Balancing Acute Care Surgery: Sleep, Nutrition, & Mentorship with Dr. Katie Bower

Dr. Chris Myers: Welcome to episode eight of White Coat Warriors. The views expressed by myself and the guests of this podcast do not reflect the official policy or position of the US Air Force, Department of Defense, or the us government. Welcome to white coat warriors. I’m your host, Doctor Chris Myers. And on this podcast, we talk about human performance optimization and training paradigms for you, the young medical professionals, and how you can use it in your own professional practices to help yourselves and your clients. Hey, everyone. Welcome to episode eight of White, coat warriors. today we have one of my favorite guests and a great friend of mine, Doctor Katie Bower. before we get into it, just remember, if you like what we’re doing, give us a, like, tickle that bell gives, a five star rating on whatever platform that you’re listening or watching us on. Every little bit helps. On today’s podcast, we got a lot of areas to cover. We’re going to talk about human performance and medicine, sleep. We’re going to, even talk about, mentoring residents, which is a big one. We’ve been kind of building up to this, and doctor Bower has done it all. Doctor Bower, she has a great background.

Katie is a full time acute care surgeon at a Virginia trauma center

But before I actually do any more of that, I’m going to let you introduce yourself a little bit. Katie, how you doing today?

Dr. Katie Bower: I’m doing well. Thanks, Chris. And thanks for having me on your podcast.

Dr. Chris Myers: Yeah, tell us about yourself.

Dr. Katie Bower: It’s an honor to be invited.

Dr. Chris Myers: It’s all good.

Dr. Katie Bower: I’m a wife, and a mother, and an associate professor of surgery. Full time acute care surgeon. I work at a level one trauma center in Virginia. What that entails is, acute care surgery is made up of three subspecialties in general surgery. So, surgical critical care, which is taking care of ICU patients, emergency general surgery, which is taking care of all the people coming through the emergency department, or who have surgical emergencies arise on the units, and then trauma surgery. So, taking care of injured patients who are in motor vehicle crashes or have gunshot wounds, or any number of other mechanisms of injury. These services require 24/7 coverage of at least 60 to 100 patients in the hospital at all times. we take consultations from the ED and all over the hospital. we work, in the, or operating on people in the midst of all that. And, it requires in house call for one of us to be in the hospital at all times.

Dr. Chris Myers: Okay. Okay. So that I think that in call is a really important point that we’re going to touch on. But also the fact that the sheer number of people, patients, 6200 or 62,000, that’s amazing. I didn’t even know.

Dr. Katie Bower: Oh, 6000 to 100.

Dr. Chris Myers: 6200.

Dr. Katie Bower: Okay.

Dr. Chris Myers: Yeah. Sorry. Yeah. Okay. A factor of ten too much. But yeah, yeah, that’s still a lot of patients.

Give us a brief description of your typical day in the hospital

you know, and once you give us a brief description on like a typical day for you, with what you do in the hospital.

Dr. Katie Bower: Okay, well it usually starts the night before or early in the morning of ah, looking through charts and collecting data on the patients that I already know about. When I get there, I meet with a multidisciplinary team of all different levels of trainings, all the way from medical students all the way up to other surgeons. We have residents at different levels and then we have advanced care practitioners like nurse practitioners and physician assistants that work with us. So we meet with them, we talk about the patients that came in overnight, the operations that need to be done for the day, and then any issues that have arisen with patients that were already in the hospital. We go and make rounds and see all those patients and do what we can to help them feel better and progress their care. Decide who needs an operation, who doesn’t. We’re taking care of people in the postoperative period. We’re actively resuscitating people from different forms of shock. And then we spend you know, we go, go to the, or there’s usually three to five cases done in a twelve hour period. In between cases we are running down to the emergency department to see consults or seeing other patients that need, okay. Attention. And then if I’m on call that night, I stay the night in the hospital. that would take me to about 24 hours of accepting new patients. And then usually it’s wrapped up around 30 hours after you complete all the, as much paperwork as you can and wrap things up afterwards. So then I would go home the next day and try to take a nap.

Dr. Chris Myers: A nap, okay. I would jock out for about 14 hours. That reminds me of some of the, yeah, a lot of the infantry operations I would do back in my army times. And it’s interesting that you mentioned that because there’s a lot of correlations between what you just said and with the tactical populations that I work with on a daily basis. Right. So time management’s one. Stress, doing too many things at one time, and lack of sleep. Ah, one could argue that working in your professional environment, ways to an extreme or an austere environment that a lot of tactical populations work with. Right. And so you have, you have to have particular skills, strategies to be able to manage all this. Right, so talk to us about some of the methods that you’ve learned or try to employ that work or even fail in the past to kind of be successful and to get to where you’ve at, where you’re at right now.

