What Can Victorian Literature Teach Us About Coronavirus/ COVID-19?

What can an English professor with expertise in Victorian Literature teach us about the coronavirus? Germ theory became popularized during that era, so this is when people realized that we were the vectors of our own illnesses. One would think that this would cause us to isolate ourselves from one another, like we are doing now, but the literature of the time, which reflects the thinking of the time, shows us that it brought us closer together. A message of hope in these dire times.

Dr. Kari Nixon is an assistant professor of English at Whitworth University. She teaches medical humanities, Victorian literature, and is forever interested in death, disease, risk, and why we fear them. Dr. Nixon’s work has been shared on Huffington Post, March for Science, and more.

Her first book, “Kept from All Contagion:” Germ Theory, Disease, and the Dilemma of Human Contact will be in print Spring 2020.

She got her PhD at Southern Methodist University in Dallas, TX, with a dissertation in Victorian Bioethics, which she turned into the aforementioned book. She teaches both Victorian literature and contemporary medical humanities. She can be found at MKNixon.com

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EPISODE TRANSCRIPT

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What can an English professor with expertise in Victorian literature teach us about the Coronavirus? Well, germ theory became popularized during that error. So this is when people realize that we were the vectors of our own illnesses, that one would think that this would cause us to isolate ourselves from one another, like we’re doing now. But the literature at the time, which reflects the thinking at the time shows us that it actually brought us closer together. So a message of hope in these dire times. Dr. Karen Nixon is an assistant professor of English at Whitworth University, and she teaches medical humanities Victorian literature, and is forever interested in death, disease risk, and why we fear them. Dr. Nixon’s work has been shared on the Huffington Post march for science and more. Her first book kept from all contagion, germ theory disease, and the dilemma of human contact will be in print in spring 2020. She got her PhD at Southern Methodist University in Dallas, Texas, with a dissertation in Victorian bioethics, which she turned into the affer mentioned book. She teaches Both Victorian literature and contemporary medical humanities, and can be found at MK Nixon calm.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Professor Carr Nixon, thanks so much for being on the podcast.
Thank you so much for having me. I’ve been really looking forward to it.
So how is it that you wrote a book about epidemics that’s set to come out in April of 2020. And, and it was the topic of your dissertation. So this was done years ago. Mm hmm. And it’s being released in the midst of The worst pandemic The world has seen in 100 years. So where is your time machine? What stocks have you been buying Now that everything’s down? So clearly, I can’t ask you about sports betting since the NBA and the NFL have been canceled. So right, how do you? How does it happen?
Uh, you know, the funny thing is that I think, I mean, I guess there’s not too many of us disease scholars, but I would venture to bet and apparently I’m good at betting, you would say, I would venture to bet that most disease scholars would just simply say that diseases always relevant, unless that seem just any professor who is of course going to say that there are esoteric specialty in research is always relevant, which I think is a sort of professorial thing to say, for me, the idea I mean, of course, it is oddly coincidental that my book is coming out in the middle of this pandemic book For me, the reason I wrote the book and the reason I’m fascinated with what society does in the face of disease is because it’s always just a matter of time. It is an inevitability. And that’s sort of a crux of my book on an individual level. I argue that disease is an inevitability we will all get sick. People say death and taxes, but I say death, taxes and disease are the three things you can depend on in life. And so if you think about any other catastrophe, I don’t know, war, maybe I can visualize a way in which we could theoretically avoid war, because we’re talking about diplomacy and people may be negotiating. We don’t get to negotiate with diseases. There’s diseases and disease outbreaks, which are essentially one form of, I guess, a natural disaster. So for me, it’s not that surprising that it happens to come out in this really Relevant time because Have you seen that meme? It goes around a lot of Kermit sipping tea?
What is he saying? Well, he’s sipping tea and what kind of tea is it?
