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Unbound is a weekly podcast, created to help you achieve more as a leader. Join Chris DuBois as he shares his growth journey and interviews others on their path to becoming unbound. Delivered weekly on Thursdays.
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On today's episode burnout, boundaries, boosting resilience and more.
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Are you leader trying to get more from your business in life? Me too. So join me as I document the conversations, stories and advice to help you achieve what matters in your life. Welcome to unbound with me, Chris DuBois.
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Gary Simmons is a retired neurosurgeon, educator and author who's cared for 1000s of patients over his decades long career. After heading the neurosurgery department and residency program at Virginia Tech. He now teaches neuroscience healthcare and ethics. Gary has written several nonfiction books on burnout and resilience as well as an acclaimed medical thriller combining his passions for neuroscience and the paranormal. Gary welcome Ratan Beth.
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Well, thanks so much for having me. I'm honored. Guests. It's good. We'll likely get into your nonfiction book at some point because I am currently reading it, which has been a lot of fun for a break from everything else that I'm that I'm currently reading. But let's actually kick off with your origin story.
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Well,
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I mean, it all started. I mean, if you really want to trace things back several centuries ago when my family No, I don't need to get into that for
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No, I guess, origins wise.
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I think the one thing that may be a little unusual is when I headed to college, I really thought I would be ending up in the ministry, I thought I would study religion and eventually
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go into the seminary and go from there. But I always held that the possibility of other careers and I shuffled through a bunch including going into the FBI, the CIA, being a fighter pilot,
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and
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had also thought of going into medicine.
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Eventually, I decided medicine don't ask me why I somehow the the roulette wheel ended up there.
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And I eventually went to medical school and Rutgers in New Jersey. And, like, I think a lot of medical students, I cycled again through multiple specialties, including family practice and oncology in general surgery, but I decided on cardiothoracic surgery, and was all set up to do cardiothoracic surgery to go into residency and learn cardiothoracic. And in my last month in medical school, I saw my first brain operation, and I went, Oh, my God, I have got to do that.
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Had to switch horses in midstream. Probably Well, past midstream, actually. And I entered into a neurosurgery training program, actually, at Walter Reed and DC, having zero idea what I was getting myself into and man that that was a big bite. But it worked out for me. And I use it as a tail both of caution and maybe of eventually following your heart because
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I keep looking back. I can't imagine doing anything else. So that's it. That's my origin story. Awesome. So let's go right into burnout. And what are some of the common early kind of warning signs? I guess that you've seen with burnout with people?
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Yeah, I think, you know, if you get into
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looking into burnout, and get into the formal definitions, you can you can go through these assays that you can find online, and
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you can register in whether you're burning out or not, I suppose. And obviously, there's a lot of justification behind them. But I think, you know, the question of early burnout, or what we begin to see, I think is definitely more subtle. I think
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what we noticed the most, at least,
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particularly amongst our team and the people around us in the medical sphere, at least, was almost kind of a a personality change, if you will, because most people who go into medicine, I still believe go in out of the goodness of their heart. They want to help people they want to want to be kind and caring to people. And I'm telling you so many hospitals are these these bubbling Cauldrons of seething anger and snappiness and cynicism
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Amid biting each other's heads off, and you're like, wait a second, who are these people? I thought, you know, everybody was all loving and kind and caring and considerate. And I truly think this is one of the signs. And I think, you know, a way to kind of, I don't know, judge it in yourself is to say to yourself, you know, who am I what am I about? We all went at what am I truly, you know, what am I truly holding on to as a person, and then imagine having a film crew secretly filming you, in your days, and see if those two things match up. And if if they match up? Well, all well and good, but I would argue that for a lot of us, they don't match up, we start to fail, the person that we really would like to be, and the person that we kind of believe we are even until we stop and think about it and say, you know, am I truly this ray of sunshine, this ray of light in everybody else's world, and I'm afraid a lot of us start to fall down. And I think that may be an early sign that we just start losing the energy to really project the person that we want to be.
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Right.
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Yeah. So
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I mean, obviously, it bleeds into other areas of your life, you can probably start noticing it, as well, right?
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I think the so my past life, I was in the military. And I think the place you see it the most there is with people spending time with their families, and it not being the most positive of times with their families, because they're under so much stress at work.
