The Upper Hand: Chuck & Chris Talk Hand Surgery

Interview 14: Chuck and Chris Welcome Terry Light for a Medicolegal Education

August 15, 2021 Chuck and Chris Season 2 Episode 33
The Upper Hand: Chuck & Chris Talk Hand Surgery
Interview 14: Chuck and Chris Welcome Terry Light for a Medicolegal Education
Show Notes Transcript

Episode 33, Season 2: Chuck and Chris welcome Terry Light, a mentor to many, to the show.  Terry shares his medicolegal thoughts on both how to avoid issues as well as when to consider expert witness work.  Many pearls for listeners of all levels and training.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

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Charles Goldfarb:

Oh, hey, Chris.

Chris Dy:

Chuck, how are ya?

Charles Goldfarb:

I'm doing really well. It's a special night for us.

Chris Dy:

It is it is. We're coming in live from my friend's basement. We're still homeless. A staff member put it to me recently, that I'm the first homeless surgeon that they've known. So it's been fun we're, looks like there's light at the end of the tunnel.

Charles Goldfarb:

It's all relative in our privileged world. It's all relative.

Chris Dy:

Yeah, exactly. We're very fortunate to have these friends that have put up with us. So yeah, things are things are good. How about you?

Charles Goldfarb:

I things are good. You know, I, Missouri is not the best place to be in in 2021 with the COVID variant, but we're you know, we're getting by it's a little scary, because a couple of our partners have have gotten COVID recently, and thankfully, they've been sick for a couple days and not just a little sick, but pretty sick. And then they recover. And once their quarantine is over they they're getting back to work.

Chris Dy:

Yeah, the whole the whole breakthrough infection we hear about.

Charles Goldfarb:

Yeah, it's a little frightening. However, I'm excited because we have a great guest and it really is my pleasure to introduce Terry Light. I hope and expect most of our listeners know of Dr. Light or have heard Dr. Light speak. He has been a friend and a mentor to me he I guess I should say I share his love for congenital hand and really all things hand. And I know Chris and I have talked about what are but just a great mentor from afar he has been so. Terry, I don't know how long you worked at Loyola. But he's still affiliated with Loyola. He's not really clinically active, but he's doing admissions. But he is at least sort of clinically active at the shrine. So Dr. Light welcome. And thank you for joining us.

Terry Light:

Hey guys. I'm delighted to be here.

Chris Dy:

We're happy that you decided to tune into our podcast on all of the the wonderful walks that you've been going on recently with your newly discovered time.

Terry Light:

Yeah, you guys are my companion.

Charles Goldfarb:

Definitely good times.

Chris Dy:

I have a really interesting story that I'd like to share with both of you has actually talked about both of you in my clinic the other day. So a recent clinic encounter I had a patient come in complaining of numbness and tingling in their thumb index and middle finger. And the fellow saw the patient ahead of me and kind of filled me in on what was going on. Here's the thing though. The thumb wasn't a thumb. The thumb was an index finger, somebody put on the thumb. And you know who that somebody was is all of our mutual acquaintance. Paul Manske. So she told me that she was actually Paul Manske's first pulsation patient patient. She said that Dr. Manske, actually, during her recovery, had brought her into the shrine in front of hundreds of others, to share her story and show her recovery because she was so active, she was climbing everything. And I was actually telling her I was like, well, I, you know, I just had a conversation was actually one on firsthand with you, Terry. And we were talking about policies ation and how the procedure really hasn't changed any of the fundamentals. Since, you know, the procedure that was described by Buck-Gramcko. And I thought it was a really funny occasion that she came in, and now of course, properly I sent her to you chuck for follow up. It's like, if you want me doing your carpal tunnel, I'm happy to do it. But I thought it was a really funny interaction.

Terry Light:

It turns out that the first pollicization I ever did in Connecticut, walked into the office of a hand surgeon friend there, Rich Bernstein, who, who called me and and he didn't know it was the first one I'd ever done. But as soon as he mentioned her first name, I knew exactly who it was and could tell him the whole history. Probably better than the patient I saw the week before.

Charles Goldfarb:

That is that is crazy. I haven't seen carpal tunnel after pollicization specifically, I have seen carpal tunnel after abductor digiti minimi opposition transfer. I wonder saying I know that Paul would occasionally do that. I haven't had occasion to do that much. And I know the audience probably don't want to hear Terry and I go into depth about you know, congenital but interesting, though.