I think it’s Lipton tea tea, okay, he’s always it’s usually captioned with, but that’s none of my business. But he has this kind of look on his face, like he could have told you this was gonna happen. And I just keep visualizing myself that way. Like, the coincidence doesn’t seem coincidental to me, because I feel like the very nature of my book has been kind of screaming into a void, that disease is coming for all of us. And we ought to think about that, when we’re not in that moment of crisis, to understand what we will feel like in the moment of crisis and do better at that point. So,
yeah, so if you can use that time machine again, right, your your book is arranged by disease, each disease, you cover, get to chapter right. So So, you’ve now written a Coronavirus chapter. What are some of the highlights? Or are there no, is there no Coronavirus chapter since people are now mostly buying into germ theory? I’m sure there are some fringe people out there. But really, it’s not. I guess it’s not germ theory anymore. So is that even a chapter?
Right? It’s not really a theory anymore, is it? It’s just germs. You know, I actually think there’s a really great parallel between the things I cover in my book, the diseases I cover, and the emerging Corona virus disease right now. The reason I cover the specific diseases I do and the time period I do is because in the 1880s to the 1818 9597, this 15 year period is this really interesting slice of history in which most people are buying into germ theory at that time, although they are still calling it germ theory. Most people pretty much believe it. They’ve started using Robert Cook’s theories to identify certain bacteria under a microscope. And I’m sure anybody who’s done laboratory science in undergrad or post grad is familiar with Cook’s postulates of how we culture a bacteria in a petri dish and then correlated with the causal pathogen that we see creating clinical manifestations in a patient. So people were believing in bacteria at this time as disease causing vectors. But they had they couldn’t do anything about it. Anything. We don’t even have penicillin till 1928. So there’s this really interesting time period and this little 15 year segment that I studied, in which there’s sort of just this existential horror, and I know that sounds sort of like an unscientific term, but I just love when the sort of cerebral realm of science and history meets up with what are the undeniable Least human components of our existence such as fear and hope and a desire to live. So there’s this existential horror that I noticed in this time period where they suddenly see and identify everything that’s killing them. And they have zero tools against it, except maybe they had started to understand antiseptics. At that time, they had a few they did understand that hand washing and sanitation helped. And isn’t that exactly where we find ourselves today at 6:15pm Pacific central time on March 16 2020. When we have a disease that is an emerging infectious disease, an ID that we don’t fully understand, we are back in the Victorians footsteps where we see something and we definitely see the epidemiological data that proves that it is killing people and all we really know to do is our basic sanitation practices. Just it’s so for me it is exactly that human and societal reaction that I wanted to isolate culture, if you will to use cooks words and Petris words, in this book that I’m seeing, again here with this infection, it’s like you’ve got all the same ingredients, the same media in that petri dish. I’m going to stick with that metaphor until it gets rolled. And and what I’m seeing are the same social reactions on all ends of the spectrum that I identified in my book happening to the Victorians. What do you mean, what are some examples? Well, the thing that I talked about in my book, and sort of the crux of it is that germ theory as it really took hold, and as people sort of looked up, I sort of imagine a married couple looking at each other over their morning coffee with the slow, cold realization that that’s the person that probably gave you tuberculosis. I always see it very cinematically, in my mind. My thesis is that That moment in history, catalyze this sort of individualistic, neoliberal idea that we should just isolate ourselves and protect ourselves. That’s the only way to survive these things that we don’t know how to control called germs. And yet, what I identify in my chapters and as you note, I do it disease by disease because I highlight the different specific social questions coming out of each disease. I identify these really beautiful moments in history where people are saying, No, I will look out for the greater good. I’m not just going to try to hermetically seal myself away in my house to preserve what I call bare biological life, a beating heart, but I’m going to help my community members engage in rich, fulfilling intrapreneurs relationships that are what make life worth living.
Okay, but if you’re listening to this, and the Coronavirus epidemic is still hot pandemic is still happening. Don’t do that. Right. Your house?
Well, no, no.
Listen right now this comes later.
Right now double down. I’m gonna double down. It’s what I do. Here we go. So yes, we are isolating and staying in our home and social distancing, which I would actually love to talk a bit more about this because my first chapter goes way before the Victorian era and talks about Daniel Defoe writing about plague in 1722. Way before germ theory and he my whole chapter is about how he promotes social distancing. Before I became apprised of that term with Coronavirus, but no, I mean, of course, I don’t mean ignore public health mandates and that would never be the goal of medical humanities. The first thing I would say is of course, my book is a literary criticism books. I am able to identify the ways that authors promote the communal good in the imaginative space of literature, right, where people are actually dying from this. But secondly, I actually think that we have much greater opportunities to live this out real in reality than the Victorians did because we have social media. I mean, I’m sitting here right now having a really fulfilling, Enriching conversation with you, in spite of the fact that we can’t leave our house
and then never would have taken place had we not gotten in touch over social media. Exactly the toxicity that occurs in there.