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I guess are there ever, like have people just look at the signs of from outside of just when they're showing up at work doing their job of like, other ways that their lives are being impacted, that could kind of point to, hey, maybe you are suffering from burnout here, and we got to take a step back.
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Yeah, it's I mean, it's a great point. And we, we try to make the point that the two are not separate separable, that if you're burning out at home, you're gonna burn out at work. And if you're burning out at work, you're gonna burn out at home. They're definitely intertwined. And, you know, I in either one, I think depending on which, which one you're at, you may be able to put on a show, you may be able to, you know, or lower your head and drive, if you will, get the job done. And, and kind of hide it if you will, but it will start to come out. And maybe if you're really keeping it in check in one place, it'll start bubbling over in another. But you know, you're, we were talking about early signs, and I think, another classic one that I see a lot at work, but I think we really take this one at home with us. And that is to tell stories to ourselves, about the people we're with, you know, with a with a, we create a whole story, a whole mythology, behind whatever their behavior is, whatever they, whatever they're even saying to us or, or, you know, they're, they're restocking the dishwasher, and we get into this long, drawn out story is they're doing this because they're pissed off at us, and they want to show us that they're mad at us and, and they're gonna punish us. By doing this, we're really maybe they were thinking I, you know, the dishes will get more clean if I stack them this way. And we do this at work all the time to you know, we have an interaction at work, and we just immediately assume that the person is doing this for other motives than they may be. And a lot of times, we're not very charitable about it. And that's a big one. I think I've seen it at least personally at at home where, you know, I have the most loving, most wonderful wife on Earth. People call her a saint for putting up with me. And and yet I tell myself all these horrible stories about why she's doing things and why she said things, why she folded the bed covers this way and that sort of thing. So yeah, I think the two are very intertwined. Yeah. So I guess what's happening in the brain, right, that starts to cause our bodies to take, have these reactions to burnout.
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Yeah, the
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I will have to make it up for you.
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In some ways, because the actual
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solid neuroscience background to burnout is not
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is not replete. It's not there's not tons of it.
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It's really we're we're really just seeing the beginnings of it
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for a couple of reasons. But but one of them is, for example, a lot of what you study in the lab and neuroscience labs, for example, you're doing in, in animal models, usually rats and mice. And so for example, in depression and stress, there are rat and mice models who you set them up with these, you know, situations of stress and, and look for their reactions and look for behaviors which resemble human responses to stress and human depression. And thus far, at least, as far as I know, there aren't a lot of models for that. We haven't really been able to pin down burnout necessarily, if you will, in animal models.
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So I guess what I would say is, if, if I were to speculate it, we'd be dependent on what we know happens in our brains and animal brains, as well. But it's not just mice, and mice and rats, it's Mice and Men, if you will. And what happens in our brain and in
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prolonged stressful situations and depressive situations is our brains go through true significant changes. And I think it's an important concept, because it really will come out in what do we do about burnout. And that is, I like to talk about how I think a lot of people perceive the brain as almost like a computer where, you know, when you're being built in the factory, if you will, a whole bunch of wires get set up, and they get connected and soldered together. And these wires communicate and they're all basically binary. As we know, in a computer, it's either zero or one you either fire or you don't. Well, that's that's what's happening within the brain is well, we have lots of connections on the order of quadrillions of corrections, you know, almost 100 billion nerve cells. But I think there's a familiar thinking that they're just set up and they're, they're static, that's the way they'll always be one wire connects to another wire and, and that's how it works. And it couldn't be further from the truth, that wiring diagram is always changing in in us, they're each each neuron has 1000s of connections it makes, and those connections depend on these things that we call synapses, where we're little bundles of chemicals get spit out on one side, and get picked up on the other side. And you can change how many of those chemicals are released, how quickly they're removed, how many receptors there are on the other side, even the genes that dictate it can be changed all by what we experience and what we do through our days. So various areas of the brain are getting strengthened, their communications, their connections are getting strengthened. And various areas of our brain are getting kind of slowly shut down depending on how we use our brain. And what we experience. So long story short, in a you know, in a chronic stressful situation, for example, we start shutting down the the pleasurable areas of our brain, the reward centers of our brain, we kind of go more into a survival mode and we reinforce areas that are much more Oh aversive to bad things and, and are are related to stressful situations fight or flight and that sort of thing. Whereas you know, the areas that that are usually more engaged and more thinking and more
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pulling in our environment start to shut down.
