VO: Welcome to Extraordinary People, a podcast series from UK HealthCare. The stories you'll hear are from patients who've overcome the most challenging moments of their lives and our providers who've helped thousands of patients navigate those moments.

Host: In August of last year, 13-year-old Levi Yoder accidentally severed his left hand with a saw while working on his family's farm. Surgeons from the UK HealthCare Hand Center successfully replanted the Amish boy's hand, and a team of therapists helped him regain almost full functionality.

The following interview is with Dr. Chase Kluemper, who oversaw Levi's care. Dr. Kluemper discusses the uniqueness of Levi's case and how UK HealthCare was prepared to take it on. The questions here have been recreated for audio purposes.

Thanks for joining us, Dr. Kluemper. To start, could you walk us through Levi's case?

Dr. Chase Kluemper: So, he injured himself about lunchtime, if I remember right; maybe 1:00, something like that. He immediately was taken to one of the community hospitals who recognized that this needed to be escalated. And so then, he was transferred as urgently as possible to our ER. Our orthopedic residents were on the spot ready to go. They saw him. The whole system was triggered even before he arrived. And then, I personally was kind of wrapping up a clinic day and got a phone call and some messages and said, "All right. Here we go." So, it's one of those drop everything, and that becomes your plan for the rest of the night.

So, I think we got him to the OR 4:00, if I remember right, maybe happened at 12:30 or 1:00. So, we had him in the OR about three hours after it happened, maybe four. And there's obviously a time sensitive component to these types of injuries, right? So when you amputate a part of the hand or any part of your body, the vessels change. They slowly undergo a process that prevents them from accepting new blood flow even after you hook it up. And so, you've got to intervene before that happens or while it's happening. And if you don't, then it's unsuccessful. I spent a little bit of time with him right before the surgery, maybe a two-minute, three-minute conversation to try and expedite it. We immediately took the hand and started working on it on what we call the back table, which is basically a setup that's kind of semi-sterile prior to getting Levi ready to go, and that helped. Dr. Winter, our fellow, went through and identified important structures that we would then find the reciprocal part on his stump, and that saves time. So, it's all about how quickly can you get the patient there, how quickly can you identify the structures that need to be repaired, in this case arteries, and to get blood flow to the hand. And then, it's go time.

So as soon as he arrived in the operating room, he was put to sleep by our great anesthesia team. We started working on his arm, his wrist, where the amputation happened. And Dr. Winter was on the table a few feet away working on the amputated part. And at some point after you identify enough structures, you combine the two. And at that point, kind of your studying kicks in and your practice kicks in and the sequence of events for this type of surgery is bony stabilization. So, that's number one, not because bones are that important, but because without structure, the tension on the vessels change. So if I hook up a vessel without fixing the bone, then there's no stability. It's like spaghetti that's just got no tension on it, right? So, I could rip it apart or tear it with a little inadvertent motion. So, we stabilized first. I think one of our residents was in there, Dr. Nazal. He was helping pin some metacarpals.

And then, we started the part that really defines whether or not this is going to survive, and that's the vessel anastomosis, the sewing of the vessel. So, in this case, it was a large saw blade, which means there's a lot of tearing of the tissue and those vessels shorten, they retract basically after you cut them, they retract and so they're hard to find. And finding good vessels is a very tedious process and you also have to be very gentle in your search because, when you're looking for them, if you disrupt them inadvertently, that could sink the whole process, the whole surgery. So, you very carefully look for them, identify them. We use medication in the OR to keep them open and try to help facilitate flow.

And then, you begin. You bring in the microscope once you've got the two ends ready to go and and you start sewing. And it's essentially like trying to connect a severed hose in the front yard. You know, you use microscopic sutures under huge magnification and use tiny instruments. And you sew one suture at a time around in a circumferential manner, similar to kind of maybe putting on a hubcap on a car where you're going to start on this side and that side. And you kind of balance out until you've filled all the holes. And then, you allow blood flow to come in. So prior to the sewing, you've put on a tourniquet or clamped the vessel so that no inflow happens. So, he's got blood flowing through his whole body, but we need it to stop right at the source of the anastomosis so we can kind of do our work. And then, we let it go. And that's, you know, the part where you're hoping it stays patent or open.