Yeah. And I mean, I haven’t seen so many people saying, you know, people with people that are extreme extroverts people with really high anxiety right now people with substance abuse disorders that can’t get to their a meetings right now. Reach out to me, I’m seeing that on Twitter. I’m seeing people develop groups Hangouts and FaceTime and acknowledging what I, again, sort of as an academic feel like I just kind of scream into the void of my office so often, that these social relationships are why we’re trying to keep staying alive. It’s not just the functional existence of a beating heart. It’s because we like other people, and others,
right? Yes, yes. And you’ve seen the great videos coming out of Italy, I’m sure that have gone viral. Haha, pun intended, intended of the Italians singing together from their balconies, and enjoying the communal space of song across a busy street and a balcony. So they’re safe, but they’re together. I mean, I just, I actually think we absolutely are doing these things because we’re lucky enough to have this technology. Now.
Another thing that I’m seeing is crowdsourcing of information I’m a member of a bunch of physician communities, and just the exchange of ideas globally, and I’m just floored by how smart people are like, like, you know, yet we don’t have a vaccine for this. We don’t have a medical treatment for this. But what worked into your IC? What’s been working for you? Have you tried this? Have you tried, we tried this, like, just, you know, clearly not disclosing patient information, but like, just the back and forth and the exchange of ideas is, you know, across the globe, it’s a testament, you know, how social media just shows the rawness of how horrible we can be to each other, and how creative and wonderful we can be.
Yes, I always say it’s becoming more and more of my mantra, as I think these things become, I think, as you say, more more raw and exposed in times of crisis, which again, is why I think diseases is interesting space to study. I’ve been seeing more and more humans are my Least favorite and most favorite part of humanity? Um, yeah, I’ve been seeing it in my profit sorial communities, because so many of us are now having to suddenly teach online. And just the way people have come together to make sure that we all are focused on the most ethical way to handle this with our students. I mean, initially, I was thinking, we’re talking on a zoom meeting right now You and I, I was like, Well, great. Like, we’ll just zoom all our classes, it’ll be fine. And I start seeing people posting and making Google Docs that are open access, saying, you really can’t assume that your students have internet reliably at home, if they can’t live in the dorms anymore. For many of them being on a college campus was a vital point of access to resources. Please don’t do synchronous learning. You’ve got to do asynchronous learning where they can get on when they can. And I’ve just been so grateful that as much as I try to do my best as well that we can crowdsource these things and Think about things that we may not have thought of. Or, for instance, I was home insecure as an undergrad, I didn’t have reliable housing outside of my dorms. So my students that might have been displaced into an unsafe non existence or unhealthy home when the doors closed, it was at the forefront of my mind. And I emailed all the professors in my department and I said, What do we do like we could probably offer students a place to stay. But I don’t want to offer students that are currently taking my courses a place to stay because that gets kind of thorny when I’m still in greeting authority. And we sort of develop this elaborate system by which we would house one another students to make sure that nobody was housing a student they were grading but that all the students have housing turned out to be unnecessary because my university opted to keep limited dorms open because they weren’t thinking about students, housing security, but like you I’ve seen my communities coming together and I also say, you know, academics can, they can sometimes not be the most pleasant people. But I’ve seen like the best and my most, my favorite sides of academia and why I became an academic coming out of this crisis, one of
the questions that I had was gonna lead to, can you please restore my faith in humanity with all of the horribleness that’s about to ensue? And you did. So we will not be able to skip that question. Thank you for restoring my faith in humanity. So, during our first season of my first season of doing this podcast, I had an episode called bad words. The title was longer than that. But the idea is words. While we think that our ideas help us choose our words, and they do, words can shape our ideas so that the interview was in the terms of patients with weight issues. But you say that our words can shape our ideas with regards to Even a pandemic, so and can ultimately influence the pandemic. So given that this is a largely physician audience, how can we as physicians utilize language that we use with our patients to convey the appropriate amount of gravity, right and help to help to shape that outbreak narrative that you talked about? Right?