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And we can see this on multiple levels, we can see it on the very, very basic molecular level, the the how the DNA gets read, how those neuro chemicals are used, and all that sort of thing. But we can even see them on a larger scale, certain areas of the brain start to shrink, and certain areas of the brain start to get bigger.
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So
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long story short, I would expect that when we see burnout, we're seeing that sort of effect going on within the brain, where we are de emphasizing certain channels of our brain. And we are over emphasizing kind of the more negative side of our brain, if you will, and I think it would in there is some early evidence that it does seem to mimic depression
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And then stress, depression, anxiety and stress. So I think it's a real important concept, though, to realize that it's dynamic. And you can actually alter it, therefore, by what you do and what you encounter. Right? So I imagine that on some level, we're never going to be able to learn more about burnout from doing animal studies, because of how much we're creating these stories, and we're increasing stakes that a mouse isn't going to care about, right? Like, they don't have to worry about their finances, the their family, making sure the kids get to school on time, right, their physical health, like all of these other things that we're able to, like compound and stress out over together.
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So are there people starting to do research on other like human studies for burnout, that could start shed some more light on, on how that's gonna work? Yeah, and, you know, on, on the, it's all kind of, if you will, from a 50,000 foot level, whereas all that molecular stuff that I was talking about, that's, you know, you get that out of out of mice and rats, or sometimes autopsy studies on human beings. But at the 50,000 foot level, we have these special MRIs that we call functional MRIs and diffusion tensor MRIs and stuff, where we can look at communications in the brain, and various areas of the brain and what lights up and what takes off. But, but again, you're looking at millions of nerve cells at that point, not singular or small areas. But in those situations, with Burnett, it seems to be mimicking depression, which isn't a big surprise, because certainly, in certain populations, burnout can lead to more fixed and profound depression and anxiety states for sure. Right. So I guess, what are some of the ways once once you start noticing burnout coming on? Right? What are some of the things that you could be doing in order to mitigate the the impact, you know, just blunt some of those effects that you're going to start feeling so that you either can prolong? Go through whatever you're trying to work through at the time, until you get to that, you know, vacation or rest period? Or just to be able to lead a more sustainable life?
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Yeah, it's a big question of, you know, which
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I wrote three books on that, in that, and not in not to sound like a wiseass about that. What I mean is, I'm not going to be able to give you a complete distillation. So I'm going to give you some highlights, if I, if I can,
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I think we have to start kind of from a very basic level. And it's what we what we call self compassion and self care. And that is, I think, when we get into these loops, like, you know, you're talking about, and we get into our jobs, we get into maybe a stressful home situation, or, you know, we're upset about the kids or worried about the kids or, you know, or at work, you know, the boss is on us, or we have a million things to do all at once. What happens is we tend to very much focus on our external environments and the people around us, and we lose track very quickly of ourselves, how we're doing what what, what is what is stressing us, what is bringing us,
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you know, some, some happiness, some pleasures, some excitement, some Enthrallment some engagement, we very quickly just completely shift out of that mode of, of, of thinking about ourselves to the point as matter of fact that we often will feel guilty if we start thinking about well, where am i How am I feeling today? Am I Am I down or up when what's going on in in here as opposed to on around us? I know that was that was really big in our field, you know, you're always supposed to be focused on the patient, the patient, the patient, of course, of course you are. But if you completely defocus from yourself, it's going to be very hard to care for yourself. So one of the first things that we say is you know, you have to grant yourself permission periodically to to take your pulse, if you will, to see where am I am I feeling what's what's bringing me up? What's bringing me down? Is are things going in the right direction, or am I just spiraling out of control? It's even you know, and even take that step backwards, like we said in a match
