Intro: Welcome to Pediatric Voices, Duke Children's podcast about kids' healthcare. Now, here's our host, Dr. Richard Chung.

Dr Richard Chung (Host): Hello and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a physician at Duke Children's and a co-host of this show.

This episode is a very special episode. Now, all episodes are special in their own right, but today's is particularly special because I am joined today in this virtual studio for the first time ever by my co-host of this podcast, Dr. Angelo Milazzo. Angelo, great to see you.

Dr Angelo Milazzo (Co-host): Hi, Richard. It's so nice to be talking together on one of these shows for the first time.

Host: That's right. I've been really looking forward to this. So Angelo, you and I have had the privilege of recording several really insightful and inspiring conversations with the people who make up our Duke Children's team. And what we wanted to do as we discussed is to kind of just pause, you know, take a look back at these first several episodes of the podcast, sort of walk through them with our listeners, maybe talking about key takeaways or points that really struck us particularly well. And then also, to look ahead to what we have in store for future episodes. How does that sound, Angelo?

Co-host: I think that sounds like a fantastic idea. You know, as you said, we've had the privilege to speak with a really interesting group of our colleagues over the first several episodes of the show. And as I've said on the show, and I believe I've shared this with you outside of the show, one of the great benefits of doing this is learning things about the people with whom we work every day and sharing insights that we don't always have opportunities in our day-to-day work to share. So, this has been a really nice forum for bringing out those conversations. And if I've learned something, it's I've learned that the people I work with are just endlessly fascinating, endlessly multi-dimensional, and it just feels like a privilege to be able to talk to them on the show.

Host: I wholeheartedly agree. I think that's exactly, I think, a core essence of the show and why it's been so really enjoyable for me and something that I've learned and benefited from myself. But first, you know, Angelo, I was thinking about this every episode, as you were alluding to, we do really focus in on who the guest is as a person, not just what they do or what they've accomplished, but who they are. But I've also realized that you and I really haven't done our own proper introductions. And so, why don't we take this opportunity to do that first. Angelo, can you introduce yourselves to our listeners, who you are, what you do, and I don't know, maybe why you got into this podcasting thing?

Co-host: Yeah, absolutely. No, it's a great point. We really have not had that opportunity to introduce ourselves in a proper way. Certainly, we've given our guests opportunities to do that. And again, it's been really fun and informative to hear those stories. I call them origin stories. So, I'm happy to share my origin story as well.

So, you know, my day job is as a pediatric cardiologist. So, I'm someone who has trained in pediatrics and then in the specialty area of pediatric cardiology. So, I treat and manage children with a wide range of problems that relate to the heart and to the cardiovascular system. Some of those are problems that these children are born with. Some of those are problems that they acquire over the course of their growth and development. So, it's a broad specialty area that takes care of patients with a wide variety of problems. And it's, for my money, a very endlessly fascinating discipline, and we have the opportunity to meet interesting patients and to have a real impact on their lives. So, you know, I really enjoy my practice as a pediatric cardiologist.

I came to it probably in a way that's a little bit different than how other pediatricians come to their work. And again, it's been interesting talking to our guests, many of whom had early experiences in their lives, which inspired them to be pediatricians. I would say in my case, I was inspired early to want to become a physician. We had a tradition in our family, in my family of physicians who had sort of set that path. So, I had some exemplars to learn from as a child and as a young person growing up. So, I was interested in medicine from an early age, but came to pediatric cardiology much later in my medical school training and then in my postgraduate training. I was very interested in cardiology first and actually struggled with whether I wanted to pursue cardiovascular medicine from the pediatric perspective or from the adult perspective. As it turns out today, I wind up treating both children and adults, which is another fun part of the work that I do. So, I think I won. I think I made a choice that led me to where I could actually have my cake and eat it as well. So, that's how I got to the fascinating world of pediatric cardiology.