And once we got one, we found another. And then, no time for celebrating, we immediately got to find a vein, because if you pump a bunch of blood into an area, it has to have a way to go out or else it doesn't go well. So, we found a good vein. And then, it was like, "Okay. Now, we can take a deep breath." We can get the microscope out, and start working on all the nerves, all the tendons, all the muscle, and then the skin. So, you know, it was probably a 7 or 8-hour surgery.

And, you know, you can high five when you're leaving the OR, right? You're proud of your work and you're happy for the kid and the family, but you go immediately to talk to the family and I spoke with them 5 minutes after scrubbing out and said, "Listen, you know, just because we're happy right now doesn't unfortunately mean that this happiness is going to last, right?" Within 48 hours is the time period where most replantations go down. Meaning for whatever reason, the vessels, that process that's ongoing immediately when you cut a vessel is more powerful than your repair sometimes and a clot develops or another process happens that impedes inflow. Sometimes the outflow of the vein is impeded and that can cause problems too. So, it's a very tenuous two or three days after surgery.

Once you make it out of that two or three-day window, things are starting to be on the up and up. And that's when the nursing care around the clock, that first 48 hours is so important. The nurses help us all night long, listening to the vessels, making sure his perfusion is there, his capillary refill, and then obviously taking care of any pain. So, it is an all-hands-on-deck type of approach. You couldn't get an outcome like he got without any one of those processes. All those people are super important. It doesn't happen without any of them.

Host: How complex was Levi's case? Is it something you see a lot of or is it pretty atypical?

Dr. Chase Kluemper: You know, that surgery and high level hand surgery, that's about as hard as it gets. There's not much in my field that is more difficult than that. A mid-palmar amputation involving the thumb, we call it a zone 3. We divide the hand into zones. And that zone 3 mid-palmar amputation is about as hard as it gets. And then even if, you know, if you had ten people who had that injury, nine of them would not get the result that Levi got. And that's primarily based on his therapy afterwards.

The outcome, you know, we can hook the vessels up and we're trained to do that, and, you know, I think we did a good job, but we can restore the viability to his hand. Without those therapists, so Sara Bisher at Shriners was awesome; Matt Rose and the whole team at our UK Hand Therapy Center, they really are the ones that are able to facilitate a great outcome. You know, we can give him his hand back if we're lucky. And we try hard and we're ready to go and the whole system works. But without that followup, that outpatient therapy, his range of motion is not the same. And a hand with, you know, little motion, chronic pain, swelling, that's not the outcome that you want. You know, it's better than not having a hand, but if you can get the motion that he has, the sensation that he has, that strength that he's gaining, that's really the slam dunk that you're looking for.

Host: From a surgical standpoint, what are the keys to getting a hand to the point where you have an opportunity to restore function?

Dr. Chase Kluemper: Blood vessels are the first step, right? But like we were talking about, having a hand that's not sensate, that you can't feel, that you can't manipulate objects with, you don't have the motion to grasp, the strength, that's not the goal, right? You know, prosthetics can give you a non-sensate thing that looks like a hand. What you want is the motion and the sensation and the feedback. And part of his success, Levi, is his age. At 13, he can heal, like miraculously, right? It is truly a miracle. You or I wouldn't have gotten the outcome, even if every other step was the same. It's just based on age.

But nerves heal about a millimeter a day after they're cut and if you realign the axons perfectly. And so, you know, we obviously spent a long time with more microscopic suture, finding each nerve and sewing them back together. When a saw blade rips through an area, it damages a few centimeters of tissue on either side besides the width of the blade. You know, it rips, it pulls, and it tears. And so, we have to do a job. Our job is to kind of what we say trim back, meaning get out of the zone of injury for those structures. And mostly, that's for nerves, but also for vessels and bones as well. So, you know, we spend time dissecting back and trimming back the nerves until they're fresh and they're not, you know, ripped like the end of a mop or something. They got to be fresh and ready to be sewed back together, okay, like two cut ends of spaghetti. And if that doesn't happen, then axons can escape. The nerve is trying to reach its targets. And if it doesn't have a tube to go down that's prepped and ready to receive it then it may reach out over here and you may get tingling and pain down there. You may develop what's called a neuroma, which is just an angry ball of nerves that's looking for a target. We want it to go back to its original target. So, nerves are kind of complex. But luckily, the way we were made and the miracle of the body is that if you realign it well, it will grow back, especially in a 13-year-old. So, he has almost normal sensation, which is just truly incredible.

