S6E8: Medicine's 80+ Hours Weeks

Margaux: We're doing our cold up. Should it be about how we're in the studio? For me, Margaux, it's the first time in three years, actually three years, because it was February 2020 I think.

Lina: Oh, my God.

Margaux: This is crazy.

Mariam: This is my first time. This is Mariam, by the way.

Lina: Do you feel very official and cool?

Mariam: Um.

Lina: No? Okay.

Mariam: I mean, I want to answer honestly. I think I'll feel cool once we start going.

Margaux: Fair. Chloe did all her fidgeting and things are going to be good.

All right. Well, in the actual real-life studio, the "Bundle of Hers." So it's me, Margaux, and I'm here with Mariam and Lina.

Lina: Hi.

Mariam: Hello.

Margaux: Hey. So I haven't seen you guys in a while, because I've been in peds, which has sucked my time and my soul, which is what we're going to talk about today.

Mariam: Yeah.

Lina: We miss you.

Mariam: Yeah, we really do miss you.

Lina: Let's talk about how sad we are.

Margaux: Yes, how sad I am because I didn't get to hang out with you guys and all hours of the day were taken up by work. And that's the topic for the day, is work hours. Even the 40-hour workweek, how that became standardized is kind of a BS idea. But then medical education and training and work hours are even more BS than that.

Mariam: Oh, yeah.

Margaux: But I'm just curious before we get started . . . because you are both still in medical school. So, Lina, you're a fourth-year. How many hours do you think you've worked this week? And that's counting studying, going to be in clinic. Maybe you're on a more "chill" . . .

Lina: I am. I've been loving my life lately. I have been on a more chill rotation, and it's an elective rotation. But I don't know, I feel like it's been about five to six hours a day. But again, it's very different than what third-years . . . maybe Mariam would have a better . . .

Margaux: Yeah. But Mariam is also on psych life, so . . .

Mariam: You guys, maybe this wasn't the best time to record this episode. I'm on my psych rotation, or what we med students like to call our psych-cation. So my hours are actually pretty good. But I have a lot to say about this topic.

Margaux: Yes.

Lina: Everyone has been warning me about intern year and about the many, many more-than-80-hour workweeks I will be partaking in. So it's been a great reminder. Every time they know I'm a fourth-year they're like, "Oh, get ready."

Margaux: That's because it does hit you like a wall. But I think to start us out, I want to talk a little bit about the history, because I was questioning this. Why is there a 40-hour workweek? It was really bothering me that we spend all day working. We, society. There's this 40-hour standard and then the weekends are off.

And recently, I felt like with that model, weekends get crowded. Why does everyone have the weekend off? Why can't just some people have days off during the week and like sort of shift that? And then I got thinking, "What even was the history of it?" Of course, in my radical mind, I'm like, "It's probably some racist, capitalistic, patriarchal BS." And sure enough.

Lina: It is.

Mariam: And it is. Spoiler alert, it is.

Margaux: Let's get into it. Historically, way, way, way back, our great-great-great-ancestors primarily were agrarian societies, or communities and/or hunter-gatherer type communities. And your workflow would ebb and flow with the seasons, and the needs, and the demands of your community and the sun, what you could do and what was needed. And it was always focused on community. You would work for yourself and for your community to fulfill and live and thrive.

But then enter the Industrial Revolution, capitalism, dun, dun, dun, and electricity. And so then the few people, white people, who had power became very hyper-focused on productivity.

One of the pillars of white supremacy that we talked about in a previous episode with Harjit is capitalism, and that is based on free enslaved people's labor or cheap labor to get the most profit.

So it's often oppressed people who were having to work for the benefit and profit of the few privileged on top. And so it wasn't uncommon for these laborers to be working 80 or 100-plus hours a week, six to seven days. There were no work-hour restrictions and laborers were not seen as people. They were not respected as people. So that's not healthy physically or mentally. And of course, eventually, laborers were like, "We're not going to keep doing it," and revolted.