Podcasting is a whole other story. I'd actually like to ask you, I'm going to turn the tables on you here, Richard, get to your origin story, then maybe we can finish up this part of the conversation with our experiences in podcasting. So, how did you become Dr. Richard Chung, adolescent medicine specialist, and someone who does so many interesting and amazing things here at Duke Children's?

Host: Yeah. Thanks for that, Angelo. It's really great to hear your origin story as we were sort of alluding to. I mean, you and I know each other pretty well at this point. But we rarely, in the busyness of work, pause to kind of ask like, "What were you thinking when you were a kid?" Or "How did this turn up?" You know, we just never get to that point in conversation very often. So, this is actually really fun for me.

And, as you mentioned, I am a adolescent medicine specialist here at Duke. So, I work with teenagers and young adults and really keenly focus on many health issues, questions, complexities that come up during this really important time of life of adolescence and, over time, becoming an independent adult. And I have a particular focus on young people who have different health complexities, so chronic conditions or other things that cause some challenge as they try to navigate adolescence and independent adulthood. And that's been really rewarding for me.

I think I kind of landed on adolescence because in my training, I trained both as a pediatrician as well as an internal medicine doctor, so an adult specialist as well. And really thinking across the life course, where are there real gaps and where is there real opportunity for impact both to prevent things in the first place, but also once something has started up, how do we actually modify that course and optimize it? And I'm a big believer that the first couple of years of life are certainly the most profound in terms of impacts over the life course, but I would say second to that is adolescence. And that's where a lot of health decisions and behaviors are solidified and really become your future life course. And talking with teenagers, informing them of their options, helping them to make really positive decisions is really rewarding for me. And so, that's kind of how I've landed here. And even though there are many teenagers out in the world and many who really do need our support, there aren't many people who are focusing on them exclusively. And so, that's been really special and a privilege to be a part of.

To the question of podcasting, you know, I am new to this. I think, as you alluded to earlier, I really like the format. I'm a big podcaster from a listening standpoint and really enjoy hearing really curious, inspiring, insightful people just share and have a long conversation. You know, very often with social media and our other media sources, we get sound bites, right? We get five to 10-second snippets, and it's rare that you get to any depth. And so, podcasting, I think, is one of those really wonderful formats that are contemporary in sort of technological form, but are really quite traditional and old school in the way that they are longer form conversations with a lot of nuance. And so, as you mentioned, it's been really a privilege to have those kinds of conversations with our colleagues.

Co-host: Well, as usual, that's supremely well said, Richard. I couldn't agree with you more about podcasting. I think it's a really interesting format. I think the phenomenon of podcasting as it's grown over the last several years, it's been really interesting to see it grow as a media format. In some respects, it's like traditional terrestrial radio. In many respects, it's not. And I think the similarities and the differences, again, make it endlessly interesting.

I came to it first as a listener and found it to be just a really engaging way to get content, to get information, something that you could either focus directly on or maybe have in the background during another activity. So, it's flexible in that regard, which is why I think it's so powerful as a format.

My younger brother, who I'm going to give a shoutout to, my younger brother, Robert, who I would consider to be a very accomplished podcaster was an inspiration for me. He is a faculty member at Virginia Commonwealth University, where he teaches communications and related disciplines. And he has a long history of doing podcasts in the arts. And he's spoken with a lot of interesting people over the years in a variety of different shows that he's put together. And I learned a lot from him about what works and what doesn't and continue to learn. So, using him as a sounding board as we develop this content, and that's been really nice to have his feedback.

So, again, this is a great opportunity for us, I think, to utilize the format, first and foremost, to shine a light on the people we are as pediatricians, as pediatric specialists, and in particular, the kinds of folks that have wound up coming to Duke Children's to grow their careers, because I think these folks have a lot of interesting stories to share, and this is a great way for them to be able to share those stories.

Host: Well said, Angelo. Thank you for sharing that. I really love the comment about your brother and the inspiration there. I think that's really wonderful to know and to hear, and I'm sure he appreciated the shoutout.

Why don't we move into talking about the podcast itself? Again, what Angelo and I wanted to do is just to kind of walk down memory lane. It's only been a couple months, but memory lane nonetheless. Sort of talking about some of the key insights that we've gleaned from some of our wonderful guests.