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Some people looking at you, from you know, through a TV camera, am I am I going through my day the way I would want to or am I just, you know, dragging myself down and everybody around me. But every so often to give your grant yourself permission to do that, get a fix on yourself. And then the corollary to is it matters nothing if you don't commit to saying to yourself, Okay, I'm going to take care of some of this, I'm going to, I'm going to attack what I need to start bringing myself back in line with where I want to be. Another analogy that I think I like a lot is the idea that we all kind of have a energy bank in us, if you will, you can call it psychic or emotional energy, whatever it is, that you have that allows you to go through your day that gets you up and gets you to work and gets you taking on things and then go into the kids ballgame and all that sort of thing, it takes a certain amount of energy, and we all have a bank of it. And everything we experience in our days, either make a deposit in that bag, or the maker withdraw. And so one of the one of the things to do, you know, right off the bat, is to start figuring out what does make the deposits and what makes the withdraws, some of which you can control some of which you can't. But you know, you might want to start seeking out the things that are making the deposits and start seeing if you can start, you know, at least modifying the things that are making the withdraws. Yeah. So, all right, you might not have an answer to this one. So I'm gonna I'm gonna throw it out anyways. Something that I've often wondered is how much any of my burnout has just been from decision fatigue, where, like, I'm just making so many decisions during the day that I burn out much faster, because I'm constantly processing and having to think through everything. And so I took some steps to habituate certain parts of my day to not have to make certain decisions. And I found it's much easier to kind of sustain, like a higher tempo, I guess, from my work life than I could maintain before when I was doing everything. Is that something you've seen as like a potential thing where decision fatigue can actually directly correlate to how fast you feel burnout? Yeah, I would, you know, I would certainly think so. And just one corollary to this is that, you know, what burns you out, what burns me up may be two different things, what and there, and the flip side of that is what helps us, you know, what helps me may not help for the next person down the line. So, you know, a lot of this has to be trial and error, there is no prescription we can, right, and this is going to get rid of burnout. But certainly we are aware of many of the common stressors. And and you're absolutely right, I think decision fatigue, in a setting of multitasking. We're not our brains aren't really just designed to multitask, we're, you know, it's pretty much designed to take on one thing, and another, it may work on other things, but our focus, our actual focus is going to be on one thing and another but we're in an environment where our dog on phones are going off every second, you know, and emails are coming in and texts are coming in instant messages, and then Somebody's knocking on the door and, and asking you questions. And and it can mount up very fast. And particularly, you know, it's interesting that
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frequent, fast multiple decision making is not necessarily the driver, as opposed to frequent, fast multiple decision making, in a situation where your control is, is limited. You know, if I have control over everything, and I say, okay, yeah, do this, okay, yeah, do that, okay, do this, and it all comes to pass, that's fine. But if half the time you have a sense that it's not making any impact, then that's going to drag you down much, much faster. But as a, as you said, you already took up already created a strategy, and that is, you figured out a way maybe to bundle some of the things that you don't need to tackle immediately or that you can automate. And so there are multiple strategies for doing this. One of the things for example, uh, you know, you're not going to get away with this in all situations. But I in the middle of all my neurosurgery, I turned off all alarms other than my phone, and that and the thing was, if you want me if you know if you really need me, you call me otherwise, I'll get to my texts. I'll get to my emails at certain parts of the day. So they're all just put together in one bank, and I'll get to them when I get to them.
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But if it's an emergency, then then you use the phone. So I've, you know, I've already created a way of keeping that, that bombardment limited. Another way is, you know, there's this Foursquare way of simply breaking down, you know, your tasks in your day, to the things that are critical and immediate, versus not critical and not immediate at all. And then the in betweens, and and that's another way that, you know, we can start organizing our days if we're in that type of environment of just a decision overload, if you will, right. Another huge shift for any listeners, I started using motion, which is a AI based calendar tool. And on Sundays, I just, I put every task that I needed to do during the week, and it reviews, all of my meetings, and it fits those tasks in between the meetings, based on how it flows. And if I miss one of them, so we got busy, it'll just push it further into my, my week. But I don't have to think about my workload anymore, I just sit down at my desk in the morning, and it's all lined up for me.