Terry Light:

Well, Paul, what Paul was one of my mentors. I came to Chicago after I'd been in practice for three years in Connecticut. And I knew then that I was interested in doing pediatric hand. And when I told my met my department chair, he said, Oh, well, I've got I do lots of kids. No problem. It turned off that his practice was filled with children with cerebral palsy. And I knew nothing about cerebral palsy. But I knew the name Paul Manske, and I just cold called him and said, Can I come to St. Louis spend a week hanging out with you, learning how to take care of cerebral palsy. And that was really the beginning of a wonderful friendship.

Chris Dy:

Interesting. I actually never got to meet Dr. Mansky. I know him based on the stories that I've always told, including both you Chuck and Terry as well as stories from his daughter, who I had the pleasure of traveling to India with for our microsurgery training. When I was a fellow and she was the chief resident, I've had the privilege of taking care of a handful of his former patients who have somehow find their way to me. And every one of them has such an amazing story about not only how great of a doctor he was, but just how good of a person he was. It's almost like they paused in some of the moments tear up about how great he was.

Charles Goldfarb:

Yeah, it goes it. We've had a mentor episode. But you know, the power of finding the right mentor. And, you know, it is a very personal decision, although some of it may be outside of your control. But certainly Paul was an amazing mentor to me, and made me you know, a better surgeon a better person, a better doctor. So I was very fortunate note, no doubt about it. All right. So enough, sentimental.

Chris Dy:

Enough Manske fanboying. So to say. Well, Terry, Terry, you're you're a mentor to a lot of folks. And it seems like one of the topics that the Loyola crew always wants you to talk about with them is interactions with lawyers. And I don't know why you're the go to person to talk about, quote, medical legal issues, but it seems like you are someone who has a fountain of knowledge for them. And it was, it'd be great if you could share with us some of your pearls about at least starting about interacting with lawyers.

Terry Light:

Well, it was one of my recent hand fellows, who at the end of the year, we we do an hour long, I still do this an hour each week with the handful of going over a chapter in green or something that's of interest to them, we're getting to the end of the year. And I said, Well, what else should we talk about? And, and and she said, I've got a job, everything's lined up. But I'm afraid and lawyers that I'm going to have to deal with as an orthopedic surgeon. And that led me to put together some ideas and thoughts and some of some of the things I learned along the way. I am not a lawyer. I don't even have a lawyer in the family. But I've learned some some some lessons that have made the whole process much more palatable to me.

Charles Goldfarb:

Yeah, I there are probably a lot of different lessons you can share. Let's start by how to stay away from the attorneys. Let's start by things you did or do when you interact with patients. How you think about adverse events, and how the that may change interaction with patients. Just just share your your pearls for keeping the lawyers away.

Terry Light:

Well, the first thing is you you want to be kind to every patient. And you want to listen and acknowledge patients and when I look at litigation, it often is from people who are mad at their doctor and want to send a message. And so you, you want to be your patient's advocate, and they need to understand that. And when things go wrong, you have a complication. Somehow, the way our minds work cognitive dissonance or whatever it is, we are looking for someone to blame. Why did this happen? We have m&ms where we're trying to figure out what what happened. Whose fault was it? And subconsciously, a lot of doctors turned to the patient. If they'd come back in two days, instead of three days, I would have noticed it. Or if they kept their bandage on or why did they play baseball with the cast on whatever it is, you need to always avoid that shifting blame to the patient, even if they did something boneheaded. That doesn't solve anything. So patients though they understand it. And if you read depositions by patients who are upset with their doctor, they say after I got my infection, it seemed like he was mad at me all the time. And that that's a very common scenario. So when something doesn't go, Well, the first thing to tell the patient is you're sorry, and that you're with them. And together, you're going to solve this and that you're on aside and not create that antagonistic environment, but really one of I care for you. And I'm going to care for you. And we're going to get through this.

Chris Dy:

I think that's really that's really interesting. And really well said, I mean, one of the things, you natural gut reaction is to get defensive and maybe want to put your head in the sand. And then like you're saying, maybe act out a bit, I'm hoping you could elaborate a bit more on a couple of things. One being, you know, where's the distinction. And sometimes there's overlap between when something doesn't go well, and the patient doesn't get the outcome they want versus when you actually had a complication. Because I feel like there are times where patients may be upset, and not happy with the outcome. But really, there is no complication. So to stay on your end. And then also, the second thing I hope you elaborate on is, you know, because I've seen conflicting messages, is it okay to say sorry, is that an admission of guilt?