Before we do that, Angelo, I did want to ask you just one more question, and this is more of an existential question. Do we really need another children's health podcast in the world? There's a lot of podcasts out there. Many of them actually focused on children's health and pediatrics. How do you view that in terms of our additive contribution to that discourse?

Co-host: Yeah. That's a fantastic question to kick us off here, Richard. And it does feel like everyone has a podcast today, right? Which, you know, is interesting again, thinking about the medium itself. It's so democratic. You know, anyone with a microphone and some software and an idea can essentially be putting it out into the world in this format. So, there is a danger of just getting lost in that sea of noise.

Does the world need another podcast about pediatric health? It may or may not. I think from my perspective, our opportunity here, again, is to expose some of the really interesting personalities that make up our team. And through exploring those personalities, we can get at some broader issues in pediatric medicine. So in that sense, I hope this show is different than the average podcast about pediatric medicine. And I say that with all due respect to what's out there, because we are fortunate to exist within a universe of amazing content, not just in pediatric medicine, but in healthcare in general. So many fabulous shows, some of which are very small, some of which are very big and have quite large followings.

So, I think we have a place. I hope that in these first few episodes, we've staked out our territory a little bit. And I'm actually excited to see how the show evolves. Because if there's one thing that's true about all the podcasts that I listen to, none of them are quite the same show they were when they first started.

Host: That's a great point, Angelo. I think really well stated. And I think that keen focus on the people doing the work and really understanding kind of the core humanity of these researchers and clinicians and advocates and all the others who we'll have an opportunity to talk to in the future as well.

Let's touch on each of the episodes that we've had the privilege of recording thus far. Two, actually that you recorded Angelo and hosted, were with experts in genetics actually. One was with Dr. Andrew Landstrom, who is one of your fellow pediatric cardiology colleagues and then also, with Dr. Jennifer Cohen, who's one of our expert pediatric geneticists. And so, any key takeaways or insights from those conversations?

Co-host: Those conversations were fascinating from a number of perspectives. And I think in terms of what I hoped to bring out for our audience is the absolute seismic impact that recent advances in genetics is having and will continue to have in terms of the healthcare of young people from fetal life through childhood and adolescence and into adulthood. And these genetic conditions have far ranging implications. And for the first time, we have tools that not only promised to allow us to make these diagnoses really quickly, really effectively, but also to offer treatment. And that was the piece of both of those conversations that was most exciting to me.

The idea that we could actually impact these diseases, which for the longest time, we suspected not only were untreatable, but in many cases, uniformly fatal or uniformly impacting young people in devastating ways. So, the real optimism that came out of both of those conversations is this proposition that, "Hey, we can actually treat patients with these diseases that are fundamentally related to the very blueprint of life," whether it's giving a medication that replicates something that that patient lacks due to a genetic condition or whether it's actually replacing a gene. You know, as I said to Dr. Cohen, it feels more like science fiction than it does like science fact or medical fact.

I also love in both of those conversations the human perspective that both Dr. Landstrom and Dr. Cohen brought to it. I think when we think of people who do molecular biology or genetics or these very esoteric and complicated disciplines, we tend to think of people who are really hyperfocused on the work. But these are both physicians who can go from the laboratory to the bedside of the patient with such ease, with such confidence, with such poise. I think that's really important. I think that's what's made both Andrew and Jennifer really successful as clinician scientists.

Host: Really well said. I think those are really key insights and it actually makes me think of one of the episodes I recorded with Dr. Sarah Armstrong actually, who's a child obesity expert. This idea that there are significant advances in the science and the tools available to treat different health conditions, but that it's really drawing in those advances and melding it with the human connection of clinical medicine where the magic happens.

And that's what Dr. Armstrong really underscored in my conversation with her. We started out by kind of reviewing some of the advances in the tools available to clinicians and the recommendations for general practice. But she underscored time and time again the critical importance of knowing the kid in front of you and understanding the family that you're working with, really centering their experience and their values and their priorities, and only then kind of melding in the expertise of science.