So in 1810, here's the history of specifically the 40-hour workweek, this dude named Robert Owen, who was a wealthy textile owner, surprise, surprise, he wanted to be like, "I'm a socialist, and I'm cool. Even though I already made a lot of money off of this BS system, I'm going to change things."

So in order to be a socialist and friends with the laborers, he's like, "How about I just split the day into thirds? You guys only work for eight hours, you can sleep for eight hours, and then have eight hours to play." That kind of gave people the idea that you could still have some freedom in your day, and you weren't being overworked to death, because eight hours isn't too bad. But at the end of the day, the companies were still able to get enough profit from that amount of work.

That then became the platform for a lot of labor activists and movements in the U.S. And then in 1926, Henry Ford introduced specifically the 40-hour workweek to his factories. He did some research, as we all know is so important in these systems, and he discovered that working 48-hour workweeks yielded only a small increase in productivity. And so why not just make your laborers a little bit happier? So decreased it by eight hours.

Mariam: How cute.

Lina: How cute.

Margaux: Right?

Mariam: "Small adjustments and maybe they just won't revolt anymore," is what that sounds like.

Margaux: Right. "Give them some cake," or whatever Marie Antoinette would say.

Mariam: "Let them eat cake."

Margaux: "Let them eat cake." And so eventually, in 1940, Congress passed the law that said 40-hour workweeks were mandated. And under most circumstances, if people were working more than that, they had to be paid overtime. How do you feel about the 40-hour workweek?

Mariam: I mean, I personally don't like it. But I mean, it's funny because when I was working before medical school and had my, I guess, more traditional 9-to-5 job, 40 hours is a lot of hours.

My first full-time job was out of college and 40 hours was an adjustment for me. I thought I was exhausted in college, but waking up, going to work, sitting for eight hours, and doing things, that was a really difficult adjustment for me.

The 40-hour workweek now, being a third-year, I feel like I'm lucky to have a 40-hour workweek. I think my psych rotation, I work around 40 hours and it actually feels a lot more manageable. But it's interesting, when I first started doing that, it is a lot. Forty hours is quite a bit of time to be working, in my opinion.

Margaux: A hundred percent agree.

Lina: I always felt like the weeks that I did work 40 hours when I did have my jobs before med school, I was always tired throughout those weeks. I felt like I didn't have time to do anything else. My life was about work and that's about it.

And maybe the few times that I would have more time for myself, more time for hobbies or traveling or something, would be the time that I actually took off and didn't work 40-hour workweeks, or I had an extra day off here and there. Other than that, my whole life was about work.

As much as society makes us think, "Oh, this is very normal. Forty hours is great. You have time for everything," I was one person and I felt like I didn't have time for anything.

Margaux: That is so true, Lina. Having the time to be able to recover from the work, because oftentimes the work that we're doing is not always fulfilling. It is mentally and intellectually demanding, and that takes a lot from us.

But the other thing I think is important to remember is the eight hours for recreation, or whatever he said, is not consecutive either, right? It's a few hours in the morning so you can get up and get showered and get ready for work. And then coming home is barely enough time to go grocery shopping and cook food so that you can actually survive as a human, and then go to bed. And also, who has time for eight hours of sleep when you're trying to cram it all in?

Lina: Yeah, which is interesting when 40 hours is nothing close to what we're actually working. Then everything that we put aside for us is even smaller and smaller. It's even less of a life at this point. It's just work.

Margaux: How can you feel human?

Mariam: Our society is so centered on our careers, right? I think the phases of my life, it was very much so largely defined by my work. I wanted to make time to spend time with my family and travel and do all . . . I had all these goals, right? And in reality, I wasn't actually able to fulfill a lot of those goals that I had for my own personal growth because my life was so centered on that workday.