Dr. Katie Bower: Well, the gut it out technique, which is usually how we all start out as medical students, those of us that want to go into surgery have a certain personality. And we say, we’ll get up early, we’ll stay up late, we’ll do whatever it takes. We’ll stand for 14 hours straight and not sit down. we’ll do whatever it takes to get through the day and get, all the work done. That takes you to about 32, age 32, and then you really can’t physically do that anymore. So you have to start applying some other strategies. the gutted out strategy means you don’t eat, you don’t sleep, you don’t, drink. and that can really take its toll the next day in terms of your recovery. So, as I’ve gotten older, I’ve learned, you have to pay attention to nutrition, number one, just like, just like you would if you were in a long endurance race, you have to plan to have at least food or supplements available. I like to, I like to pack actual food, but that doesn’t mean I’m always going to get to eat it. And so I’ve used some of the, some of the techniques I learned and endurance racing, like energy gels and ketones, and, you know, things you can kind of keep in your pocket and, protein bars. So that helps. And then planning, out making sure you’re taking in liquids. That’s key as well.

Dr. Chris Myers: It. I love. Yeah, I don’t want to cut you off right there, but it’s interesting that you mentioned that. So especially keeping something small in your pocket, of course, definitely pushing fluids. It goes exactly back to. Actually, two of our past guests have mentioned the same exact thing, back in our episode with, megan louts, nutritionist. she mentioned that it is keep it simple. Always try to keep something in your pocket. And in our previous episode, our guest said the same thing as well. And he is a professional triathlete, and hes, like, I always have to keep a protein bar in my pocket, when he goes through his routes, as hes a third year med student at Ohio State. So.

Dr. Katie Bower: Yeah, proteins key. You can tell you dont take in any protein for 24 straight hours. You really feel sick the next couple of days.

Dr. Chris Myers: Yeah, typically, from some of the antibodies. some of the pilot studies, ive read the average medical, professional intakes about grams per kilogram of body weight per day. That’s that’s not even enough for protein synthesis in the human body. So you want to go into a catabolic state even if you are eating enough. So, yeah, yeah.

Dr. Katie Bower: You almost have to take in more, just like as if you were training for endurance event.

Dr. Chris Myers: Yeah, yeah. And you know, typically it’s, you know, you, USDA, says, you know, eight, grams per kilogram. many can argue it could be closer to one 1 gram/kg so. But either way, getting it in doesn’t matter the source as long as it’s protein at this point. Keeping it simple. Yeah, so. Wow. Yeah. So I love that fact that you’re touching on that point. and you got more, cognizant of about it, as you got older and more experienced, especially with our time together, kind of training together for long endurance triathlons and stuff like that, we both learned from each other on that one. with that, you’ve kind of taught me a little bit more about the importance of sleep, just from your professional schedule and. Yeah. Just knowing how you work. Right. It’s. You sometimes put in multiple calls in a, in a week, in a seven day period. how do you. Right, wrong or worse or for better, how do you manage that?

Dr. Katie Bower: Not well. I haven’t found the magic solution there. there was ah, there was a paper published by doctor Jamie Coleman. She’s at the University of Louisville in October of last year.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: And she, What she did was she had she had acute care surgeons wear whip bands all the time while they were on call, not on call. And then she had them fill out subjective data and do surveys about burnout and illustrate what their call shift was. Like. Did you have a horrible event like a child die or you know, did you have a really hard case or did you feel like you were stretched too thin? So there was lots of qualitative data collected at the same time.

Dr. Chris Myers: Okay.

Dr. Katie Bower: And what she found was that we have significantly, irregular and disrupted sleep without evidence of sleep recovery.

Dr. Chris Myers: Oh, really?

Dr. Katie Bower: Yep. And it’s exacerbated when stressful events occur during in house call.