And when I think about Sarah, who's a prized colleague here at Duke, she really is the epitome. And similar to Dr. Landstrom and Dr. Cohen, she has the brilliant mind of a scientist, but she has the fundamental humanity of a healer. And I think it's that combination that I think we are privileged to be able to really draw forward in these conversations, informing our listeners about what the latest advances are, but again putting a bit more humanity behind what those advances actually represent. Does that sound right to you, Angelo?

Co-host: It does sound right. And furthermore, it sounds like the substrate for the concept of the children's hospital or the academic teaching hospital or the university-based hospital. And you had an episode, you were able to talk with Kyle Rehder about what this thing is, what this concept is, the teaching hospital. And many people may not be familiar with the concept, or they've had some exposure to it through mass media, television, the movies, books, et cetera, and so on, and may have formed an opinion or may have formed a picture of it that isn't exactly correct.

But I think one of the great benefits of the teaching hospital structure is that it attracts the kind of people that you and I are talking about, the Dr. Armstrongs, the Dr. Landstroms, the Dr. Cohens. People who can simultaneously have one foot in each of these different worlds, the research world, the academic world, where they're doing breakthrough science, where they're creating advances, where they're collaborating with scientists, looking at these fundamental issues, these fundamental questions, and then have another foot in the world of actually providing care directly to the people who will benefit from it. That's what the teaching hospital, that's one of its great functions. And I think that concept came out in your conversation with Kyle, which I found really a fascinating discussion. And for someone who works in a teaching hospital environment every day, we take for granted that that environment exists, but it's really interesting to see it specced out the way you guys discussed it.

Host: Yeah, I think that's right. And Kyle was exactly the right person to talk about this. As you know, Angelo, he is an expert and a leader in education. He's also somebody very deeply involved in clinical practice in the most complex and highest acuity setting we have. And he also is an expert in safety and quality. And it's really kind of drawing in all three of those and hearing Kyle really explain how that all works where it really became clear, not just to me as somebody who works, but hopefully to also our listeners who are seeking out care for their kids or family members, and it is that spirit of inquiry.

You know, you might think that if you're receiving a particular healthcare service in a setting where there are learners that might somehow hold things back or complicate matters unnecessarily, but it's just not the case. It's because of that inquiry and the learning that's happening that your care is being really looked at under a microscope every step of the way. There are people asking questions, "Is that the right thing to do or not? And if not, why not? If it is, then let's kind of push it forward," or "Are there new advances, right?" New sort of research studies that might help us tweak things and make it even better. And I think that's why a teaching hospital is such a vibrant place, not only to teach and learn, but also to get care for yourself and your loved ones. And so, yes, that was a really helpful conversation.

Co-host: You know, Richard, I firmly agree. And as part of that inquiry that you're alluding to, we are looking today at so many facets of healthcare delivery for children, right? And we see the Children's Hospital, the Children's Medical Center as a central locus for how we're delivering care. Some patients are quite literally coming to us, coming to the hospital, to our clinics, to our procedural areas for care. We are also pushing care out using the Children's Hospital as sort of the home base. We have clinics in the community. We have initiatives that are expanding out from the center to address the needs of larger and larger populations of children.

So, an issue that comes up, and you spoke to our colleague Gabby Maradiaga about this, is the issue of equity. And among all of our episodes so far, and, you know, we love our episodes equally, like we love our children equally, right? But that episode is so timely and so important at this moment.

Now, one thing we've learned in the last few years with the pandemic and the public health emergency is that inequities in healthcare are abundant, they're rife. And as pediatricians and physicians and other healthcare providers who manage the care of children, we consider ourselves, and I think I speak for our community when I say this, we consider ourselves advocates for the healthcare needs of. kids. And whenever we can examine the equity of care delivery, I think we're obligated to try to understand inequities and to have an impact on them when we can.