Well, I think what you’re referring to is something that I started calling it this in my teaching, just kind of, because it’s what made sense to me and my students have found it really helpful. So I’ve, I’ve kind of developed it further, I believe it was in my cnn article, and it’s a huge part of my my second book, I call what you’re discussing this dynamic, this socio scientific discursive cycle, meaning that of course, as you say, the way we talk about things can affect the way we frame scientific questions and inquiry. One really concrete way to think about that as it may frame the grant money that people ask For and what they’re asking to study with certain grant monies, but that also, of course, the way we develop that science then filters into the way we speak, generally. So the fact that we just mentioned something a meme going viral Porsche that comes out of the original notion of biology developed in the 1940s or so. Yeah. So, initially, what I was focusing on with this pin, well, before it was a pandemic, or recognized as one was really talking about Origin Points of viruses, that has been something kind of a soapbox of mine, I suppose you would say that when, when we try to identify a patient zero. And this is where you’ll have to let me know if you if if I’ve lost you, because people sometimes bristle at this idea. I’m not saying that epidemiology is incorrect when they identify a patient zero, but what a medical humanism General would ask is when we frame the question that way to pinpoint a single source of an infection. What are we implying by that? And what are we looking for? And what might we be not thinking about? When we ask that question? The answer to that I would suggest is, I mean, we essentially are wanting someone to blame. I would think right now, there may be broader scientific reasons why we just need to know an origin point and I cannot speak to those nor do I intend to. But I do think it’s very, very stunningly human that we would like to figure out what started at all, and I think, therefore, that easily slides all too easily into blame. One of my favorite scholars ever from whom I learned everything I know about patient zero and healthy carriers and outbreak narratives. That’s her term. Her name is Priscilla Wald. She’s at Duke and one thing I love about her book. In her intro, it’s called contagious cultures, carriers and the outbreak narrative. she identifies the way that over and over and over again in history, we tend to say that diseases come from the east. We being Of course, Western culture. And what’s great about the way she does this intro is she does not at all address, whether she’s saying the epidemiology is accurate or inaccurate. It’s not a point of her argument. That’s not her field. She’s a literature scholar like me. She simply presents it as the narrative that we’ve said about h one n one and SARS and MERS. And she just lets the that speak for itself, so that you can leave her book in my opinion as a reader without thinking that’s just a little too convenient for us over in America and it makes you want to know more About if there might be some myopia in the way we’ve constructed these epidemiological questions that perhaps keep leading us to the same answer at the exclusion of other possible answers. I hope that didn’t sound too much. Like I’m trying to debunk the entire field of epidemiology. I’ve, as I was editing my cnn piece over and over, I kept getting that criticism, and it’s certainly not my or any medical humanists. I know. It’s not our intention,
know that the pattern is definitely there. Is it coincidence? Or is there actually something there? I’m certainly under qualified or completely unqualified to answer a question like that. But But I would think identifying a patient zero identifying where this came from, you know, we need things like that in order to find order in the chaos. Right? And just that’s, that’s a very human it’s a scientific need. Right? Where did it come from can help us hopefully prevent another one but it can also inform us as to What might help in terms of treatment? Now? I’m just I’m just guessing there, do we need to know patient zero in order to in order to accurately track the spread? Clearly, that didn’t help us here? Because it was being community spread before we realized it. So, yeah, I don’t know. Those are definitely interesting concepts that bear some evaluation, right. always seem to come from the quote, other.
Right, I think and something you said and the way you said that back to me, maybe it kind of clarified for me a better way to say it, but what we would say in the medical humanities is not that it’s necessarily wrong or not wrong, but that if we as a society aren’t seeing that there might be a potential bias there. If we’re incapable of possibly identifying possible biases, then you’re just absolutely certain to get some biases, right. So we’re always just trying to get people to like, think in different frameworks all the time to make sure that we do better science to make sure that we’re not missing something.
Yeah, we’re always bringing in our biases, we need to recognize that in order to account for it in order to make sure we’re being as objective as possible.