Terry Light:

I don't think it's an admission of guilt, I think, saying that, that you're disappointed it turned out this way, or you're you wish that it had gone better. Again, you want to be on the patient side, and you want to be able to see their, their point of view. If it gets to, we'll look back in the record, I told you that you might not have more than 40 degrees of motion, see. And now you're you're on the other side, and you're trying to prove to them that I'm right, and you're wrong. And and you're not gonna win that argument.

Charles Goldfarb:

I like two things, I want to, I want to reiterate one thing you said and, and present another scenario would be, what I really liked is, you know, obviously, we need to be our patients advocates. And that's gotten easier for me, as I've advanced in my career. You know, I think when we're younger, and we're trying to build a practice, and we want to see a lot of patients and, and we want to establish our credentials, so to speak, it's easy to fall into the trap of coming across, even if you're not, but coming across as arrogant, or just the classic surgeon and cash avoiding that I feel like my interactions. While they're not always perfect in clinic, I think as I've gotten older, it's been no easier. I feel less concerned about reputation and building and just can be myself with patients, which has been helpful in regards to complications, your friend, and my mentor, Peter Stern, likes to say when things don't go right, and maybe getting to Chris's point complication versus simply not the outcome we want. See the patient back more often, rather than less often, which can be hard.

Terry Light:

Absolutely. And actually, my father was a ophthalmologist. And he taught me that very early, that, that he's like, I need to love these people. And sometimes, you know, you're going along and your office hours, you see one patient, doing great, the next one's doing wonderful. And then you walk up to the door of another one. And you say, Oh, my gosh, I got to see so and so who's not doing well. And you almost have to put on your game, Facebook, compose yourself before you go in the room. So that you, you have the proper demeanor.

Charles Goldfarb:

I think and Chris, I'd love your take also on this, when a patient comes in who again, maybe isn't doing quite as well. Actually, it helps me when I have a resident or a fellow with me, because I try to make it a teachable moment. And it's hard. It's demoralizing. It's frustrating, especially if something could have or should have gone differently, not just the patient wasn't happy. But that's helped me, you know, just approach it differently, which I think may be a good tip. I don't know.

Chris Dy:

I don't have much to add on that. But I did have a patient in one of my recent clinics who had not been doing well. And I did the same thing that she mentioned, Terry, I saw their name on the chart was about to walk in the room, took a deep breath, and had my game face on. And she's like, I love it. I'm better. You healed me. And I was like, Wow, it's completely floored. And, you know, I know I got lucky on that one, or you know, something was on my side. But I definitely know the feeling of what you're talking about, you know, rolling through your clinic, and then all of a sudden seeing a name and I'm not great about remembering everybody by name. But you know those names? Absolutely. What are the other what are the other pearls that you teach your trainees about, you know, just interacting with lawyers because inevitably, even if you do everything, quote unquote, perfectly, you may be deposed because you're the treating physician and you're not implicated in the lawsuit so to say, but you're asked to give your opinion on you know, or give your record turns on what happened? And perhaps an opinion? How do you approach that interaction?

Terry Light:

Well, first of all, I would hope that you're going to be doing depositions as a treating physician far more than as, as someone who's who's involved in as the object defendant of litigation. So look at that as a way to get your training wheels to understand how the legal profession works and interacts with doctors. I think lawyers see the world differently than physicians do. And we think that we can teach them the same way, maybe we teach a medical student or a resident, but that's not the game they play. They're, they're playing in a different a different rules. And if you're doing a deposition, you're playing in their field, and you need to understand their rules. And so I think, when you just go into practice, you've never done a deposition before. You're just a witness to the facts. But it is not a bad idea to have your own attorney with you. Just to hold your hand to run through beforehand, this is probably what they're going to ask. If they ask some confusing question, you can just turn to your attorney who will say I want to talk to Dr. Light for a minute, or whatever, and keep you on track. So that's one thing that our medical center has provided for young physicians is just an attorney to sit with them, the first couple times they do a deposition. But the other thing is, they're, you're going to be involved several ways. Number one, you've created a medical record. If your medical record is truly clear, that may obviate the need for deposition, because they can submit your records. And they'll answer a lot of the questions they don't even need to call you. But when they do subpoena you and ask for something beyond your records, then you do have an obligation to to make yourself available, which people do all kinds of things to try and get out of it. But I think just your your acting actually for your, for your patient, your patient needs this, they've got a whatever it is a lawsuit against the person who t boned them. And so you're a witness to the facts. And when you do that deposition, you have an obligation to explain the facts as you recorded them in the record. Nothing more. One of the places that I think young physicians get astray, is that the attorney will try and turn you into an expert. And they'll say, well, isn't it possible that or couldn't this have happened in some other way? Or Shouldn't the EMT have put a splint on and you have no obligation to have an opinion? That's probably the most valuable thing, that you have an obligation to explain the record and you've got w nl to tell them. Tell them what it means for what you intended with two point or something like that. No problem with that. But for them to give you hypotheticals or to ask you, wouldn't it have been better if they'd done this or that? That's not your job. And you just simply say, I have no opinion. I wasn't there. I'm happy to tell you about all the encounters I had with this patient. But beyond that, you have no obligation.