So, all this is to say that that conversation is an episode that I will go back to as I listen again to our work to date. And I think that will be an anchor for future conversations. I know we have other guests waiting in the wings who are going to help us examine this issue. But I can't think of a single issue more important than this particular issue around the equity of healthcare and the equity of healthcare outcomes. You and I talk about this in our day jobs. You and I have had a lot of experience. We've had a lot of conversations about this. I would love for you to share with the audience, you know, your perspective on that issue and on that episode in particular.

Host: I think talking with Gabby was truly inspiring, really kind of thinking about the work that she and her close colleagues have done in this space throughout the pandemic and in the wake of the pandemic in particular. And as you mentioned, the pandemic drew out in fuller relief a lot of the inequities that pre-existed in our society, and those broadened, inequities persist. And it's people like Gabby who are really shining a light and not just pointing at the issue, but actually going to the issue and doing their part to try to bridge those gaps and close those gaps for kids and youth.

Gabby shared a bit about LATIN-19, which is a local and now regional organization that has really done that throughout the pandemic for a key group within our community. And several other examples exist, where people are really doing this work. And it's really inspirational for people like Gabby to not sort of remain within the confines of Duke or the historical ivory towers of the academic institution, but really to go where patients and families are, and where trusted community members are, and really create those relationships that are foundational to doing a collaborative work. And it takes not only expertise that she brings, but also a sense of humility, to know that you can't do anything valuable without being in close collaboration with the actual kids and families and the people in the community. And so, that is really a key learning point for me, something that we've learned over time, and only will hopefully continue to live out in fuller ways over time.

And so, I think this issue of health equity for sure is profoundly important. I think as healthcare systems and as a broader healthcare community, we're still in the early phases of our learning curve as to what that means and, importantly, what we can do about it. And it's people like Gabby who point that this is not an option, right? This is a moral obligation that the care of each individual kid has high relevance. It's not just whoever can get to see us, whoever can access the specific resources, but it's all of the kids in our community. And the wellbeing of each individual kid has cascading consequences to other kids and other families. So, we're all sort of in this together. And the more that we can really take that approach and really live that day to day, the better off we'll all be.

Co-host: Absolutely. And I would add only that context of care is so important. The Duke Children's Hospital is embedded in a community here in sunny Durham, North Carolina, where we've got this amazing diversity, and I mean that in every respect, including socioeconomic diversity, ethnic diversity, intellectual diversity. It's a fascinating place to live and to practice medicine.

And in the last couple of years in our programs here at Duke Children's, we've become more and more deliberate in terms of thinking about how that diversity affects the people we hire, the kinds of programs that we want to offer to our patients and families. All these factors are now incorporated into our thinking. On the academic side, which is a huge part of what we do, training medical students, training residents and other learners, these issues are being brought into play, and we're thinking much more closely about the experiences of these folks as well, because they're an important part of the team here at Duke Children's, as they are an important part of the team in other academic medical centers. We want to make sure that the people who are part of the Duke Children's family, in some ways at least, reflect the diversity of the people that we take care of. Because we know that when those things match up, that health outcomes are actually better. That's what's really exciting. And you alluded to this before, part of what we do is to constantly review our work to make sure that we are doing better whenever possible.

Another thing that jumped out to me, reflecting on episodes and the conversations we've had so far is the connection between an episode you did and an episode that I did. I had an opportunity to have a conversation about resilience and the challenges facing children today. I spoke with our colleague, Gary Maslow, who's both a pediatrician and a psychiatrist, which is a really interesting combination. And you had an opportunity to discuss the health concerns of teens and young adults, and there's tremendous overlap, I think, thematically in those conversations.

Gary illustrated something for me that I hadn't really considered. He actually defined resilience in a really concrete, really functional way as the product of these skills that young people either do or do not develop over the course of their early lives. And that was an aha moment for me because, up to that point, resilience had always seemed like a really fuzzy, really gray concept that I couldn't really quite get my hands around in a concrete or tangible way. But Gary has this amazing ability to take these concepts and put them into real world practical terms. And once you think of resilience as the product of accumulating these skills, you can understand where it breaks down. You can say, "Okay, here's a child who did not have certain formative skill development. And this has led to a deterioration in his or her ability to face the challenges of growth and development." And again, thinking about the last few years, it seems like our young people are as challenged as they have ever been. Again, I saw a lot of overlay and overlap between that conversation and discussion you had about general health concerns for teens and young adults.