Sleep deprivation is linked with an increase of burnout, feelings of burn out

And both of these are linked with an increase of burnout, feelings of burnout and overall poor well being. So when she started out to do the study, it was, you know, some people said, why? We already know we’re going to, we’re going to. The data is going to show we’re tired. Right. But she said, she said, we know this, but the, the first step to fixing it is to define it and to outline it.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: Get some data on it. And how tired are we really, and how much of an impact is it having? And so that was really the first data done on my population in terms of sleep deprivation. there. It’s actually a pretty tremendous problem because just within, if you work one night per week over a period of ten years, for women, they have a 60% increased, risk of breast cancer, and men have an increased risk of prostate cancer. there’s an increased risk of depression, suicidal ideation, behavioral disturbances. so it’s not a benign occupation. there aren’t really any solutions yet. It’s just a matter of self, regulation. Know your limits. You know, for instance, we used to take every other night call. So you’d be on call Monday night, you’d work all day Tuesday, and then you’d be on call Wednesday night, and you work all day Thursday. I can’t. I did that. I think the longest I ever did that was nine days straight. My husband’s a search in two. He did a little earlier than I did. He did it for three months in a row at one point.

Dr. Chris Myers: Was that during your residency or was that actually beyond.

Dr. Katie Bower: Okay, well, I was during residency. I’ve not done it since I’ve become an attending. Okay. I’ve never done more than two or three in a row. But even now, that was probably ten years ago. Now, I know I can’t manage that. Just can’t manage it. So we try to keep it to one. One call per week, sometimes two calls per week within a seven day period.

Dr. Chris Myers: Yeah. And how. Coming off of that. So, coming off your, calls, how do you personally kind of self regulate you get home? Because, like you said, your wife, your mother, you’re also a long course triathlete. How do you manage those priorities and still trying to, you know, recover from that 30 hours shift?

Dr. Katie Bower: Well, the easiest thing is to skip the workout. That’s. That’s step one.

Dr. Chris Myers: Fair enough.

Dr. Katie Bower: Although I find when I actually do the workouts you prescribe on those days, I feel better. But m so it’s, you know, it’s. I, learned I can’t have any caffeine after 03:00 a.m. or I can’t sleep in the afternoon when I get a chance to take a nap before school pickup and after school sports, et cetera begins, I make sure that I have water, that I’m hydrated before I try to sleep. I learned not to ever schedule anything important on post call days. So I will protect that time in terms of having meetings or setting myself up for obligations like you know, I’m not going to be the snack person that day for soccer.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: Instance.

Dr. Chris Myers: So so in a sense you’re trying to, you pro, you know, within reason, you prioritize yourself on that, you know, that post call time period.

Dr. Katie Bower: Yes, that’s what I try to do. That helps with recovery.

Dr. Chris Myers: Yeah. And about, you know, since you’ve learned that, about how long does it take for you to kind of feel back to normal or as we would say in the exercise physiology world, back to baseline, coming back off of, you know, coming off call.

Dr. Katie Bower: So it usually takes about four to five days and there’s, for me to feel normal, then there’s and it has to be four to five days of getting good sleep. So about 8 hours of sleep, which doesn’t happen. And in Jamie’s paper, she demonstrated that we were getting acute care surgeons like 6 hours of sleep. We were not making up that time. there’s data out there that says you have to get nine to 12 hours of sleep for four days straight to make up a sleep deficit.

Dr. Chris Myers: Exactly.

Dr. Katie Bower: You know, even 3 hours of missing m. 3 hours of sleep. So I feel that it’s a good four to five days before I feel normal again.

Dr. Chris Myers: Yeah. And I can’t remember the exact paper, two papers off top my head, but they came out of military general, military mess. And that same, said the same exact thing, where they looked at army rangers when they went out to the field. And with the average sleep of four, 4 hours a day, it took about four to six days with the same sleep time range that you mentioned, up to eight to 12 hours to kind of get back up near baseline, metrics. Cool. Yeah. It’s good to see that the same, the same theme, it can cross different populations.

Dr. Katie Bower: M right. My problem is the next morning that school still starts at the same time. So I still get the boy up at 630 and off to school before eight. There’s no, yeah, there’s no sleep again.

Dr. Chris Myers: Yeah, fair enough. Yeah.

You talked about sacrificing sleep in order to train for big races

So, you know, with that, you know, so we, that, you know, okay, we’ve kind of, you know, we’re talking sleep and stuff, but you know, and the other thing that you kind of mentioned, some of our previous conversations with this is the different stress levels that this can cause, whether it’s just going in fresh, coming out the job, but then with reduction in sleep and, recovery, the stress levels kind of go up. How are you able to manage that if at all?