And it is hard. I think on paper it sounds good to be at work for eight hours, and then you have eight hours for recreation throughout your day, and then you somehow end up sleeping for eight hours at night, which, by the way, never happens. It sounds ideal on paper, it sounds manageable, but it is often easier said than done.

And factor in individuals who aren't just single people taking care of themselves. What if they have families? What if there are people who have disabilities? The list can go on and on.

Margaux: Mariam, you bring up a great point about how capitalism is driven or sort of succeeds by making us or socializing us to tie our self-worth into productivity. So we feel like we can never really rest, or when we do have time to rest in these eight hours, allegedly, we feel unsettled or like we can't relax because we're not doing something "productive." That helps drive and maintain the system, but also is so detrimental to our mental health.

Mariam: Yeah, I was scrolling on Instagram the other day and there's this really funny account that has the best memes. And one of them was . . . it's like a medical-student-themed account. And they were like, "When you haven't finished your Anki flashcards or your UWorld questions, and you decide to anxiously watch Netflix." I just think it's funny because we've all been there anxiously watching Netflix.

But it kind of ties into your point of even in your downtime, we're so socialized to be driven and productive that when we do have these moments to decompress, it's uncomfortable. There's so much tension.

And I've been there. I'm actually experiencing it right now. I mentioned I'm on psych. I was so anxious and I was talking to . . . I was actually talking to Harjit last week, and I was like, "I don't know why I'm anxious." And she's like, "Mariam, I think you're just so used to chaos."

This year is a lot. They tell you that you need to work at least 10- to 16-hour days, and then you go home, and you have to do 30 UWorld questions, and then figure out how to meal prep and all these things and figure out your life, and it's a lot.

And now in psychiatry, I have more free time and I don't even know how to unwind. It's Week 3, and I'm still like, "I need to do more. I need to just finish my UWorld questions," which is toxic I'll admit that. But it's hard to get out of that mindset.

Lina: You feel so much guilt. As a fourth-year, I've had much more time.

Mariam: Oh, yeah, fourth-year.

Lina: She laughs.

Mariam: I've seen it. I've witnessed this. She's my roommate, y'all. I've seen this.

Lina: Lina's been chilling. But it has caused me to spiral just mentally. I feel guilty, like, "I should be doing something. I should be productive." How many times have I talked to you? I'm like, "I didn't do anything today. This is bad. It's not right." And even trying to relax, trying to have some time for myself, I don't feel comfortable. That's so real and I hate that I feel that.

Margaux: There's a term for it that we use in triple board, which is the deacceleration injury, which is so true. When we're on pediatrics, it's go, go, go, working seven to six days a week, and 80-plus hours a week. And then all of a sudden, you switch to psychiatry, and then you have your weekends free and it's eight-hour days, and you're like, "What do I do?"

It's this phenomenon of being constantly booked and having always something to do to be "productive" in our medical training, but then all of a sudden, you have time open up. It feels bad. It feels like you just hit a wall and you're like, "I don't know what to do." So that's a real phenomenon, and I'm pretty sure there are a lot of physiological things going on with the amount of cortisol in our bodies.

Mariam: Oh, 100%.

Margaux: And maybe some minor adrenal crises happening when you stop and go from 60 to 0 all of a sudden. Deacceleration injury is what we call it.

Mariam: I'm glad that there's a term for how I'm feeling. It's validating.

Margaux: Yeah. So what I wanted to get to in the second part of this is why was medical training exempt from the 40-hour workweek and not being paid overtime? I was like, "Yeah, interesting. If you're going to make people work 40-hour workweeks and then be paid overtime for extra hours above that, why aren't we?"

There's a learned professional exemption in this Act, which says "To qualify," as if it's a goal or gift that we get to qualify for this, "all of the following must be met." And I think it is a gift for the employer, right? Because then they don't have to pay us.

But it's basically if the employee's primary duty is the performance of work requiring advancing of knowledge, basically training for medicine, and as long as they're compensated a yearly salary that is above minimum wage.

