S04E80 - Balancing Precision and Passion: Dr. Jennifer Waljee, Plastic Surgeon

She has 242 research publications , which is absolutely staggering , and all of these impressive accomplishments over her 12 years as an attending surgeon would certainly prove that she is walking on rarefied ground as an elite academic surgeon , but it is the manner in which she goes about achieving her success which is truly special to me .

I didn't know her well when I was a plastic surgery resident at Michigan . Dr Walgi was a general surgery resident at that time . It was only years later when I would see her at the plastic surgery division reunions or national meetings , where her name seemed to be everywhere .

She not only appeared to be contributing to every facet of administrative and clinical care at the university , but her research has had national and international impact as well .

Jennifer facilitates positive interaction amongst her junior and senior partners within the division and let me tell you from personal experience some of the senior surgeons at Michigan are not the easiest people with whom to work . She was in charge of the last alumni symposium at the University of Michigan Plastic Surgery Division , and it went off beautifully .

I was really impressed how she managed to hold together a great meeting that include the current faculty and residents as well as a large number of crotchety old surgeons from the outside , and she has been truly able to bridge the culture between old and new within surgery .

Jennifer currently holds the record for the fastest response time to say yes to guesting on this podcast as well .

It was no more than exactly five minutes after I sent the email invitation that she replied that she would be glad to do it and , as you can tell , she managed to fit in this recording after being in the OR on call on a weekend when she could have gone and should have gone home instead of staying at the office .

I'm extremely grateful for the gift of her time . This is what success in life looks like . It is not being afraid of hard work , humility , the ability to work well with others and a fierce inner drive that you only see when you step back and look at what she's accomplished . Dr Walji is soft-spoken , but her words do carry great weight .

I hope you enjoy listening to her as much as I did speaking with her . Thank you very much . Welcome everyone to another episode of Botox and Burpees , our surgical series . We have with us our guest , dr Jennifer Walji . She is a full professor of surgery at University of Michigan I guess medical school , right , yeah ?

Or University of Michigan Medical Center I don't even know what . The right way to say that is University of Michigan Medical Center . Okay , let's stick with that . Let me talk a little bit about you , jennifer , and your background so people know who you are .

You graduated from University of Michigan in biology for your undergraduate training and then you went to Emory University for your medical degree and you also picked up two master's degrees along the way , one in epidemiology at University of Michigan School of Public Health and then another one , also at Michigan , in health services research .

You did your general surgery residency at University of Michigan and you did a full looks like seven years . So you did seven years of residency at Michigan for your general surgery training , so it's five plus two of research . Yes , so for those who don't know and actually we had a previous guest as well like nowadays , plastic surgery , residency is integrated .

So you do a couple of years of general surgery , usually like three years of training as a resident and then maybe like another three in plastic surgery .

But for the really deep , well-trained old school surgeons they did a full general surgery residency , which is five plus usually a couple of years of research , which you did , and that's how all of our mentors did it . I think pretty much Obviously things have changed now .

And then you did your plastic surgery residency also at University of Michigan and you stayed on to do your hand surgery fellowship at University of Michigan as well . So just kind of picking through your background , you're now full professor of surgery in plastic surgery and in orthopedic surgery at Michigan .

You are also doing a couple of other administrative responsibilities . You're the vice chair of research strategy for the department . You hold the Zunima endowed professorship and you are also vice chair for both faculty life and health services research . You have one of the longest publication lists I've seen for someone . How long have you been in practice now ?

You are also a peer reviewer for the New England Journal of Medicine , which is I don't know if I know another plastic surgeon who is a peer reviewer for that journal , as well as a million other board members and committee members for a number of organized board members and committee members for a number of organized national organizations , which I'm not going to

get into because there's so many to list . Thank you so much for agreeing to guest and I really appreciate you spending the time . I know you were operating this morning and you just got out , so I really appreciate that you were able to to to to bop over here to do this .

And I always feel like the people who are , you know , who get to stay at the institution that you trained at for the most part , and I always feel like the people who get to stay at the institution they trained at are some of the superstars , for a couple of reasons .

One is they uphold the tradition and the excellence that is that institution that they trained at and also they really know you warts and all , and for them to want you to stay you warts and all and for them to want you to stay , like they know you you know more , better than almost anyone else who comes in as a candidate , so it's really a mark of honor .