Exactly, exactly. I think I might have answered your question in a really circuitous way, the xenophobia was on my mind. First of all, as the disease has developed, what I’ve been more concerned with is ablest language, people saying, you know, well, it’s only gonna affect the infirm and the elderly. And there were great disability scholars coming out on on Twitter and Social Media and saying, you know, that’s unacceptable to phrase that as though the rest of you know people without those conditions can stop worrying because that treats that population as disposable. I I feel like the medical community has done really great with this. I would not suspect generally that doctors would have been perpetuating any of those problematic stereotypes. But I do think that risk is really hard to convey accurately to patients who are almost certainly not medically as medically literate as their doctor, right, by definition. Well, and
that also has been a problem in our past, as you mentioned in the that same cnn article, right. So syphilis was seen as a disease of sex workers, not a disease of the husbands that were then taking it home, their wives who were then giving it to their children, you know, their their unborn children, or HIV being a disease of homosexuals. So thinking that it was only affecting homosexuals while it was rapidly spreading in the heterosexual community as well. So by thinking it was a disease of the other, right, that helped it to continue spreading, and that’s happening right now with the Coronavirus, right like I’m sure we all have seen pictures of millennials out at bars, carousing and spreading them. Guess that shows that I’m not a millennial prior to them as carousing, and potentially spreading the virus among themselves, and then spreading it to others beyond that, right, so they’re disregarding it because it’s a disease that primarily affects the older population and those with comorbidities.
Right, exactly. I mean, we’ve talked about seeing the the most beautiful parts of human nature, and that would be the part that has disturbed me the most is that again, that I identify in my book, that sort of individualism of well, if I’m gonna be okay, then who cares about anything else. And the American concept
it is It is I, the older I get, maybe I’m showing my age here, but the older I get, the more I’m convinced that that’s the root of all our problems in America. But I think
also the root of our solutions, like, I can figure this out. Whereas in America, you feel more empowered to be able to innovate. Whereas other countries, if you’re the member of a cast, I mean, we do really poor this poorly with this in terms of socio economic status and race, right? Where you might not feel as empowered as you otherwise would be if you were a white male, who feel like caught as a white male, you know, you feel a constant sense of empowerment. But but in America, like you do have more social and mobility than in other places, and more of an opportunity to innovate. And that’s why we see all these, you know, innovation happening, certainly happening other places in the world. But, you know, America is definitely a popular place where that for that to take place. So the individualism is horrible, when you’re being horrible to each other and ignoring other people’s needs. But at the same time, you know, I have an idea. I think I can do this in vain,
that American gumption
like that, yeah, yeah. And do attitude.
No, but you’re absolutely right. I mean, I think that’s the sort of problematic attitude that, in fact, is allowing it. I mean, we see it epidemiologically It’s a fact that that is how it spread, because people weren’t worrying early enough about the most vulnerable among them.
Yeah, unknowingly putting themselves at risk because, right some of the data that we’ve seen said there’s the mortality from this is point 2%. in I think it was like 10 to 40 year olds and and point 4% in 40 to 50 year olds. So right point 2% seems like it’s not going to happen to you, but if you’re if you’re in a high school of man, am I going to do this math correctly? Let’s say 500 people, right, your high school class then that means that I’m gonna get this wrong, you know, one or two people are gonna dive It doesn’t mean the middle but you know, that’s what this is. So, so like, right, well, that you know, like, and yet you’re out and passing into among each other thinking that you are invincible, right.
And one of my students told me about Coronavirus parties Where people earlier on were using it for the masks and stuff for costumes. And again, that speaks to this sort of privileged flipping, see that it’s not going to happen to you. And yeah, I think one of the ironies I tried to highlight in my cnn piece is that you get really rude awakenings when you behave that way. One of the texts that I discussed in my chapter on syphilis, actually is by Henrik Ibsen. It’s a play called ghosts. And it is literally about the the way that his mother tried the main character his mother tried to hide from the main character, the fact that he had syphilis. She tried to stay with this philandering husband to have this perfect seeming home, that that in fact delayed him getting this imaginary treatment in the realm of the play and causes his death doodoo syphilis and He was writing that in direct response to exactly what you said, these sort of, quote unquote good Victorian middle class women who are giving birth to babies with the sniffles. You kind of only learn about this in medical school anymore because you don’t typically see congenital syphilis these days, but the sniffles and the notched teeth and all these very physical signs that a mother could see the second she held her baby just as easily as a doctor could that this was not what she had imagined. And it was striking visual evidence of the epidemiological fact that these were, as Epson called it. The ghosts of their behaviors and prejudices coming back to haunt them.