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Chris, I would argue I mean, we are big advocates of for the idea of schedules when people feel multi, excuse me when they feel multitask. But I would argue, first of all, in that schedule, for example, that you schedule in breaks, you know, intermittent breaks through the day, even just a few minutes of peace, a few minutes of whatever brings you peace, you know, and brings you a little bit or whatever you want to call it, mindfulness or whatever. And if you can even step outside and get some sunset, and some I mean sunlight and fresh air, it can go a million miles. But also, as we were talking about our home life, so earlier, what we found, because, you know, our, for example, my residents were working 80 hour weeks, as was I you can you can do that with your home life as well, to a certain degree, and I don't want us to be OCD about it. But you know, to be able to say, you know, these, these hours on these three days a week, they're, they're going to family time, date, time, you know, going out for dinner time, whatever it is, you know, put, put a line in the sand and say, this is going to be used for my family, my friends, and that sort of thing. Yep, definitely do. And even just adding a, I put a task in called The moment of presence. It's literally just a couple minutes, but just wherever I am, at the time, when that pops up is just like trying to be print like it's really hard. If you are, you know, drinking your coffee, or just taking a sip of water, if you really focus on what you're doing in the moment, it's really hard to remember other things are happening around you. Right, just like feeling that ice water going down like that in your body in your stomach, just like being there. It really does reset you. And so I guess following this kind of stream of thought here, are there there any other recommendations you would have for people to kind of unplug from work in order to regain some of their
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composure is the right word, their mental faculties right to be able to show up at work? Even better? Yeah, I think again, the whole notion of breaks is really important. And, and again, I think you have to find what works for you, where I've tried the techniques you were talking about, it's never worked for me. And yet for the next person, it may work very well for me, just to be able to literally breathe some fresh air off and open a door and step out for half a minute would go a long way, or just sit over a cup of coffee. And as you say, let the world go go by me when better for me. But I think again, these this idea of creating schedules and and really making sure that you take those times, I think again, picturing yourself in that environment and thinking of how do I look and how do I want to be
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and you know, the old stopping and periodically engaging. Here's another thing that that we found was kind of interesting in our world at least. There is a tremendous sense amongst people in health care of loneliness at work, and you're like loneliness, how can you be lonely? You spend your entire day surrounded by people talking to people nonstop all day long.
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And yet, you know, if you really boil it down, all those interactions are kind of transactional. There I need this done. I
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need that then I this information is coming in, I'm going to act on that information. We did an interesting, a little study with our team at one point. And we just asked them for the two people that they worked closest with. Could they give us certain details about their home lives? Just Are they married? What do they do on weekends? Do they have kids stuff like that, and our team uniformly failed. And it's because all interactions had been boiled down to this, you know, extreme efficiency, as opposed to periodically, actually relating to each other as people stopping and talking and learning a little bit about each other and sharing, you know, something amusing, or something interesting.
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And so one of the big drivers of resilience is certainly just is real human interaction, and maintaining relationships that matter to you and all. And if we go through our day, just basically not engaging as human beings, just as machines, you know, we're bound to feel that kind of loneliness, and that sense of isolation.
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Are there any other like, organizational kind of changes that either you've put in place or that you've recommended others do that help with burnout?
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Well,
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yeah, you know, I, I've seen plenty of organizations, you know, bring in a few puppies a couple, a couple of times a year and have people pet the puppies. And I say this cynically, because what's happened is burnout has at least been acknowledged. And in the medical world, for example, the there's an overseeing body to the training programs, called the ACGME. And it's mandated resilience training or wellness training. But you know, there, there's a lot of cynicism that gets picked up in this. And by the way, I think supreme cynicism about burnout may be a sign of burnout, actually, but
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But you know, literally doing things like bringing in puppies for people to pet, where, you know, that's not going to, that's not going to solve a lot of things per per se, you know, step one, I might say, they might pay more, you know, truly show the value of your employees, let the employees know it. You are in the military, you can relate to this one, though, you know, beyond beyond paying our people more. When, when I was at Walter Reed for a while there, there was a new gen came on board. And I used to park right out front of the hospital, because we got there at you know, five in the morning. And so we were the first people there. And, and instead, the general painted the whole front section of the hospital, parking in black with stars on it, and only the General Staff in general could park there. Okay, no big deal. And and every so often the general would, you know, come and make rounds in the hospital, but it would be telegraphed weeks ahead of time, you would be notified. And everybody was supposed to be standing there all pressed and you know, yes, sir. Everything's going great, sir. Perfect, sir. Couldn't be better, sir. And then, you know, off this entourage of the general and 10 people with clipboards would would March March through. Well, another general came along after a while and complete opposite. You would appear out of nowhere in the middle of the night, you'd be on call. And you'd be you know, hunched over some, some patient or some chart and you come by and how's it going, and you've got all of a sudden realize who it was, he'd have no entourage? And he'd say, No, really, how's it going? And you're going Well, sir, it's going pretty well. He goes, what what what do you need to make your job easier? And if you were brave enough, you might actually tell them and, and that was a real sign of engagement, right? That of leadership engagement of, of actually listening, which allows your people to feel listened to whether they can act upon it or not, who knows? But at least you know, you knew they were making the effort. And you were being here you're being heard. And so those would be to me would be prime examples of how an institution can tackle this and then obviously, you know you what often gets what happens again in my world, but I know it happens everywhere is you get staffed to, you know, average output or maybe even slightly below average output. And then there's a wave of business if you will, in my world. It's a wave of sick you know, an injured but you're not staff there.