I think that they , you know , would want you to stay and become part of their faculty . That was not something that was offered to me when I finished , trust me . They were like go , go forth . But as you trained at Michigan , is there anything that you remember in particular that was really impactful or really sort of affected you as a surgeon in training ?

I knew absolutely nothing , so I remember the kindness of the residents above me trying to , you know , teach me how to take care of really sick patients who had complex injuries . I felt , you know , it's hard to come to a new place right out of medical school . So I try to , you know , remember that and be , you know , particularly mindful of that .

For our residents that join us in July , it's a tough month and starting off intern year is really hard . And then I think , as I moved through my general surgery training which I loved I found that I was really drawn to breast cases and breast reconstruction and had an opportunity to work with Dr Amy Alderman and that was really formative for me .

I then took two years off for research and she was one of my mentors during that time and I found that I really liked the thinking about those clinical questions and how we could impact somebody's quality of life and then found kind of throughout the rest of training that I was drawn to a little bit more of the anatomic challenge that plastic surgery had to

offer . And the first rotation I had when I started in plastic surgery here was the hand service . I didn't know what any of the various letters meant for the first few cases that I was doing . So that was a pretty steep learning curve and obviously Dr Chung wasa tremendously influential mentor on me because now most of what I do is hand surgery .

So I fell in love with that and that challenge and variety that comes with that and I think those things stick out of my mind when I reflect back on training .

And I think the other big piece was you know we spend a fair amount of time in the trauma burn unit as junior residents and then as trauma chiefs and so was , you know , very influenced by Dr Wang and Dr Hamela taking care of burn patients and then watching , you know , dr Soderna and others do reconstruction for them later and kind of having that longitudinal

experience was really rewarding for me .

When I first started on faculty in plastics they had a need for someone to come back and cover a burn call and so I did that for a few years , which has been really fun , and I enjoy taking care of individuals with , you know , injuries that require late burn reconstruction still , even if I don't cover the acute burn call anymore .

So I think those are some of the experiences that have stood out to me .

As a senior resident in surgical oncology I got a little bit more exposure when Plath would come in and do a complex reconstruction and it was really towards the end of my general surgery residency and I remember Dr Osmond was always so kind to let me stay and could watch some of her cases and I think that's what really flipped the switch in my mind that wow ,

this is , you know , incredible anatomy and the things that you're able to do to manipulate anatomy to help somebody , help somebody's long form quality of life is pretty incredible .

So what was it that you decided was so appealing about hand surgery itself that made you decide that's what you wanted to specialize in , Because in plastic surgery is so much right there's , like you said , breast reconstruction , there's micro , there's general reconstruction , there's aesthetics , there's craniofacial , there's hand Like you could literally choose anywhere on the

body to operate on . What was it about like this that made it so fascinating to you ?

As you know , a pretty routine condition like carpal tunnel syndrome has a huge impact on somebody's quality of life If their finger's catching and triggering that has a huge impact on their quality of life , if they can't type or they can't do the things that they like to do .

So I like the fact that it's a huge swath of cases , from things that take five minutes that really impact somebody's quality of life to cases that are , you know , pretty complex and involve and you know , involve , you know pretty complex and involve , you know , involve you know free tissue transfer and those kinds of things , so I like the breadth and depth of

that .

Um , how do you , uh , what kind of advice do you give to people who are , like , interested in what you do in terms of the amount of work and effort that you needed to do in order to get to where you are ?

I have two kids and it's important for me , especially now that they're a little bit older . They have lots of activities and things that they I mean I think our kids need to . Hopefully they need us for a lot of things that they I mean I think our kids need to . Hopefully they need us for a lot , of , a lot of things that they do .

But I feel like I'm needed in different ways than they were when they were a little bit smaller .

So , and when I reflect back on that , when I first started on faculty , my kids were pretty young and so they , you know , had different hours and times that they were awake and needed me than they do now , and so I think I kind of structure my life around that .

I think it gets easier when you're on the other side as an attending , because you have more autonomy over your schedule . Easy , or they're not going to be things that don't necessarily align with exactly when you wanted to do them . But you do have some choice over you know .

Well , this is what I'm going to book these late cases , or this is what I'm going to take call , or this is a hard no for maybe my daughter's birthday or whatever the situation might be . I also look back on it and for the most part , I've really enjoyed all the things that I've gotten to do .