Host: Yeah, that's right. As somebody who works with a lot of teens and young adults day to day, I think what Dr. Maslow shared is really foundational. That's sort of the basic premise of caring for teenagers. This idea that our primary goal is to build up their strengths and to cultivate those intrinsic strengths, and then to provide them with these extrinsic or external supports, assets, resources that they need to really develop positively.

And It's interesting, the research shows that the more you can promote positive development, the less risk, the less sort of harm comes along. And so, very often as clinicians and parents, we're kind of chasing these risks, right? And we're trying to snuff them out. We're trying to extinguish these little fires before they become too much. And that is necessary to some extent, but it's neither sufficient and it's certainly not satisfying to kind of simply snuff out problems here and there. And so, this idea of positive development is that you can promote strength, build your young person up and, oh, by the way, at the same time, they will have less problems in the long run. And so, I think that principle is something that I hope all of us who are caring for teens and young adults, and then all parents and caring adults in our community really take to heart. And frankly, it's more enjoyable if you take a more of a strength-based approach to caring for young people.

And you mentioned Dr. Trinh's explanation of some of the very specific issues that come up in day to day clinical practice with teens and young adults. And she's a great example of somebody who's living that out and practicing that kind of strength-based approach, whether it's the issues of social media or different health decisions that young people are making. I think that conversation really drew out and put in more concrete terms what that really looks like in the clinic room.

Angelo, to sort of round things out, it looks like the final conversation was a timely one about summer safety. We're in the waning days of summer, and I hope that our listeners have been safe. But what did you take from that? And maybe broadly, the real important practical contributions of our emergency room doctors, our urgent care doctors, people who are dealing with acute crises that come up all of a sudden in the lives of families.

Co-host: Well, it was a privilege to have Emily Greenwald on. As you stated, Richard, Emily spoke to us about summer safety issues for our young people. And, you know, we think of summertime as a time for fun and vacation and to kind of take a break from school and from work. And I think most people that we know who are pediatricians with young children or pediatricians with children in general look forward to the summertime as a time to relax and reconnect with family and friends.

But of course, there are hidden dangers that are seemingly lurking behind every corner. And it was really interesting to get Emily's perspective on what we can do to be proactive in terms of avoidance, because the best way to deal with an emergency is to prevent it from happening. So, that was a key takeaway for me from that conversation.

The other thing that was interesting, and again something that our audience may or may not have considered, is that pediatric emergency medicine is its own discipline. Lots of people have passing familiarity with the idea of the emergency department. A lot of that comes from popular media and justifiably so, a great television show that I think many of us watched while we were either in training or early, at least in my generation, our generation and our careers, it came along kind of at the right time. and there is certainly a subdiscipline of emergency medicine that is focused only on the care of children. And we're lucky here at Duke Children's, like many children's hospitals across the country, to have a place, a physical location where we can focus on the emergency care of children. And the work that's done there is extraordinary. And the people who work there are sort of by definition extraordinary because to choose that is to make a very specific, a very consequential decision about how you want to spend your life as a pediatrician and as a pediatric specialist. So, I have endless admiration for people who do emergency work, which is simultaneously as rewarding as it gets in medicine and as perilous as it gets in medicine too.

And, you know, when we talk about resilience, we talked about it in terms of our patients. We've been really thoughtful in the last few years about thinking about our own resilience as healthcare professionals. And I think Emily and her colleagues are certainly at as greater risk as any group of physicians of deteriorating resilience and burnout and all these threats to resilience that we've talked about in the last few years. And I think a little bit of that came out in our conversation as well.