So I'm pretty sure some American Medical Association whatever built that into this law so they could use us. And that made me think more about the history of why our training hours are so bad and our training system in general.

And so Dr. Halstead, who most people know for the radical mastectomy and sort of developing that, was a surgeon in the turn of the 19th century who was working at Johns Hopkins and developed a way of training other surgeons.

There are a lot of theories and there are a lot of papers, and I encourage you guys . . . they're actually pretty entertaining and good papers to read on PubMed. But there was proven evidence that he was addicted to cocaine and morphine. And there are theories that he developed the system that he did in order to be able to hide his addiction and not have as much front-facing time with his trainees, but still maintain the prestige of being a surgeon and passing down this knowledge.

So his system prior to that it was really based on apprenticeship. But he developed this multi-tiered system where you have the junior-level trainees, and then senior-level trainees, and then one very coveted senior-level spot, and then an attending, which was him.

And so by developing it this way, it was also the "see one, do one, hear one" that you will frequently hear. The senior-level trainees were responsible for training the junior-level trainees, and so on, and so forth. So that made it so he had very little face time with his trainees.

And when he first started it, there was really no timeframe or protocol or stepwise fashion for how a person could graduate from one step or one level to the next. It was basically very arbitrary and random. I'm sure there was a lot of hierarchy, a lot of popularity contests that went into all of that.

But it spurred this idea that you had to spend as much time as you could proving yourself and getting those skills so that you could get to this next level.

And then the other benefits of this model that then led other hospitals to set it is that you didn't have to pay the trainees as much as you did the attendings. The attendings, because they weren't spending so much time teaching, could then do their own research, which was then prestigious for the hospital. And they didn't have to pay as many attendings. So a lot of . . .

Lina: Interesting.

Margaux: Right? There were financial benefits and you could train a lot of people this way, and then you could crank out more research. So there were a lot of benefits to institutions, which is why it became adopted, and then actually spread across specialties, and then became adopted nationally for the training system that we still work in today 100-plus years later.

Lina: I have thoughts. It's messed up, man. It's messed up.

Margaux: It's so messed up.

Mariam: Yeah, I mean, that history is actually really helpful to understand. I think going into my medical training, at least third-year, we're taught to normalize that in a lot of ways.

We chat with residents, and I've spoken with a lot of residents this year, and a lot of them are usually down for the cause. They are like, "No, the system needs to change."

But something that I thought was really interesting is how much it's normalized. And also, some conversations with some of the residents will also kind of go like, "Yeah, we kind of lie about our work hours, too, because you're not supposed to go over hours." But we know that people always do. And they're encouraged to lie about that when they're reporting their hours, which is just insane that people feel comfortable doing that. But I think given this history, it kind of makes sense.

And also you mentioned, Margaux, this hierarchical system kind of perpetuates that as well. I see it even now just in my limited time as a third-year. You see the interns and the residents. I mean, they're working insane hours. They're exhausted. They're kind of like the ones that get the emotional and the physical burden of healthcare, right?

And it's a lot. It's frankly shocking. It's one thing to really hear about the 80-hour workweek, and then to see the level of exhaustion that's associated with it.

I can work . . . I think on surgery, I averaged around, if I had to guess, a 65- to 70-hour workweek. I was so tired. I was cranky. I was just not myself at all. I can't imagine. Honestly, it makes me a little bit frightened for residency, I'm not going to lie.

Margaux: That's totally valid.

Lina: It's not beneficial to patients when people are working 48 hours straight. Not even just those crazy shifts, but even working the 80-hour workweeks, people are exhausted. And when you're tired, you're functioning at . . . what is it? You're functioning at a level of some percent of alcohol in your body, and yet we still continue to do it.