So it's not to say that it didn't feel like work along the way , but I feel like they were meaningful and rewarding experiences , and so I think that kind of helps stay motivated every day .

You know , the webinars and things like that that are at night often are recorded on other platforms and you can listen to them when you're driving to work or , you know , whenever you have downtime . So I try to do that for my own continuous education . I think I try to be really critical about you know why I made decisions . How did that turn out ?

Was that the right thing to do or not ? And I often seek the counsel of my senior partners about should I have done this differently , or how should I have thought about this case , or , if I'm thinking about a case that I haven't done yet , what might be the pearls and pitfalls with that .

I also think that over time I've gotten more aware of what I'm good at and what I'm probably not as good at or should be handled by somebody else , and so I'm trying to be more mindful of that and not let my own ego get in the way . I think it's important to me .

Or is it that how you decide who gets it , or or how you know how you choose what operation for a particular person with a particular injury has changed more for you ?

The way I've managed nerve injuries have changed , For example , thinking about earlier nerve transfers or tendon transfers for individuals with peripheral nerve injuries . So some of those things have changed in terms of the techniques . I might choose , but I think a lot of it .

More is the clinical decision-making and or how I counsel patients in terms of what to expect after surgery .

I don't think that we can , and I think that whenever we have conversations , we only hear pieces of it , and so I try to keep reiterating that again and again , just because I know that patients are overwhelmed particularly if it's a patient who has an injury they're probably hearing part of what I'm saying , but not all of it .

So , making sure that I'm consistent and , you know , providing them as much information as they need to know ahead of time , particularly on what can I expect in terms of getting back to work , caring for my family , picking up my child .

You know , I probably used to say , oh yeah , sure , it'll be three to four weeks , and I'm like it's probably going to be more , like six to eight . This is when you can drive , this is , you know , when you can lift things , those kinds of things . I think I'm a little bit more realistic now than I used to be .

I remember I don't do as many for those anymore , but I think the elegance of the geometry and planning it and making it just so that it works perfectly . And then you have this really nice , smooth surface where before it was like this big scar band . Is that what you like about it or is it just seeing the function afterwards ?

What do you love about Zplastis ?

I love that and I think all plastic surgeons have that sense of like just making that soft tissue work the way you know , like just setting it up nicely , like that , Like it's just a nice sense of accomplishment . I think surgeons love accomplishment after a case , like you're like okay , I did something really really cool or nice there . That fulfills that .

So when you operate you know I know a lot of surgeons they have rituals , they have certain things that they're always doing . There are certain things that are very important to them . Is there anything that you have that's very important , specific to your setup or your prep routine or anything before surgery , to help you optimize that surgical procedure ?

Once we're all scrubbed in and we're started , so that people don't have to run back and forth to get a million things I forgot about , I often will usually pick out the suture that I want , put all that up , put all the dressings up that I want , if it's not up already , because I just want to make sure that we're all moving through this expeditiously .

And so I think for almost all cases I do that . For one that I think are going to be particularly involved or challenging , I usually mentally go through the steps in my mind multiple times before the procedures write them out .

Sometimes , especially if it's something where there might be some nuance and I want to make sure that it flows smoothly , and then , especially when I'm working with trainees , depending on what it is , I'll often share . You know , these are the techniques that I'm planning on . This is my personal plan A , b and C .

If you have other plans that you'd like to consider , sure we can talk about that too , because I feel like when we're all coming to the operating room , it shouldn't be a pop quiz , like we should all be on the same page about what we're going to do .

I , you know , we may have different experience in terms of the number of years that we've been doing something , but we should all come there with the same working knowledge of the anatomy , the plan A , b and C and what the recovery and prognosis are going to look like .

Doing critical things is like sort of making sure you have that flow , either written or at least mental , in mind in order to make sure that you're hitting the steps that you need to in the order that you need to to hit them .

Um , and I and I assume that some of the reconstructions you're doing are fairly complex and you need to make sure that , like , you're flowing through it stepwise , because they're all different too in a lot of cases . So it you know , there are many variations , probably on a particular type of operation you might need to do for somebody .

So what do you listen to in the OR once you get in there ?

What so , when you have your team either in the OR or out , is there anyone that's particularly important to you that makes you Dr Jennifer Walji , the person that you are either operating or outside the operating room that helps you be the best person that you can be ?

So for some people in the operating room , I've worked with them for a really long time and I really trust their judgment and their wisdom and expertise and that was really helpful , particularly when I was starting out in practice .