Charles Goldfarb:

I love that. Especially how you started and when you know, when you said you're playing in their sandbox. I think I've seen physicians get in trouble. When we enter a deposition as whether we're whether we're deposed as an expert or treating physician, but we come in with the mindset that we're the expert. We know everything. And you know, you don't know anything? Well, the reality is I'm sure you've seen it, Terry, some of the attorneys not all are really smart and know the medical side of things incredibly well. And we're playing in their sandbox, as you said, and they can lead you down this garden path and and catch you if you're not careful. And so I think humility is one one really important thing and the other is extremely Again, as you suggested that this is an acquired skill set, like so many things we do?

Terry Light:

Well, I think we're teachers. And we think that we could if we explain stuff enough that the issue will go away. And that's not the case. And, you know, in French word for attorney, as in Spanish avocate, basically advocate. And there are two advocates, at least in each of these interactions. And they each have a point of view differently. as physicians, two physicians get together, we try to build consensus, and we try and come to an agreement. This event is taking place because they don't have agreement. And we're not going to be the ones to bring them together, that is not really our job. We're not a mediator. And their job is to ask us questions. And the theory of discovery is that if both sides know how the witnesses are going to answer all the questions, then the resolution becomes much simpler. So the next bit of advice is just answer the questions that are asked and stop. And even before you get to that point, when a question is asked, stop, listen to what was said, play it over in your head, formulate your answer, and then speak. Because at least in the first instance, in a discovery, deposition, what's being created, is a written record. And it doesn't say that Dr. Light scratched his head for 45 seconds before he decided to answer. So if you're sitting in court, maybe a little bit different than juries watching you and and what what was he stalling around for, but just use the silence and come up with an answer. And usually fewer words is better than the more.

Chris Dy:

Terry, what I loved about preparing for this episode was that you are the only upper hand guest that sent a slide deck. And I looked through it, I thought it was fantastic. And a lot of the things that you've mentioned, you've already touched upon, you know, that you've put inside you already touched upon, there were a couple of things that I thought just were very, you know, good logistics things for, for those that are starting so many of our listeners are either refreshing practice, they're going to practice within the next few years. When you receive that, you know that notice that you're being deposed? How do you go about figuring out, you know, how much money to charge for these things, you know, and then also, the key point was, most lawyers don't want to pay your fee, request prepayment in advance. I love that, you know, when I started, I was fortunate enough to have the office across from Marty Boyer, who, you know, does some medical legal work, and he was kind enough to share his fee agreement, fee schedule with me. But how do you approach this, if you're in a practice where you don't have a lot of people around, you're not in academics?

Terry Light:

Well. And when I started, I'm like, Well, I, you know, my partners were, like, get paid in advance. And I thought, well, that's ridiculous. You know, I'll send them a bill and they'll pay me. And then I realized that was sometimes true. But I was spending a lot of time doing the clerical work of trying to track down people and, and then I've actually asked my secretary to be the bad guy. And so she schedules the depositions. And she tells them, this is the policy. And if we don't receive payment, 48 hours in advance, we'll, we'll postpone the deposition. And somehow they all managed to do it. Occasionally, a lawyer will show up without it, and I say, Well, I can wait until you write a check. And, and they're like, well, it'll come in and I'm like, No, I've got time. I can wait. And they all end up. They had a check with them. They knew how the games played. So it just helps it more than anything, it helps give you some credibility. And one of the other things that I had difficulty with occasionally you have to testify in court. And inevitably, you block out a half day, but he could have been in the or to testify in court. You've given them your fee schedule, you've done the deposition and the night before you get a phone Call saying good news. You don't have to come to court tomorrow, we settled. And then I'm thinking, Okay, well, I have the afternoon free. And but there was an opportunity cost. I'm not spending that afternoon in the operating room because of this. And the reason they were able to settle that was they told the other side that Dr. Lights cancelled his surgery. He's going to be in court tomorrow. And they said, Okay, well, we'll settle it. So the fact that they knew you were going to be in court is part of that settlement. And so I don't have a problem with them actually paying for, for that unused time of mine.