And it’s happening now. Well, history repeats itself, so that’s why we need It’s why we need more historians out there. I’m sure you’ve been shouting from the rooftops for a while from the very beginning here.
Yeah. Well, I mentioned the Kermit tea thing. That’s kind of how I keep thinking, you know, a zombie class this January. And we use that to talk about access to health care ableism cognitive alterity so many different things. And one of the movies of course we watched was contagion even though that’s not a zombie movie zombies have become sort of synonymous with contagious disease these days. And it’s been funny to watch people online now watching contagion because now it seems relevant to them. And, and as I said in the beginning of this interview, for me, it’s always it’s always been relevant. It’s always been about to happen to us. And now just finally have
your classes next semester are going to suddenly get a whole lot more popular.
I know my poor kids in my zombie class thought it was all theoretical. And
then I Oh, and the CDC years ago played on the popularity of the zombie theme by having a page for what to do during the zombie apocalypse, but it was just a way for them to publicize disaster preparedness. For any disaster, there are a few things you’re going to need. And they just, that was just the same list they had for every disaster.
And then the required text in that class a stroke of genius. Yeah, they have to read that and analyze it and kind of tell me what they think it means about our society.
So, do you have any any parting words for the physician audience in the age of Coronavirus? What we should be looking for what should be prepared, how we should be talking about it, how we should be addressing it to to patients or we happen to have the media in front of us?
Ah, well, I mean, I think I would just circle back to sort of the theme of this whole interview that times like this give us the ability to really live our values, whatever those may be. And that applies to doctors of course to right now. I feel like doctors just by you know, being on the front lines of this even in private you know, non hospitalist practice are doing that but I think just kind of realizing teach my medical ethics students all the time, my my sort of mantra, I hope I don’t get in trouble for this. My mantra to these, these pre med kids is Kaiser Permanente is coming for you. You think that you want to help people, that’s why you want to be a doctor and because you’re smart, and nobody’s going to warn you until they throw you into the trenches that you’re going to have a 15 minute appointment slot per patient. seven of those minutes need to be writing up orders and notes. So you get eight minutes for a patient who is a human with a history and needs and worries that are uniquely theirs. And I mostly spend my entire medical ethics class teaching my students about the lack of ethics in the pressures that are put on doctors today, and just trying to give get their heads wrapped around that so they can prepare now for how to make maintain their humanity and the good heart that got them into doctoring. When those pressures arrive, and I guess I would just say that this is a great time to try to, if you can like be in the moment and just be the human talking to another human. That is the reason you got into medicine because at the end of the day, nobody really knows perfectly what to do. And so I think more than anything, what we’ll call them patients down is that human connection that so many people crave from their doctors, and I say all that background to say that I completely recognize the pressures that are on doctors to do that to stop for a minute and say, Okay, I’m a person, I’m talking to a worried person. Let’s start from there. But I think you know, in modern society, we all unfortunately are under those very frustrating economic Productivity pressures. And it behooves all of us even myself as well to stop sometimes and just remind myself why I’m doing this to begin with and as doctors, and for me, too, as a disease scholar, this is that moment where I think we are called to do that as part of our calling.
I don’t think we can hear that enough. No, we do. We do hear that. But certainly, we could hear it more. So I appreciate that. Professor Carr Nixon author of kept from all contagion, germ theory, disease and the dilemma of human contact. When is that available? And where can we find it
should be coming out in June? I have not been willing to ask it if it’s delayed because of the COVID issues, and it’s coming out from SUNY press. You can follow them on Twitter, and they’ll definitely be there promoting the book a lot lately because of
its relevance to the press. I’m a Sunni graduate, myself and your alumni in Washington.
Yeah,
that’s awesome. So you press All right. Well, Professor Carr Nixon. Thank you again. And hopefully we will get to do this again. Thank you so much.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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