You know you're nervous , you're worrying if you're going to forget something , and it's kind of nice to see the same team members in the operating room because you know they've got your back .

I think the other I mean , you know , certainly the most important people outside of the patient in the room are also the trainees that we get to teach , because this may be the operation that they've seen 500 times , or it may be one of two that they get to see before they go out into training and then are either doing it themselves or using the principles

that they might have learned or the anatomy that they might have learned to apply in whatever way going forward . So I think that's really important .

You knew them , treat them like your big brother , like you knew them , like you know , like they . It took them a little while to sort of uh , grow into that position , because everyone knew them as a resident versus an attending . At what point ? As an attending were you like ? People aren't treating me like a super resident .

I now am an attending , attending at this point .

So I think from a trainee perspective , you know it probably takes , you know , through the period of time that people knew you as a resident , but I hope that I'm still approachable and they feel like they can , you know , ask me questions and it's not intimidating or , you know , come to me with mistakes or those kinds of things or questions and advice that they

have . I probably noticed it when you start hearing about , you know , various things that come up all of a sudden the residents like aren't telling you everything anymore , Like you're not really one of them and you're like , oh , okay , I think they don't want , I think they're ready for me to leave now because they look at me attending .

So there's probably a little bit of that phenomenon . And then I think with my partners , they were all just really gracious in terms of , you know , giving me advice along the way , especially you know , when you have complications and you're not sure what to do . you're in a word collection period .

They were all really supportive but also would be , you know , encouraging , like hey , you've got this , you can do it , and so that was very helpful along the way . But I don't think it was like a black and white switch moment . Took a long time to reflect back on that .

Did you start that from day one , or was that something that you grew into , or is that something that you don't need to have as an attending ?

your clinic such that you'll have enough time to spend with patients and you'll be able to , you know , collect all the pieces that you need to get to the next step in terms of your board certification .

So I think we probably all do it subconsciously , but that is definitely an exercise during that board collection period that really makes you feel like , OK , I'm in this experience and it's different for me than it was when I was a chief resident , and I think that helps make that switch when I was a chief resident .

And sometimes , you know , the right time for me to be doing something might be on a Saturday afternoon or a Saturday morning , like when my head is clear , and not necessarily , you know , on a Monday at three o'clock , when you know I'm a little bit tired , you know , by towards the end of the afternoon .

I find that I'm much better at thinking in terms of writing , research and those types of things in the early morning hours , you know , and then throughout the rest of the day and into the evening . I , you know , always have energy for , you know , doing operative cases or signing notes or some of those kinds of things .

So I think it just depends on what are the right rhythms for a person . Some people might have a completely opposite schedule than that . I also think that it's important to find time to completely shut off during the day .

So there are some times during the day that I try to protect , particularly if I'm dropping my kids off or taking them to activities and those kinds of things and I want to be there for dinner when I can . Then those times I really do try to protect them .

And then kind of going into residency , um , so no , not at all . And then , kind of going into residency , I , you know , liked all of my rotations and so um had opted to um go into general surgery . And then um liked all of the rotations . But then was increasingly um drawn to plastic surgery and hand surgery , um .

So yeah , it's been a little bit of a circuitous path . I would not have imagined I was going to be a hand surgeon .

What other future goals do you have at this point for yourself that you need to accomplish or plan on accomplishing or want to work towards accomplishing ?

I think trying to figure out how to be a better surgical educator . I think I probably have a lot of blind spots in the operating room where I'm , you know , trying not to do an operation but talk somebody through it .

So I'm trying to be more cognizant of that and giving them , you know , verbal cues and advice , rather than trying to take over the operation and doing it myself . I think , in terms of you know , research and you know the more academic part of my life , I , you know , really enjoy mentoring .

You know students , residents and other faculty members , so I hope that will always continue . I think there's , you know , a lot of our work now is trying to understand how we can help individuals with substance use disorders , mental health conditions , kind of support them through perioperative care .

So there's a lot of work to do there which will be really enjoyable going forward . So , yeah , those are things that I think about over the next 10 years .

Or what kind of comments would you make , either going through surgical training as a woman or now , on the other end , as a leader , as a mentor yourself , now being a surgeon who's a woman ?