Dr. Katie Bower: Well, I learned what my limits were the hard way. okay. I think we first started working together in January 2020, I think right before the pandemic. So. Right. Probably six months later, I started a part time fellowship in medicine while I was still working full time as an acute care surgeon. So I just rearranged my schedule so that I didn’t, have any time off at all. yeah. And I was also learning to swim because I didn’t know how to swim. And I was actually pretty terrified of putting my face in the water. So it took a long time. It was briefing.

Dr. Chris Myers: You make it sound worse than what it is. It was.

Dr. Katie Bower: I don’t think I told you about all of it, but. So I would get up at 415 in the morning, swim from five to six, and then go put in, you know, 60 to 80 hours a week, sometimes hitting 90 hours a week. but. And I kept. I kept pushing through it. I said, well, in post call, I’m going to do that bike ride anyway, or, you know, I need to get this extra run in. Let me get up an hour earlier than I would normally get up. So I was really sacrificing sleep in order to train. And I actually developed an ulcer, like an actual stomach ulcer in the midst of all that. So there were some other stressful things going on at work. you know, some of the things that. That cause, people to have difficulty at work, you know, bad outcomes that are out of your control, but you feel responsible for them and, you know, pressure from insurance companies and lawyers and that sort of thing that just make your job really hard to do. So everything, everything kind of came together and, you know, you feel the effects of the severity of inflammation you have when you don’t get enough sleep.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: And so I learned the hard way. And then the next. The next. For the next race, we trained a little bit different. I wasn’t working two jobs. I had a little more time to play with. And we actually. I think we did fewer training sessions and shorter, more intense training sessions.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: In order to get it in without losing sleep. And then I was choosing to sleep rather than do work at some times when I just couldn’t fit it all in. And that worked out a lot better. That felt. That felt healthier in the end.

Dr. Chris Myers: Yeah. Well, to kind of give everyone context. Katie and I were training together for a half ironman distance, so it’s like 70.3 miles, when you, when you do all three events, the swim, bike, run together. So this is, this is kind of the training sets that, Katie is talking about. You know, we were training together for a couple of different ironmen. and they’re Virginia and. Yeah, those are the iterations we’re talking, she’s, mentioning right now. And so, yeah, and that, that did really work. That worked really well, that we’re still kind of working with that paradigm at this point where how do we, you know, we finally figured out how your body adapts, given all the stress, the, the limited sleep, but it’s still maximized to the best you can do, nutrition and everything else. So it’s definitely kind of keeping a steady state. But, you know, with that, it’s all trying to keep a balance. Right.

How do you balance all this with the family as well

And talk to us a little bit about that. Some of the insights that you’ve gained with this journey that we’ve kind of been on for the past four or five years together.

Dr. Katie Bower: Well, some of the insights I’ve gained. You had me start using the wearables to, to collect heart rate variability data and recovery data. And so that was very interesting to see that objective data in terms of how exhausted I actually was. Sometimes I’d feel exhausted, but my numbers would look good, and I’d do a workout and I’d feel fine. And other times I wouldn’t feel as exhausted, my numbers would look terrible. And if I did the workout anyway, it wouldn’t go well. So it was interesting to see that. But those sort of failed me because they have no way of tracking when you don’t get any sleep. Most of my calls, I’m up all night, I don’t take a nap. There’s no, you know, there’s no sleep on set, and there’s no, you know, time of awakening that they can calculate in their algorithm. So those days would not really get accounted for in terms of the overall exhaustion.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: Somebody needs to develop a wearable that can count nights where you get no sleep ever. You know, if we’re going to collect data on people who do jobs like mine.

Dr. Chris Myers: Yeah. Well, even tactical professionals, too. I mean, it’s the same thing. Yeah.

Dr. Katie Bower: so there were the wearables, and then, you know, we, we experimented with some different supplements. you know, we added the ketones in, and that made a difference. Haven’t quite figured out exactly where those, make the biggest difference. But yeah, I know when I just, you know, get to part, like, gosh, I should have had protein or carbs 4 hours ago, and I just, that’s all I have on me. I take that and I can go a little bit longer.

Dr. Chris Myers: Yeah, glucose management, because that’s the other.

Dr. Katie Bower: We’re going to add in the glucose monitor, too. We need to do that.