And there are a lot of people that I've encountered while working crazy hours that believe in order to succeed as a resident and in order to be good and have the skills and really reach your potential is through working those crazy hours, which I feel part of me gets. Repetition and doing a lot of things and practicing your skills, yes, we become better residents and better physicians, but not at the expense of our . . .

Margaux: Basic human needs.

Lina: Yes. Exactly.

Mariam: Basic human needs.

Lina: And that's what's crazy about this. You need this, you need to succeed, but also there's data showing this is very dangerous.

Mariam: Can I tell a story?

Margaux: Of course.

Mariam: I just thought of it. I think it's super relevant.

Margaux: Story time.

Mariam: I'm not trying to put anybody on blast here, but I have a story about an attending.

Lina: Blast them.

Mariam: When I was on my surgery rotation . . . which, by the way, my general surgery rotation I actually enjoyed a lot. I'm not an OR girly, but it was fun for what it was. I loved working with my team. My team was awesome.

I was at IMC. During our surgery rotation, we have to do to 24-hour shifts. But on my first 24-hour shift, I was expected to round on patients after my 24 hours was up, essentially. So I was actually there for 29 hours. So I went over the 28 hours. And I reported it, got into a little bit of trouble, but I honestly couldn't leave because my team actually relied on me to do the notes and everything, and rounds just took forever. So I actually couldn't leave. I was so tired. I went home, I collapsed. I logged my hours, got in a little bit of trouble.

I brought this up to an attending, who was kind of in charge of the experience and asked if we had any questions or concerns about our rotation. And I said, "I went over my hours, and I was wondering for the students that are at IMC, do we have to stay the additional four to five hours to round on patients after our 24? Because as far as I'm concerned, that wasn't an expectation that was listed out for our rotation."

And she looked at me and she said, "Frankly, it's really disheartening to hear that a medical student isn't enthusiastic about rounding on her patients after operating on them the night prior."

Lina: But it wasn't about that.

Mariam: Yeah, exactly. But she essentially . . . I'm just going to say what she did. She essentially gaslit me into making me feel guilty. But here's the thing, right? I feel like 99% of people who are hearing this story are going to be like, "That's outrageous. How dare she say that." But I felt so guilty. I was like, "Oh my gosh, I'm lazy. I'm not motivated." I went through that. That was my initial gut reaction.

And after processing it with other people on a Zoom call and a whole bunch of other people heard it, and hearing their thoughts, I was very validated in that that was a very ridiculous response.

But I mean, it's just outrageous to me that instead of being like, "Oh, yeah, next time, let's make sure that you're leaving right after your 24 hours is up because you're just a medical student. And frankly, you're not getting paid to round on your patients and you're not learning anything either during that time." Instead, the feedback was, "You need to be enthusiastic even in a sleep-deprived state." And I just thought, "That is just some BS."

This is on record. I, Mariam Asadian, will never, ever be enthusiastic about working 28 hours. I just want everybody to hear that. I will never be enthusiastic about staying an extra four to five hours to round on patients after a full 24-hour shift. And if that makes me ungrateful and unmotivated . . .

That was my little rant. But anyway, the moral of the story is it was just interesting that the immediate feeling that I got after that feedback was, "I need to work harder. I need to be more motivated."

Margaux: I'm so sorry that happened to you, but also it is so common. That is what perpetuates the system, is the ability to make the trainees feel like, "You should be grateful for the experience. You should be enthusiastic to be awake extra hours and working for your patients."

And that's always what it comes down to that drives me crazy. It's like, "Do it for your patients." And it's like, "But I am a human too and I have needs." That's also why people tend to underreport their hours, is because the way it is set up is to make you feel guilty. You said when you reported that you went over, they got you in trouble.

Mariam: Yeah.

Margaux: When we report it in our system, it also flashes red and it's like, "You are in work-hour violation. Please explain yourself." And then it makes you feel like, "Oh, okay. Maybe I'll just go edit it so I don't have to deal with this." Historically, I've just put, "That's how you scheduled it for me. You did this to me, not me. It's a you problem."