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is no redundancy staffing where, you know, where you're set up to absorb these pulses, these large pulses of business, you're, you're actually understaffed, and therefore all the stress level goes up immediately. Whereas, you know, certain certain businesses and certain, you know, even in healthcare have figured out no, wait, we have to, we have to be able to have, you know, so what if a few people are working a little slow? They're ready for, you know, if there's a series of emergencies or, you know, flu season is coming by or now COVID season is coming by and that sort of thing? Yeah. So yeah, there are plenty of things institutions can do. And there have been some are starting to get it some word. Yeah, that's as with most things, so.
35:52
But Awesome. All right, I want to move into final three questions, which a first one, actually, I'm gonna trap on this one. If anyone wants to grab a copy of deathspell flag, which is your fiction book.
36:06
Very enjoyable read so far. I'm not all the way through it. But but it's been entertaining, I'm getting you, you offer a lot of insights into what neurosurgery actually is. And like, the descriptions are awesome. Like, I did not realize the level of detail.
36:24
Obviously, it's brain surgery, right? Like, there's gonna be a level of detail. But when you're reading about it, and actually hearing these parts, you're like, wow. And then there's another element that I won't spoil for anybody that gets added to the story to make it even more exciting. But separate from your book. And you have written nonfiction books, what book would you recommend everyone read?
36:46
Oh, my gosh, you know, I,
36:49
I think
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with with my book, for example, I, I eventually decided on on fiction instead of nonfiction, because I think
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it can be very immersive.
37:06
And sometimes when you write, when you write nonfiction almost feels like a book report. And I think it almost reads like a book report. And so yeah, and so if I were to go, I probably just go with some of my favorite fiction books, even though I tend to read a lot of nonfiction, history and all that sort of thing. But there's a few and they're all world war two books, for some reason, but there's you, I'm sure, you know, The Caine Mutiny, by Herman wag. There's a book called The Last convertible, which is also basically it's not entirely a world war two book, but it's, it's just beautifully written.
37:47
And then there's one called a piece of cake. Which is, is definitely World War Two, it's about the fighter pilots, in the Battle of Britain.
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But I, because I think because of the setting World War Two, and just how intense everything is, I think the life lessons in all of these are fantastic, you really can open your eyes, even, you know, just like the the last one a piece of cake about these RAF fighter pilots. I know, you know, it caused quite a stir when it came out. It came out many years ago, but it showed the fighter pilots with, you know, kind of with their warts, it they they weren't these heroic figures, you know, and in constantly, you know, nothing could upset or scare them. Now, they were kids who, you know, went up terrified at times, which only to me made them more heroic, you know, knowing that you can die being terrified of what you know, being shot the pieces and still doing it is is to me the you know, the whole idea of heroism. So anyway, I guess I would give those because they're just amazing books.
39:08
What's next for you professionally?
39:11
Well, my wife, it tells me that I'm working just as hard as I did when I was operating and but I'm not getting paid for it. So I don't know maybe I'll find somebody somebody who wants to pay me but no, I doing a lot of teaching of undergrads and med students right now I enjoy the heck out of that. And then continuing to write I have two or three more. Two or three more fiction books that are at least started. Ones basically finished. I'm just rewriting so I guess a lot of writing as well. Awesome. And then finally, where can people find you?
39:54
I think we froze. Cut out. Finally, where can people find you?
40:00
The easiest place you know, I'm on all the social media I guess anymore, but these us place. I have my own website and it's just my name. Gary R Semmens. Si, Mo nds. Gary r simmons.com.
40:16
Awesome. All right, Gary, thank you for joining me.
40:20
Chris. It's my pleasure. What a delight. I very much appreciate you letting me ramble. No, it was a very insightful episode.
40:33
If you enjoyed today's episode, I would love a rating and review on your favorite podcast player. For more information on how to build effective and efficient teams through your leadership visit leading for effect.com As always deserve it
Transcribed by https://otter.ai