Dr. Chris Myers: Yeah. So, yeah, it’s just kind of looking at, against nutrition, sleeping nutrition or the kind of you or everything. It’s, it’s like you could be the best. You can study all day long, know all the techniques, you can have the best dexterity, but if you dont have those other two, everything else falls wayside. And so, you know, with that, how do you, you know, if this is too personal, please cut me off. How do you balance all this with the family as well? Because this is not something weve really kind of talked about in the podcast in the past, but never, we’d not have guessed with your, with your experience with this. You know, you’re, like I said, you’re a multimodal doctor, assistant professor, the acute care surgeon, associate professor. Okay, sorry, sorry, associate professor, you know, mother, husband, law course, triathlete, you know, now podcast, podcast guest. So you do a lot of it? Yeah. How do you, how do you prioritize, like the family and all this?

Dr. Katie Bower: Well, the family, the family has to come first always. that they go into the planning, they go into the calendar first, and then work and then everything else. So, my husband is a true partner. We tag team just about everything that has to be done in the house or with the kids. And so I wouldn’t be able to do that if it was, you know, more traditional arrangement where I was responsible for everything in the house, and he only went to work. Okay. he, that would never, like, I wouldn’t be able to maintain my job. He, he, knows my, he’s done my job as a resident, and so he knows what I’m doing, and how hard it is, and he’s learned my patterns of needing, recovery, so he expects very little of me on post call days. He knows he’s going to have to pick up a lot of what’s going on.

Dr. Chris Myers: Yeah.

Dr. Katie Bower: the kids know that sleep is sacred, and anybody in the house is sleeping, we’re not waking them up for any reason unless there’s an emergency. So that was ingrained from a very early age. That’s good for everybody.

Dr. Chris Myers: Yeah, I would love to pick your brain on that someday.

Dr. Katie Bower: my husband does most of the cooking because he doesn’t like what I make. So I got married and learned I didn’t know how to do laundry and I didn’t know how to cook. So it’s worked out pretty well for me so far. But he cooks, and he makes sure that he has leftovers for me to take with. Take me with me to work because.

Dr. Chris Myers: I hear he makes his own steak.

Dr. Katie Bower: Oh, he makes a. He ruins restaurants. There’s very few restaurants I can go to anymore where the food is better than his. no, he makes sure I have. I have food to take with me to work because the food that’s around a hospital in the middle of the night is not. Not really fit for consumption. If you want to avoid a, bmi that’s too high and diabetes, all of that.

Dr. Chris Myers: Yeah, it’s good.

You pre planning, you’re hitting a lot. You’re talking about a lot of points, you know

You pre planning, you’re hitting a lot. You’re talking about a lot of the points, you know, kind of talked across our entire season so far. That’s great. But I love that. But we have not talked on that aspect on the, on the family. And thanks. Thank you for bringing that up and kind of touching all that now.

Dr. Katie Bower: Yeah, it’s like some trial and error.

Dr. Chris Myers: Oh, yeah, I can imagine.

Dr. Katie Bower: Yeah, there was. There was a while there where, you know, things would get kind of explosive because I’m sleep deprived and. Yeah, you know, we didn’t. We didn’t really know what the limits were, but over time, we figured it out.

Dr. Chris Myers: Fair enough. yeah, I think that. I think that’s with a lot of people, too. but that’s part of the journey. That’s what makes it fun. But, for those who are listening, I just threw up some air quotes, but, yeah.

There are strict limitations on work hours. Um, when we look at their performance

All right, let’s. So let’s shift gears here a little bit. you know, we kind of intruded on your personal life a little bit. And thank you for being open and honest with all that. let’s. You spend a lot of time training a good chunk of your day training and mentoring, interns, residents, students, stuff like that. when we look at their performance. Right. you had mentioned before doing the day on, day off and kind of volunteering for that. Do you still see that type of, those same types of choices or even that type of culture, in the newer professionals?

Dr. Katie Bower: Oh, no, things have changed drastically from when I trained. There are strict limitations on work hours. They still work hard and they still work long hours, and they still do overnight. Shifts, but they don’t have the same, you know, they don’t do every other night. They don’t stay all day. The next day, when they’re post call, they go home by a certain time in the morning, usually by 06:00 a.m. or at the latest, 10:00 a.m. if, they’ve been there for 24 hours. So it’s very different. And they don’t take more than one of those overnight shifts week if they’re taking it at all. they have a night float system. So the residents that I see really struggling are the ones that are, doing nights. They do it for a month where they only work at night, about six days out of seven for the week. Yeah. So the ones that are successful with that, they flip their sleep schedule. They, you know, have good sleep hygiene and make it dark. They make it cool. They get up with enough time to have a meal like you would breakfast. And some of them even work out before they come to work. And then they go home and they sleep. They completely flip their schedule. The ones that I see struggle, it takes about a week or two to flip their schedule. They’re tired enough, they can sleep during the day. nutrition, just gets destroyed because they really have to plan ahead and make sure that, they have food with them when they come to the hospital, because, again, otherwise they’re eating, you know, french fries that are cooked in cold oil and pizza. That’s good, right? Pizza yet?