I'm actually looking forward to inviting Emily and her colleagues back as we talked about summer emergencies. I think we could adequately and equally spend some time on winter health emergencies and other kinds of pediatric emergencies as well. So, there is, I think, endless opportunity to discuss that topic on the show and looking forward because she was a fantastic guest.

Host: Well, I don't know about you, Angelo, but taking this walk down memory lane has really made me excited about what's coming. And as you alluded to, we have several other really exceptional members of our Duke community and the broader team supporting kids and youth in this area who we will be inviting for future conversations about all sorts of things, clinical medicine as well as other facets relevant to kids and families.

It is really an incredible opportunity to learn, to celebrate and really for me and for you, Angelo, to be inspired ourselves in these conversations. And Angelo, it's an honor to co-host this podcast with you. Let's round things out, Angelo. I'm going to throw you a question and you can toss it back to me or do whatever you'd like. If you weren't a pediatrician, Dr. Angelo Milazzo, who would you be and what would you do?

Co-host: I was hoping I could avoid this question, Richard.

Host: You can pass if you'd like, Angelo.

Co-host: I will take a stab at it. So, like a lot of people of my generation in medicine, as an undergraduate, I actually did not study science, I studied history. It was quite common at that time to major in something outside the sciences and still go to medical school. So for those of you out there who are thinking about medical school, you can study basically anything you want and still be fine. So, I majored in history and still love reading history, would see myself very easily as a professor of history somewhere in an alternative universe. So, I think if I hadn't made it as a pediatric cardiologist, the backup plan would have been history professor. How about you?

Host: Yeah, that's a really great answer and actually what I would have expected. You are, if nothing, a consummate scholar and teacher. And I appreciate the response. I think my answer would be fairly similar. I think I would be a teacher somewhere, maybe a high school science teacher or something like that. I really enjoy working with young people and supporting them in developing into who they're supposed to be. And I think teachers, very similar to pediatricians actually, teachers do that work every single day. And with appropriate supports, they can have substantial impacts. I see that all the time in kids I talk to in clinic where they point to a teacher who's had a monumental impact. So, a shout out to teachers, and that certainly would be probably my alternative universe identity.

Co-host: That is a brilliant answer and one that completely makes sense to me. And in some ways, it takes me back to where we started with this conversation. You know, one of the privileges of this podcast is that I learned something during every conversation. And as I've alluded to before, you and I get to spend a lot of time in our day jobs working together. Every time I have the opportunity to be in the room with you or in the virtual room with you in a meeting or in another type of conversation, I feel like I learn something. That to me is an honor. It's an honor to be in a place where I'm constantly being taught. And if you were a teacher, I would sign up for that class every day of the week and twice on Sundays.

Host: Thanks for saying that, Angelo.

Co-host: Absolutely. I mean it wholeheartedly. Well, I want to thank everyone for being a part of this show. I think in many ways, those of you who have chose to listen are the most important part of what we're trying to do here with the Pediatric Voices Podcast. Our show is brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center here in sunny, and not so humid today, Durham, North Carolina.

Pediatric Voices was created by Dr. Richard Chung and by me, Dr. Angelo Milazzo. We have a great team, including Debbie Taylor, and a new addition to the team that we want to welcome here, Courtney Sparrow, our new communications director. They are providing a huge assist and keeping us organized. I also want to thank our wonderful partners at DoctorPodcasting. They are amazing and they are great producers and great collaborators. I want to thank our chair of pediatrics, Dr. Anne Reed, and her team at Duke Children's for their ongoing and continued support.

You can find our show and please hit the subscribe button and leave us a review wherever you find your favorite podcasts. That includes Apple Podcasts, Google Podcasts, TuneIn, iHeartRadio and Spotify. And please, connect with us in our online locations including dukechildrens.org, facebook.com/dukechildrens. And I guess someday soon we can stop saying the site that was formerly Twitter, but it is now X/duke_childrens. We'd love to hear from you. And as I said, please leave us a review. It's a great way that you can help support the visibility of the show. Thanks for being a part of what we do. We look forward to seeing you all next time.