Host: How much more complex is it to replant a hand versus a digit like a pinky or a finger? Is there an additional complexity, or is it pretty similar?

Dr. Chase Kluemper: They're pretty similar. Obviously, it's just more work with the hand. A couple of things you have to consider, is that the hand has more muscle in it than the fingers do. There's really no true muscle in the finger. There are tendons, but there's no true muscle in the finger. Muscle dies more quickly. It can't go as long. And so, you have less time, there's less room for error in a hand replant when there's muscle involved, same for an amputation that happens at the forearm or the elbow, okay? It's got to be now. And a finger does too because those vessels will shut down, but we have some tricks to maybe prolong that by a few hours.

By and large, it's the same process. You stabilize the bone, you hook up the vessels, and you hope it works. But the elephant in the room is that one finger, unless it's the thumb, people do really well with just a loss of a finger. And I know, as a hand surgeon, people will be like, "Well, you're supposed to love every finger, you're supposed to save every finger." But the truth is, if you have a stiff, painful finger, it just gets in the way. So, yeah, we can replant it most of the time, or some of the time, and it might heal. But if it's stiff and painful, then it's not of use to you, if you have all the other ones at least and it's not the thumb. But a hand on the other hand, obviously, that's the difference in quality of life for the rest of this kid's life. So, he will now have bimanual activities available to him. There's no prosthetic that we know of that we have invented yet that comes anywhere close to the biology that we were born with. So, you know, the idea is the same, but the mid-palmar amputation is much harder. And at the end of the day, if you lose one finger, you know, life goes on pretty well.

Host: What was the family able to do when Levi initially injured himself that helped the process before they got to the hospital?

Dr. Chase Kluemper: I don't know who amongst them did that. It's a great family. I know his older brother was there with him when the injury happened. His dad was there. And they immediately flagged down a driver. Somewhere along the way, they did exactly what we are all supposed to do with an amputated part. That is they wrapped it in gauze that is soaked in saline, so wet gauze. Around the house, if you don't have gauze, you can use a washcloth, okay? Wet wash cloth. And then, you wrap the amputated part of that and put that in a Ziploc bag. You take that Ziploc bag, and you put that Ziploc bag on ice. You don't put the amputated part in ice directly, and you don't float it in water, but you get a little insulation, but keep it as cold as possible. And that prolongs the time that we have to put it back on. So, you know, talk about the six-hour window, 12 hours sometimes in a finger, because there's no muscle. But six hours if it's cold for a hand replant is what we're going for.

Host: When you first met him, was Levi in shock? How did he respond to this situation?

Dr. Chase Kluemper: That kid is about as cool as they come. You know, from the moment I saw him in pre-op, which was three hours after it happened, until two weeks ago when I saw him at six months post-op, I never once saw him tear up, complain, ask why, you know, "Woe is me." That kid was all about the work, all about the recovery, the process. He was grateful. He was fun to work with. He was kind. He was super strong. And that's a testament to his parents, obviously, and him, himself.

But, you know, when it first happens, you have bleeding that's pretty extensive and arterial, right? And so, that was probably a huge shock to him and his brother and his dad. And they, from what I heard, wrapped it immediately, the stump that is, to compress, to provide a tourniquet so that he wouldn't lose blood that would compromise his life, which is possible. They also, as I said, packaged the amputated part correctly. Some people, believe it or not, will forget to bring the amputated part. It's more common than you might think, because, you know, six months from now, when it happens, you're thinking about "Someone help me stop this bleeding, stop this pain. I got to get to a hospital quick." And then, you get there and you realize, you snap out of your shock a little bit and you think, "Oh, it's in the garage," you know, "My thumb's in the garage." So, that's where EMTs can help though. So, the 911 operator, the first responders that get there by the ambulance, they all are trained to look for that, identify it, find it and transport it in the correct way.

Host: What steps were taken to get Levi ready for therapy? And how quickly did he get to begin that after leaving the hospital?