You know individuals that are going to be honest with you and tell you , hey , like you maybe didn't make the right decision with this patient , or you know you need to think about your surgical skills in this area , and I'm thinking about , like the surgical attendings that you have when you're a resident , like the ones that give you , you know , critical and kind

feedback about hey , you know , think about doing this a little bit differently . You need more reps . You know you need to be prepared for a case in a different way . That's really helpful .

They may or may not be the same mentors that are going to give you advice about , you know , if you want to take an academic position , these are the pieces of the pieces or skills that you need to be successful and get promoted along the way , particularly during that early career , faculty phase , which is important when you're trying to make it to , kind of ,

the next level of promotion which I think is a big point of attrition for women faculty , and then having both you know , perhaps senior mentors and peer mentors who are helping you along the way when you have children , loved ones , other partners at home , is trying to navigate all of those other factors .

Not everybody's family structure looks the same , but we all have a lot of things that are going on on the outside , outside in our professional world . So figuring out how you balance that is really important . That is really important .

But at some point and we've seen older surgeons either sort of operate until they literally can't hold up a scalpel anymore or they have exit strategies in terms of what they plan to do or what aspects of their life they plan on keeping or changing .

On keeping or changing have you given any thought to what you will be doing in the distant , distant , distant , distant ?

I like when I reflect upon my dad , and when he retired he stayed incredibly active in his professional society . He was still taking tough self-assessment examinations like well past his retirement .

He's , you know , volunteering in a variety of things across the community and I think I don't know exactly what things will look like , but I imagine that I will stay active , hopefully , in you know , teaching , it being able to impart some knowledge or wisdom to the next generation of surgeons , and then , you know , traveling , finding ways to , you know , continue to

expand my own knowledge base , I think will be really rewarding .

I usually try to push them pretty hard to get down to a question that's interesting to them , because if it's not interesting to them then it's not going to be enjoyable when they're doing the project and the work . And so , and I want to challenge them to think about what is meaningful rather than what's meaningful to me , what matters the most to them .

So that's kind of how I think about it from like a research standpoint . When I have individuals who come to me and they're interested in plastic surgery and they , you know , are wondering you know , what do I have to do to ? You know , make it to the next step , either in medical school or in residency training ?

I think I'm probably maybe a little bit more prescriptive because there are some , you know , a few more external metrics as far as that's concerned . But I think that there's a place and a space for everybody .

I think , so easy for us to get caught up on you know board scores and numbers of publications and how many away rotations that we did and I think , at the end of the day , while many of those things are important , what really matters is that you're passionate and committed to it and you're pursuing things that make a difference in the world around you and are

meaningful to you , rather than just trying to write lots of papers to put on your CD .

This is my , my dream , this is what I really want to do , but if my board scores are in the toilet , I don't think there's a chance Like it's such a competitive residency to to get into that you would probably have to say the chances are very small or very little .

Like there are certain external metrics that do define whether or not you actually have a fighting shot to be , you know , to get a residency in plastic surgery , for example . So do you tell students who are looking to apply into plastic surgery this is really what you need and without these minimums you probably aren't going to have a shot .

You only get to take them once , so that's a really stressful day , but you know , there's lots of other things that you can do in terms of , you know , doing some dedicated research time or other academic time or global , you know , taking time off to do global health or other things to round out who you are coming into the application process .

That will allow you to , you know , connect with other mentors across um , across our specialty um , get the letters of support um that can strengthen your application , um , I think it's also helpful to just you know , if there's places on your application where you know you wish things looked a little bit different , um , you know , perhaps just being as honest and

open about that as as you can be and saying , you know , yes , I recognize that you know this score wasn't exactly what I wanted it to be , but I have done X , y and Z things and I think I'm prepared to come into this residency for all those reasons .

And I think that while there's , you know , only kind of one chance to take step one and step two there's lots of different chances and ways to move into our specialty , and so trying to encourage um our students that um there's lots of opportunities , um is important .

Um , in organized plastic surgery , we all know surgeons who are really good at being surgeons in terms of their surgical skills great hand-eye coordination , really good clinical skills in terms of managing patients , treating certain operations , but maybe lack the ability to lead groups , to talk to large numbers of people , to be able to or , you know , be a good

organizer , to do the things that it takes to ascend higher in , you know , if you really want to impact more people , either outside of your department or medical school or hospital , or , you know , organized plastic surgery as a whole . How did you develop those skills ? Did you always have them ?