Charles Goldfarb:

Yeah, I love that. I love that those are, we tend to learn these lessons, the hard way, is nice that we're putting it all out there. So just talk about the concept of being an expert witness. So to be clear, we've talked a little bit about if you are the object of a deposition about the care you have provided, where you are the treating physician. I've also done depositions through worker's comp, where they're just trying to understand the case. But when you truly decide to be an expert witness, obviously, you're not involved in the case. And an attorney, whether for the plaintiff or the for the defense is coming to you to add insights. So tell us how you think about, you know, are you you know, how often do you do it? Or do you think it's a good thing for our system? Do you feel guilty? Do you take one side or the other? So just tell us in general strokes, how you think about expert witness work?

Terry Light:

Well, I think that if good people don't do it, they're people who will fill the void. And then if I was involved the object of litigation, I would like the people who reviewed the case, to be good, credible people. And, and I honestly I feel, of course, my natural tendency is to want to defend the doctor. But I also feel like the patient and the plaintiff's need also they have good representation. And the system only works if they're credible people on both sides. Also, when I am defending the doctor, one of the first questions they say is Well, have you reviewed other cases before? Yes, you always review just for the defendant doctors. Know, I refer review for both sides that I think enhances your credibility as well. And then I try to be as absolutely fair as I can be, and and more than anything, I want to understand why why is this come to litigation? And that's where my insights in terms of patients being mad at their doctor, and the litigation often not being justified necessarily by the medical facts, but by the emotional facts are really what's what's behind it in some cases. And more often than not, when I'm approached by a plaintiff to look at a case, I will tell them that I think the medical grounds are pretty flimsy, and that I don't think they should waste their effort on the case. Now. Sometimes I explain that to them, they tell me and they go, they find another expert, so be it. But occasionally, you find things presented with cases where people have done things that I think are grievously wrong. You know, cutting, transacting the median nerve than a carpal tunnel release, and not sending the patient for definitive care for two months, hoping it'll get better. Just not within any standard of care that I could possibly condone, or the sin that warn everyone against is is altering the medical record. I've seen that twice. Now it was maybe easier to do or to contemplate doing with paper records before all the electronic records which now leave signatures every time you open the record looked at him, but it's surprising some of the things that that I've been confronted with. But most of the time you find good people trying to do good things.

Charles Goldfarb:

I love your I love your philosophy, and I certainly had the same and I agree that doing work for both sides. Makes sense. And I would say if people are out there thinking about it You know, reviewing a case doesn't commit you to anything. And I like you just want to give an honest opinion to the attorney who requested that a review the case. And that's what they want, most of them want. And if the attorney wants something different than that's probably not the attorney to work with. Is that fair?

Terry Light:

No well, they're, they're going to spend the next six months or a year, they don't want to pursue something that that they don't think is likely to be a winner, they've got more than enough work to do. So they're they're looking for the the winners. I will say that, when I think the physician has done something wrong, I am willing to say that in deposition, I've never had to go to court on that. But I don't take any money for that, I suggest that they write a check to the American Foundation for surgery of the hand, for an amount of equivalent equivalent to my fee. So that way, I don't feel like I have blood on my hands and for a couple of years, and so that's my favorite charity, but you can pick whatever you want.

Chris Dy:

With that talked about that option in the past, when I've forgotten some consulting fees and had them go directly to the AFSH. So I think that's a that's a good way to approach it. I mean, I like what you said that if there aren't credible people, on either side, for the expert witness system, it won't work. And then if, if people like you don't do it, other people will fill the void. And I think, you know, I recently, you know, got asked to do one of these expert witness things, and I, you know, have not had a ton of experience with it. And I wrestled with it. And, you know, I think the thing that, you know, convinced me to do it was, you know, something along the lines of what you mentioned about, you know, if credible people aren't doing it, somebody else will.