Dr. Chase Kluemper: So, you know, when we let him go home, it was a big day, you know, from the hospital, right? He'd made his way from the OR to the intensive care, had gotten around-the-clock checks and was still doing well. And then, he made his way to the floor, we did a dressing change. Jessica and I were there for the dressing change and the inpatient occupational therapist at Chandler helped to create an orthosis, which is like a hard removable cast shell. But at that point, you know, the hand is super swollen. It blows up like a balloon until the body recannulates or reforms these veins besides the one that we repaired to kind of help get the fluid out. And so, he's got pins sticking out of his skin. You compare that first picture of his hand after surgery to what it is now, and it's, you know, three times the size and scary looking.

But, you know, he came back within a few days to therapy to begin the process. And, you know, he was like a celebrity. We knew he was coming. We went down to meet him when he got here, walked him up carefully, unpacked everything. And, you know, everybody's fingers crossed that it's still pink and perfused. And then, you set to work with the therapy protocol.

So, you know, Matt and Sarah would be good to tell you more about, basically, edema control first, right? Prevent any infection. Make sure we're looking at the wounds, there's no drainage, no infection, and then edema control. And so, we try to elevate to try to help the fluid move out of the hand. You know, edema, swelling in the hand is the enemy for us. It prevents motion. And again, like we've been talking about, a hand without motion is not useful. So, getting the swelling down, getting him some gentle motion. We don't lift or anything in those first few weeks because the bones are still healing, and the tendons of course are still healing. So, it's all about passive and active motion. Whatever he has, we try to improve that, but we're not torturing him. This is still very much a tenuous kind of thing.

And so, they put him through a range of exercises. Week after week, he would come multiple times per week. And eventually, we get the pins out of the bones and that helps with his pain. Tendons start gliding. You got to keep those tendons gliding while they heal because, if they scar down and then they heal, well, again, that's the motion thing. So, you got to force yourself to move it through the pain. And I've never seen a kid like him force himself to move it and not complain. It was incredible.

And we see a lot of kids that do this stuff. You know, Shriners, we operate at Shriners a lot. Scott Riley's over there fixing kids' tendons all the time. Dr. O'Shaughnessy and I go over there, and the same thing. So, you know, with children, distraction and videos and stickers and all kinds of wonderful things for them can help. But man, he didn't need that stuff. He was very businesslike, went about his work with therapy, knew his exercises. His mom stayed on him doing the exercises at home. And I wasn't there to watch, but I know for sure based on his improvement day after day that she was.

So, that process with therapy is really the most important thing for the six months following surgery. At that point, I'm a bystander and say, "Okay, I think that, you know, the bone's healed enough to do this, the tendons are healed enough to do that." But, you know, Matt and Sarah are the ones that are in there measuring his motion day by day, testing his sensation, trying to get his edema down, measuring the circumference of his hand, and really quantifying all that stuff for us so we can check off benchmarks and compare notes from previous therapy visits. And, yeah, proud of those people.

Host: What differentiates the therapists at the UK HealthCare Hand Center?

Dr. Chase Kluemper: You know, all of our therapists are certified hand therapists, which means they went to OT or PT school, did thousands of hours extra specifically focused on the hand. So, it's an extra certificate. They are specialists in their field. You can't walk into every PT place in every city and find a certified hand therapist, okay? So, they themselves, the five that we have, all have extensive experience. They are fun to work with. They are smart and knowledgeable and great in patient care.

And it's just a relief, right? So, you know, I see a patient that I know what needs to happen for them. But if I don't trust or know the person I'm sending them to, there's always that doubt. And then, maybe I see them in three or four weeks and, you know, I've sent them a prescription to go to someplace outlying and I said, "This is what we need, this is what we want." But if I don't know that person, you know, through no fault of their own, they may not know exactly what needs to be done despite us trying to pass that information along. So, having them right there for me to you and I can say, "How are we doing on excursion of the FPL tendon?" Or, you know, "What's his wrist motion like?" It's a relief and we know that they're taken care of.

Now, there are other certified hand therapists throughout the state that do a great job. And so, we've really tried at the Hand Center, because we get people from four hours away, to identify those people. And so if someone is hurt in hazard, we see them and do their surgery. We may see him for a couple of post-op followups and our therapists will work with them when they're here. But they need, as we talked about with Levi, the more therapy visits they have, the better their outcome will be. And so, you know, I've developed some relationships with people in the outlying areas and they're experts as well. But that relationship is huge. If you don't trust the person that is helping take care of your patient, that's a sleepless night.

Host: Tell us a little bit more about Matt Rose.