Dr. Chris Myers: Yeah.

Dr. Katie Bower: Or vending machine fodder. yeah, but cheetos. yeah. you know, I see both types, and usually they get through nights one time in their junior years where they struggle through it, and the second time they go through a little bit smarter about it.

Dr. Chris Myers: Draw there.

Dr. Katie Bower: Mm

Dr. Chris Myers: Yeah.

Dr. Katie Bower: Yeah. It’s really tricky for the residents that have families, though, for the same reasons. You know, it’s hard to work nights with anybody who has families, but they have to have support and an understanding, partner. At home, though, I have seen residents who are single parents do it. They make it work.

Dr. Chris Myers: Okay. So it seems like there’s a lot of. There seems to be a couple of common themes that you’ve kind of mentioned through all this is, you know, nutrition, you know, keeping it simple, but doing some basic planning. Yeah. To ensure that you can just meet your basic needs, whether it’s just a regular shift or a full 24, 30 hours shift. sleep, of course we know that, sleep. But I love the fact that you mentioned sleep hygiene. That’s something we’ve talked about on this podcast, inadvertently, over the past five episodes, which is really interesting. but the social structure, that’s the first. We’ve not really talked about that, throughout the season. And I think that’s really important, the fact that you brought that up. but it seems like just even your personal experiences and even with, the new generation of medical, professionals, the same theme seemed to still apply. What would be your thoughts on that?

Dr. Katie Bower: Well, even though the work hours have gotten better, they’re still not, normal in the sense that our bodies are made to sleep at night, not work all night, and they’re still, withstanding the stressors of doing a physically and emotionally intense job while sleep deprived. So I’m not sure that improvements in working conditions have made that much of a change. We still need to find a solution to this problem because the people that are doing these jobs are not in them very long. It’s not really sustainable, and if they do stay in them for a long time, they end up sick because of it.

Dr. Chris Myers: Okay, interesting. So, yeah, so, I mean, yeah, you know what? I can’t come up with anything off topic. That’s a very powerful statement. So with that, you got a platform right here. we’ve got lot. We have plenty of listeners.

What advice would you give to new medical professionals coming through the ranks

if you had two or three pieces of advice for the new crop of medical professionals coming through the ranks right now, what type of advice would you impart on them?

Dr. Katie Bower: Well, m. I guess when you’re coming up and first learning about all the different subspecialties in medicine, you have to figure out if you have the stamina, to withstand the pressures that go along with being a surgeon or a trauma surgeon. Start using those wearables, whether it’s a watch or a ring or a band, and, start paying attention. Even if you’re not an athlete, start paying attention to, your sleep cycles and how different habits affect your recovery scores. For instance, if you’re drinking more alcohol and coffee than water, you may see those scores dip a little bit. you need to go into the profession.

Dr. Chris Myers: I laugh because you know how much coffee I drink.

Dr. Katie Bower: Yeah. Physically and emotionally prepared for it. you know, when you’re. When you’re a student and you’re doing rotations and you’re trying everything out, pay attention to that data and see how you tolerate it. If you’re having trouble staying up all night as a student and, you know, the rest of your life is really struggling because of it, it’s not going to change when you become an attending that much. Okay. you know, some people. Some people are more resistant to the effects of sleep deprivation than others. Now, it affects all of us, but, some people really struggle with it more than others. So try to figure that out before you sign up for a job like this.

Dr. Chris Myers: Okay? Okay. Well, excellent. That’s very powerful.

Dr. Chris Myers: you know what? Let’s cap it right there. I mean, you can’t get any better than that. so, Katie, thank you so much for your time. It’s. It’s always great to talk with you. you know, when we’re talking, just triathlon on our weekly meetings, I always still learn something, so thank you for that. and I I guarantee our audience must thank you as well. so if you got any, you know, thank you. Our audience out there, thank you very much for listening. this season, a lot more in season two. if you have any suggestions or what you’d like to hear, please write us, at influence. thank you for your time and have a great one. Cheers.

Dr. Katie Bower: Thanks. Chris.