Were you really good at managing , organizing , communicating , or was that something that you had to pick up along the way as well ?

you know , the last decade or so , and I am really encouraged to see that the residents have access to these as well . So I often encourage them to you know we have several in our department to participate in those , because I think you know we're leaders when we're leading our teams as a chief resident .

You may not realize it or feel like that at the moment , but all those skills in terms of you know , your emotional intelligence , your ability to communicate , your ability to be efficient and organized that matters at five o'clock in the morning , when you're rounding , you know five other residents and you've got 70 patients to see .

Just as much as it does when you're trying to lead a group , you know , in your research team or a clinical team . So I think I've been really excited to see those programs emerge for our residents and I think it's about lifelong learning .

And then so making sure that you're I don't think it's possible to over communicate and I think making sure that you are communicating consistently , again back to that point that you know we all hear different things from you , know a single piece of information that's being delivered , and so trying to be as clear and consistent about that is , I think , something

that I'm working on . Hopefully I'm getting better at that .

Do you make a conscious choice , like I'm going to be spending X amount doing this X percentage , doing this X percentage doing this , or is it just whatever feels most interesting or what needs to be done at a time , or I need this goal for this , and that's how you sort of divvy it up , because there's only X amount of days for you know , minutes in a day

to do anything . So how ? How do you best organize yourself in order to achieve the goals that you want ?

So I have a couple of days where I operate , a week , and then I have a full day of clinic , and on those days I'm pretty focused on almost entirely clinical care signing my notes , making sure I'm following up on whatever patient issues , prepping for cases , making sure that whatever I need for specific cases is all being taken care of , because I don't know , I

think my brain , just you know it's already kind of in that mindset and that's easier for me . And then I can , you know , respond to , you know , some emails or messages that are relatively quick and don't necessarily , you know , require , you know , a deeper conversation .

I block out one day a week for my research , for my research , and a lot of that is meetings . But I try to break that up so that there's also time to catch up on things and then address some of those deeper questions or things that are going to require a little bit more time .

And then I have another day that's a bit of research and a bit of admin . So , again , kind of more meetings and those , but it's a little bit of a faster pace with the kind of back-to-back meeting .

So I try to set aside chunks of time when because I find that you know if somebody is emailing you something that's , you know , perhaps sensitive or requires a lot of attention , that I can't respond to on my phone , and then you know email such a vacuum that all of a sudden you realize you haven't responded at all email .

Such a vacuum that all of a sudden you realize you haven't received this through at all .

So I think being intentional about your time is something that I have been trying to do better over the last several years and also leaned on my administrative partner as well to help me with that , saying like listen , we're going to block off this morning and maybe I have to have a case on , maybe I don't , but otherwise we're not going to have other meetings

and things on there .

You know , stay focused and you know , stay committed to the things that are meaningful to them and do what makes what brings them joy , because there's a lot of times during the day that are not necessarily joyful and are hard , and so you know you want to make sure that you feel like you know that you're doing every day are meaningful .

It's a challenge , I think anyone to stay at their own training institution and then make it theirs as an attending and the people that I know who have done that have been the most highly regarded both at their institution and out have been the most highly regarded both at their institution and out .

And you know , michigan Plastic Surgery , let's face it , I think , is the premier plastic surgery training program in the world .

I mean not just because I went there , but because I see it on the outside , looking in now and having seen other programs , and so it's so impressive to see just how much all of you as faculty and as attendings have accomplished there and , honestly , also how well you have meshed with the senior surgeons there and have sort of taken what they've done and gone

beyond .

Many of your senior surgeons were also my mentors when I went through , were also my mentors when I went through , and it was challenging , to say the least , for many of us and for you to excel and thrive there just shows , like you said , you may have found what really interested you and drove you , but I cannot underestimate or no one should underestimate the

amount of work , hard work , time and commitment that anyone who has faculty there has spent to achieve what you have .

And so you know , I find that inspirational and I think that most people who look at your life should also say I mean , I would say hard work , like if I , if if one of your mentees were like , how do I get to where Dr Walji is , I'd be like you got to work really , really , really , really , really hard because you're not you residency and then to continue

to progress the way you have , like I can't imagine how much you were able to do within that time in terms of being efficient and just you know , nose to the grindstone with that sort of stuff . So so I really it's , it's admirable , so that sort of stuff .

So thank you , dr Walji , and I appreciate it very much .