Dr. Chase Kluemper: So, Matt is our head therapist. And he came on board when we were creating the Hand Center. And so, Dr. David Drake, who kind of had the vision or enacted the vision, was looking for a head therapist. And so, he had tons of experience, Matt, in a couple different locations around the area. And he was very well trained and had thousands of hours of experience. But when he came here, he had to then identify and recruit talented CHTs and bring them under our roof, right? So, it is not that easy because you have to know them well enough to be comfortable with their skill set. It's almost like recruiting our residents and fellows. You have to interview them. You have to review their casework and their accolades. And finding five people that, you know, all get along, all take excellent care of patients is another step up in the challenge of his job. You know, I mean, he was used to patient care. He was used to, "I know how to get edema out of a finger and I know how to get tendon excursion." But then, he had to step up to administrative tasks and he's done a great job with that because the therapies we have now are fantastic.

Host: How does the volume of patients that UK HealthCare sees play a role in improving the quality of care that they receive?

Dr. Chase Kluemper: With every injury, there's variations in how severe. And so, I think in all of health care really, you know, you can go through a five-year residency and a year fellowship and start practicing. I'm speaking about my own journey, but you don't really get to be comfortable with everything until you get settled in a job and you've seen enough and you've been awake at night, you know, doing every type of variation on an injury. And so, I think some of that applies to them as well. So if you're in a setting where you're just seeing trigger finger post-ops and, you know, a couple exercises, but you didn't see a patient who had trigger finger and rheumatoid and tore that tendon seven years ago, you know, those little details matter. And that experience then translates to a better outcome.

So for the Hand Center, I think, you know, yes, UK is a huge referral center, tons of patients, and we filled up the Hand Center quickly. But I've noticed, since we started, an increase in volume because of people's outcomes, I think, primarily, plus word of mouth and this stuff. But, you know, this was by far the busiest winter that I can remember. Well, you know, I've been here three years, but this is the busiest winter that we've had at the Hand Center in terms of volume. And hand, you know, is a kind of a cyclical thing. You know, people get hurt more often in the warm months. They're out there on their motorcycles or in the wood shop in the warmer months. And towards the end of the year, when people have met their medical deductibles, sometimes they want to get their elective carpal tunnel or something done before December 31st. And then, the January can be a little bit of a reboot and a little bit slower, but this January has been super busy. And I think it's just a testament to what we're doing. You know, we created something that's working and kind of filled a need in the community. And, you know, people seem to be pretty happy with their outcomes and so then, word of mouth and we're humming along right now.

Host: How important is it for UK HealthCare to be an academic medical center? What does that do to kind of separate what we do from other hospitals?

Dr. Chase Kluemper: To give some credit to the residents, you know, we couldn't do what we do without them. And then inversely, they wouldn't be able to then deliver the same care in their careers without us. So, it's an awesome symbiotic relationship. But more than that, you know, everyone takes parts of their training and then delivers it to whatever community they end up in. So, I trained for fellowship in a place where they kind of invented the surgeon-therapist relationship in the Philly Hand Center in Philadelphia. So, when I was able to see that and how important it was to walk a few steps instead of telling a patient to drive, you know, immediately, I was like, "Okay. Well, I got to find this in my job or at least a plan for this." And we didn't have it when we started here, but it was in the works and we made it happen.

So from an academic perspective, you know, O'Shaughnessy and I and Drake and Brgoch and Dr. Riley as well, trying to deliver that snippet or that window of excellence to the residents and show them, you know, what we want them to take and then deliver it elsewhere. So, I don't know, I think the legacy that you can leave by teaching is almost as important as the legacy you can leave by patient care.

Host: Tell us a little bit about the fellowship program through the Hand Center and what that looks like compared to a residency for somebody who's listening that might not be as well versed in the medical world.

Dr. Chase Kluemper: So, we have a one-year fellowship. And so, Jessica Winter is our fellow right now. All of us provide some amount of didactic training and surgical training, mostly focused on her but also for the residents. And she's been just a fantastic fellow this year. She's a lot of fun to work with and an excellent surgeon. She's Canadian and I think may be going back there, but we hope that, you know, maybe she'll keep us in mind one day too.

