end of my talk. Um, let me know if you have any questions or comments, or you can put them in the trash or if you want to, um, use on, say anything that's absolutely fine. Sorry for that interruption we had in the middle. I was very confused. Us what was going on, And I think somebody for