Mariam: And that's the way you should. Yeah, it's not my fault.

I think the reason why it's also really upsetting to be perceived as being less enthusiastic is because I actually really loved my gen surg rotation and I felt like it was such a great experience. And what takes away from that learning experience is when I'm really exhausted and really not myself.

I get that there are going to be days where I'm emotionally exhausted and I'm really burnt out. The nature of the work is just so, so intense. But for it to be perceived as lack of motivation or lack of enthusiasm is just really . . . that's just the really difficult thing. And it gets to you. It really does.

Margaux: Burnout is so huge, and I think that's why we're facing what's called the Great Resignation. After the COVID pandemic, a lot of people move to virtual offices and realize how much better life can be.

People are rethinking the 40-hour workweek because people can get their shit done in a much smaller amount of time when they're at home and they don't have to procrastinate or find other things to do in the office. Then they can take their shower in the middle of the day, or go for their run, or make their food, meal prep, and still get their work done, and people overall are happier.

However, healthcare workers did not get that luxury. And in fact, we kind of had this huge burden of extra work that was way emotionally tolling. And then now the sort of shift and backlash against the healthcare field that has come out of it is just a perfect success for burnout.

And with nurses and with medical trainees, a lot of people are leaving the healthcare field, understandably.

Mariam: Yeah, valid.

Margaux: So things need to change.

Lina: We've seen it done in other countries, whether that be a four-day workweek and still less hours. Not necessarily making it 10-hour shifts, but less hours, four days, people are happier. People are still surprisingly, or not so surprisingly, more productive.

And I also think about kind of how it is back home. I have a friend whose dad is a surgeon. He used to work here in the U.S., and then he basically moved back home to the Middle East. And even though he's still working as a surgeon and he's still working those hours, he is so happy because there's just more emphasis on community and family.

And even if you're working hard jobs . . . I even remember my mom and dad, when they were working, they were both educators. My dad worked at the university. My uncles and their jobs and all of that, everyone had their job, but their life wasn't just about their job. It was about their family, about their community. People had time to do all these things, and really care for themselves and care for each other.

And I don't know. Obviously, capitalism here, everything is about life and everything is about production and all of that. But how can we move towards something about community and something about ourselves and each other and our families?

Mariam: No, I love that, an emphasis on community rather than being by yourself and working through the grind.

Margaux: And when you say that, Lina, it makes me think of if we had more community that was also centered around food and meals and helping each other. If you worked a 13-hour day, but then you could come home to a community that was there that had helped you prepare food and was there to celebrate and help you relax, and the emphasis was not on productivity and you were able to relax, that model could still work.

Mariam: And that's the thing too. I do like seeing my patients. There's a lot of satisfaction and personal gain from being able to see patients and be a part of their care. The fact that we hate working . . . I mean, sometimes I joke about it, because low key, what would it be like to just exist and eat fruit and hang out with my loved ones? But whatever.

Margaux: And Timmie.

Mariam: And Timmie, my cat. Shout out to him. He's great. I miss him so much. I've been on campus all day, and I can't wait to go home to see him.

Anyway, that aside, something that I feel particularly anxious about is a residency and the insane amount of hours when I'm in this period of my life where I want to think about other things, like do I want a family? Do I want to reconnect with my loved ones who I've been isolated from all throughout medical school? Do I want to see the world and travel before I settle down or start my career?

So there are all these things, all these personal goals that I know are going to definitely not going to be fulfilled because of residency.

The whole system needs to change, but especially . . . and I think this could be its own topic, too, specific to residency. But to me, it's insane that an 80-hour workweek is normalized. I think there needs to be some significant change there because it's a lot.

Lina: Well, it feels like you have to put your whole life on hold. Whether that be med school or residency, you have to ignore everything else that you want in your life and focus on just this work, because that's all you can do.