But having a fellow, so a fellow is someone who's done their residency, five or six years depending on the program, and they've developed a skill set and they have developed a wide field of stuff that they could go into or they're interested in, but they decide that they want to do hand surgery. And so then, they come from all over the country, and they spend one year in training full on hand and dedicated to what they want to do in the future. And that has been an unexpected joy for me. I really like working with the fellows.

So, we've had three, Jayson, Dr. Johnson; Dr. Vavra and now, Dr. Winter. And so, we're growing that part of it as well. And so, we have learners now at all levels. So, we have medical students. Dr. O'Shaughnessy runs a med student program, and they're in our clinic all the time. And, you know, the things that they're learning are so much different than the things that the fellows are learning, right? So, you know, the medical students are learning the very basics, and that's great. And they need to learn that. And then, the residents are kind of the next step up and there's different levels of residents. So, the second year is a lot greener than the fourth year. And then, the fellow is like about to go into practice and that you're just perfecting tiny little things right before they leave.

And so, I didn't realize starting academics-- I knew I wanted to teach. You know, I like to give talks and discuss things, you know, didactic kind of stuff. But I didn't realize how rewarding, also challenging, difficult it would be to tailor your teaching to different levels of learners. You say something that is like, you know, "The sky is blue" because you've researched it and know it like the back of your hand. But this, you know, poor guy, a med student, looks at you like you're crazy. And then, you have to just check yourself and remember, "Hey, you know, it's a graduated thing." All of us took that long and Mark, you know, climbed up that ladder. But having the fellow, you know, on top of the residents has been a lot of fun. And so ,we're looking to grow that. And it also helps with stuff like this case. You know, having people ready to go that are hungry for the most difficult, the most challenging surgeries and are ready to go at the drop of a hat is pretty important, both for the system and the ability to care for patients, but, you know, also for us and for them and their education.

Host: Dr. Kluemper, we can't thank you enough for your time. Just to finish this, what's Levi's prognosis? How's he doing today?

Dr. Chase Kluemper: So, Levi is going to get a fantastic outcome. He's already shooting squirrels and catching bass. I'll share a funny story, that, you know, in the first few days after surgery, we don't allow patients that have done a replant to do certain things. We don't allow them to get up and run down the hall, right? We don't allow them to consume caffeine. And that's hard for people, right? Coffee, I mean, I'd really struggle with that or, you know, Pepsi or whatever people like to drink. No caffeine, because caffeine clamps down the vessels that we need to be open to deliver blood. So, chocolate coming from the same bean also has vasoconstrictive mechanism to it. And so, you know, it's part of the protocol. No coffee, no caffeine, no chocolate and some other things.

And so, you know, as resolute and stoic as a kid he was and mature, he took it all in stride. Said, of course, "No coffee, no this, no that, no chocolate." And, you know, as time passes, you're getting excited and you're talking about what are you going to do at home and this and that. And you forget that you gave those restrictions, right? And so, he left the hospital. We're all high fiving. We're happy to see him in the therapy, and we're monitoring his progress, and everybody's so happy.

And come about three months post-op, as a matter of fact right after Halloween, I asked him, you know, "Did you get some candy and this and that?" He said, "Oh yeah. You know, I got some, but I wish I could have chocolate." I'm like, "Why can't you have chocolate?" He said, "Well, you told me in the hospital, 'You can't have chocolate.'" And I was like, "I'd robbed this kid of chocolate for the last three months." So, we gave him a big load of Reese's and Hershey's to take home. But, sorry, Levi, if you're watching. It's good for your health, I suppose. But a 13-year-old kid deserves some chocolate, so feast away.

But, you know, his stoicism and his determination really was hugely important, his mother's. They never missed a visit for therapy or a visit with me. They were there every time, on time. They did the exercises at home. I have no doubt that some of the rigidity or some of the structure to their life outside of this incident played a role on his recovery from this. He's a hard working kid. You know, he does the family chores, he helps build furniture from wood. He takes care of the animals on the farm. And, you know, if he were maybe a kid who didn't do those types of things, he might not have gotten the outcome. But everybody was on their A game. Everybody was at peak performance from the EMT to the nurses to us to the therapists and to Levi and his home situation. So, there really couldn't have been a better outcome all the way around.

VO: This episode of Extraordinary People was brought to you by the UK HealthCare Brand Strategy Team. If you were a patient at UK HealthCare and would like to share your story, please visit ukhealthcare.com/stories. We would love to help you tell it. Thank you for listening.