Terry Light:

But there's always there's always a lesson to be learned. In every case, there's some reason that someone's unhappy, and whether it's an operation that you want to avoid in the future, or or some, you know, just bad luck, and but I think you can be an arbiter, and most cases come down in a way that helps move things along.

Charles Goldfarb:

Yeah, like I that. In Chris, my mind's going a couple different directions. But, you know, we've talked about side gigs and ways to both stimulate you that are outside your direct medical practice. And one of the things was working with industry. And we talked about that, as you know, you probably don't want to work with industry, right? As you start your career for a number of reasons. One is experience. And two is building a non bias so to speak, name, you want to build your name, and then maybe work with industry. Is that how you think about being an expert witness? What's the right time to consider that kind of work?

Terry Light:

Well, I think, and I don't know how many years it is, but at a certain point. And, you know, attorneys will call you and they'll tell you a little bit about the case, this is you know, a woman who had a distal radius fracture, and they fixed it. And six months later, they had to take the plate off. Well, I'm thinking to myself, this probably is nothing wrong, and sure, I'll look at that. But you never know. And then you look at it, and you'll see that there was a screw in the joint or something like that. haven't come to a different opinion. But I think it's, it's, it's always a bit of a mystery to try and figure out what at least you think the truth is?

Chris Dy:

What's happening to you mentioned that and that's actually something that ran through my mind when I was trying to figure out whether I wanted to engage in you know, being an expert witnesses, you know, who am I like, I just, you know, I'm relatively new. And I think that more recently, I've become more comfortable with, like you were saying, you know, being yourself and more confident in who you are and not being as much about you know, establishing a reputation more as you know, kind of being you. But I absolutely think that's that's a consideration I had when I was approached about this and you know, I think I came to the right conclusion but it weighed on me for a long time for those very reasons.

Charles Goldfarb:

One of my I don't think we've talked about this Chris, but one of my favorite quotes that I've heard recently, which is resonating with me more and more and again, maybe I'm maybe I'm quoting this from a position of privilege, but you know, the quote is you can use time to make money in legal work is you know, a side gig that can be done or you can use money to buy time and not do things that you know, he a washing your car. Take your car to a car wash. You know, it's just a really interesting perspective. And I have to say I'm using that more as I consider some of the other things I do other than my day job.

Chris Dy:

Okay, I will not wash your car and just say, Oh, I love it. Well, Terry, um, you know, one of the things that not related to this topic, but I thought it would be fun to share since you know, some of the episodes that have resonated the most, I think, with our audience are the What's New in hand surgery series that we've done annually. And I will tell everybody that I may have mentioned this in past, the only reason why I was fortunate enough to, to edit that section is because you were kind enough to nominate me for it. So I wanted to thank you again, for that opportunity. I didn't know you knew who I was when I was on the the residency review committee with you on the RRC for the ACGME. But thank you for that opportunity. And clearly others, I think, have benefited from it. I honestly will miss doing it as as we're passing the reins on for next year.

Terry Light:

Well, I was asked to should do it. And I didn't have to take more than a second to say, you know, Christine, it's gonna do a wonderful job. And you have so I'd be half of the trustees of the journal. Thank you.

Chris Dy:

It's all fun. Yeah, you're welcome. I just wanted to tell one funny thing about that. I saw Dr. Gelberman at a meeting, you know, subsequently after getting that invitation. And I thanked him, and he said, You're welcome. So he didn't tell me it wasn't him.

Terry Light:

Well he may have submitted your name too, who knows.

Charles Goldfarb:

And I would just like to say, Thank you, Terry, for not submitting my name ever for this. I for those who don't know, this is an unbelievable body of work that Chris has done, and it's for a great cause. And these articles are incredibly important. But my goodness, unreal.

Chris Dy:

Well, next year is next, the next three years are going to be edited by somebody in the congenital world, Deborah Bone up in Minnesota. So we look forward to seeing maybe a couple of pediatric and congenital papers in there next year, but maybe we should have Deb on to talk about her literature update next year. So again, Terry, thank you, Terry, for joining us. I know we're gonna have you back because there's a lot more to discuss. And you got to tell us a little bit more about the upper hand brewery next time that you included on your slides.

Terry Light:

Oh, yeah. upper hand brewery is a part of Bell's brewery in Michigan. It's from the upper peninsula.

Charles Goldfarb:

I love it. I love it. Terry is great to see you and more fun to talk to you and thanks for taking the time.

Terry Light:

Thanks, guys. My pleasure.