Mariam: The other thing, and this kind of just alludes to what I was saying before, I think a lot of people in medicine, being in medicine is kind of how they primarily identify themselves. It's part of our lives. We hold so much pride in being these people, but I also want to be somebody else too. I want to make space for being other things.

Lina: Timmie's mom?

Mariam: Timmie's mother, for example. Let me tell you, being a single mother of one cat is a hard job. But I want to be a lot of different things to the people that I love, to my community. And medicine is not my whole life. In fact, I don't think the greatest thing that I'm ever going to be is a doctor. I think the greatest thing I'm going to be is myself, the person that I'm going to grow and flourish to be. And part of that is healing people through my profession, but another part of that is also being in my community, being a daughter, partner, whatever, XYZ.

Not to sound super cliché, but it's true. Medicine is not my whole life, and so if I had to reimagine this system, I would reimagine it in a way where people could be not just doctors.

Margaux: I think the theme of our whole podcast is bringing identity back into medicine, not losing that part of us. Being you and who I am and who you are is who and what is going to make us better physicians. Us training to be robots is not going to build a better healthcare force, or the healthcare force that needs to happen for the population that is coming up.

Mariam: A hundred percent.

Margaux: And so I think however the hours end up working, if we can build community and identity back into medical training, into the healthcare system, that ultimately is going to make a lot better change and happy . . .

Lina: Plan it around the community and not just yourself and being by yourself.

Mariam: Yeah. When you were saying your family asked what you do outside of medicine, I was thinking about how I answered this question. Somebody was like, "What are your interests outside of medicine?" and I was like, "I'm on a podcast."

Margaux: Yeah, you are.

Mariam: Yeah, but it's about medicine.

Lina: Hey, I need another topic.

Mariam: Yeah, I need to work on that myself. But we were whole people before we even were interested in medicine. And I think if we can kind of invest in who those people are, I think that'll make us not just better physicians, but just happier people, which frankly is also just as important.

Margaux: A better cat mom.

Mariam: Better cat moms. Honestly, the amount of guilt that I feel right now, been away from . . .

Margaux: It's true. Mom guilt. It's so real.

Lina: He does have an Instagram. Look for it.

Mariam: Oh, can I? Is that appropriate?

Margaux: Yes. Blast it.

Mariam: Okay, guys, to our loyal following, Timmie the cat, who is our official mascot of "Bundle of Hers," has an Instagram. It's called Timmie Joon. Let me spell that for you. It's @timmiejoon. Joon, which is a Persian term of endearment. Timmie Joon. So please follow for lovable cat content. It's all positive vibes. Has nothing to do with medicine.

Margaux: And make sure you're following @bundleofhers.

Mariam: Oh, yes. And follow our Instagram too, @bundleofhers. Not necessarily in that order, @bundleofhers, @timmiejoon, whatever.

Margaux: It's so true. Apparently . . . no not apparently. We are doing a promotion where if you share your stories about the BS of the medical system or your own cat stories and Instagram handles, we'll give you a pin. That's really cool. It says "Power From Identity," which is a stem off of our original ones that were "Stumbling Gracefully." Shout out to people who have both.

Mariam: The OG fans.

Margaux: Yes. Anyway, make sure you get a pin and share your stories.

Mariam: Make sure. Go get you a pin.

Margaux: They look great on your lanyard.

Mariam: They sure do.

Margaux: Okay. Is that all, Chloe?

Mariam: Okay, we should say bye.

Margaux: Bye-bye.

Mariam: Bye.

Chloe:[Inaudible 00:32:49] in person this time.

Margaux: You can see it.

Mariam: I said, "Can I plug . . ."

Lina: I love watching your reactions.

Margaux: I couldn't even see her.

Lina: She's like, "T-I-M-M-I-E."

Mariam: She's like, "Just tell . . ."

Margaux: Don't cut it out.

Mariam: I wanted to have a loyal following.