It is said that art imitates life and the episode “Personal Jesus” in Season 14 of Grey’s Anatomy revealed some hard-core facts: patients die unnecessarily because of missed diagnosis.
Three patients entered the fictitious Seattle Grace Mercy West Hospital and none of them left alive, including a woman who had just given birth to a healthy baby at 37 weeks. She was in labor at 37 weeks with a “normal” blood pressure but died of something called the “HELLP” Syndrome that is associated with pre-eclampsia.
“HELLP” is an acronym for hemolysis (breakdown of red blood cells), elevated liver enzymes and low platelets which help the blood clot thereby avoiding hemorrhage.
Do you know that we almost lost Serena Williams after she had her baby?
Fact: Serena is well versed about pulmonary embolism because she had one before.
Fact: Her postpartum nursing staff thought she was hallucinating when she requested a diagnostic study and an IV drip. Fact: Serena was right -- and saved her own life.
Fact: MY MEDICAL COLLEAGUES NEED TO START LISTENING TO PATIENTS.
A picture’s worth one thousand words and if I hadn’t seen it with my own eyes, I could never imagine that such a travesty of justice could occur within a United States healthcare system and hospital.
On a cold, January night, mental health worker, Imamu Baraka was walking down a Baltimore street and witnessed hospital security cards dumping a confused, mentally impaired woman who was wearing nothing but a thin, yellow hospital gown onto the street.
The American College of Obstetrician/Gynecologists (ACOG) and the Center for Disease Control (CDC) say yes in written opinions in 2017, and here’s why:
These words are a direct quotation from a pregnant woman who almost died.
I want to personally thank Steph Montgomery for writing one of the most honest articles about the dangers of pregnancy, something that very few of my OB colleagues have been willing to do.
In her blog, Pregnancy Almost Killed These 8 Women and Here’s What They Want You to Know, Montgomery describes the challenges of eight women who had pregnancy complications that nearly killed them. Their stories bring to light something that all OB providers know but rarely say in public: pregnancy can be lethal if people aren’t paying attention.
Women in one of the poorest communities in the District of Columbia will no longer be able to deliver babies at their community hospital, United Medical Center. Why? Please keep reading.
I will not address the absence of clinical standards performed by the staff that led to a newborn baby being infected with HIV and an obese preeclamptic patient with a severe breathing disorder being harmed. Go deeper into the root cause analysis and you will find politics and money as the culprits.
Re-posted with permission from:
I took part in a leadership workshop where I was asked to write a mission statement for my life. This was the FIRST time anyone has asked me to do this. It was a great exercise that I would suggest others to take part in. Have you ever tried this? Well, this is what happened when I wrote my mission statement.
Congratulations are in order.
The Carter twins have arrived and we can all breathe a sigh of relief.
Although twins represent “two unique souls united by one birth,” their prenatal course and birth at times are not without risks. Twins come earlier than expected. Their umbilical cords may become entangled if they are identical. Their placentas can prematurely separate too soon and there are other risks that I won’t even bother to mention. From what we know thus far, these complications have eluded the Carter pregnancy.
The tragic death of Judge Glenda Hatchett’s daughter-in-law is yet another reason why people shouldn’t think of pregnancy as a condition without risks.
Hatchett’s daughter-in-law, Kyira Dixon Johnson was 39 years old and pregnant with her second child. She had a repeat cesarean section that had been scheduled in advance at the prestigious Cedar Sinai Hospital in Los Angeles, California. The cesarean procedure went smoothly and took approximately 30 minutes. Johnson gave birth to a baby boy and was taken to the recovery room in stable condition. Three hours later, an astute nurse noticed that Johnson had blood in her Foley catheter (a tube that drains the urinary bladder) and allegedly informed the physician. A CT scan was ordered but not done.
Dr. Linda Burke-Galloway, author of the Smart Mother's Guide to a Better Pregnancy discusses the interview she had with Hollywoodlife.com about the hit series, Downton Abbey and the eclamsia episode where Sybil Crawley dies in childbirth.
I have incredible respect for Jimmy Kimmel for baring his soul in front of millions of people and crying unabashedly at the thought of losing
his infant son. Kimmel’s son was born with a congenital anomaly called Tetralogy of Fallot which causes a
lack of oxygen to reach the lungs. The story had a happy ending because the problem was corrected with a surgical procedure.
As I listened to Kimmel’s ultimate triumph, I thought back to an HBO show I saw years ago called “Something the Lord Made.”
The month of May has always been special; it is the month that I officially became a physician exactly 30 years ago; it is the month that we celebrate Mother’s Day but unfortunately it is also a month that makes us aware that some mothers are no longer with us because of a pregnancy related condition called pre-eclampsia.
As a fan of both Beyoncé and Serena, I am overflowing with excitement for their pregnancy as they embark on the mystical and magical journey called pregnancy for the first and second time
in their lives. However, as an obstetrician, I’d like to share a few pearls of wisdom to ensure that the pressure gift that they carry, arrives safely.
Serena and Beyoncé are both 35 years old which is considered advanced age in pregnancy. While age 35 is a great time to have a baby because of presumed maturity, it is also a time to exercise precaution. Queen B, you are blessed to be carrying twins, but please be aware that twins can come earlier than expected. Preterm labor is sometimes sneaky and rears its ugly head as back pain. Therefore, if you are experiencing back pain for greater than one hour, please call your pregnancy provider immediately who should advise you to go to the labor and delivery to be checked.
Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”
Thank God for common sense. For once, the state of Florida has done something right and kept Ebony Wilkerson, (the 32 year old pregnant mom who drove her kids into the ocean) into a hospital
where she rightfully belongs. Wilkerson is 7 months pregnant and certainly doesn’t need to be in a jail where the chances of her having a healthy baby are greatly diminished. Had it not been for
good Samaritans who ran into the Atlantic Ocean and rescued Wilkerson, three innocent children and an unborn baby would have met an untimely demise.
What is it about our country that prevents us from recognizing mental illness when it smacks us dead in the face? The fact that Wilkerson was interviewed and released by law enforcement agents three hours before she drove into the ocean is troubling. Mental illness is a public health disease and yet it’s treated as an afterthought in a “too-busy-society” that focuses more on entertainers’ wardrobes and scandals as opposed to its citizens that need immediate attention and intervention.
The next time you see one of those You Tube® videos singing the praises about water births, Amy Stenton wants you to think again. She had one and now wants them stopped. She sued The Legacy Healthcare system for 35 million dollars as a result of the injuries incurred by her son who now has significant disabilities including cerebral palsy and hearing problems. He will need life-long care. We often hear about patients suing for damages but when patients demand that the hospital program be shut down because it’s dangerous, it gives us reason to pause.
Stenton and her spouse, Matthew Marino, read the hospital’s website and assumed water births were safe. Allegedly the website read: “European studies have shown a lower use of pain medication, decreased need for medicines to stimulate labor, decreased perception of pain, and high patient satisfaction, among other benefits, during labor and delivery in a birth tub."
Sometimes a woman marries the wrong man. And then things become more complicated because there are children involved. This man that you should have never married is now looking for a big pay day. However, please do not allow innocent children and babies to suffer because of a highly contentious divorce and certainly do no drag the surrogate mother into your mess.
Surrogate parenting (aka Gestational Carriers) is tricky. A woman is hired to have a baby for a couple with the expectation that the couple will pay her and take responsibility for their child. She is screened very carefully to make sure that she’s healthy enough to carry a pregnancy and that there is mutual agreement with the intended parents. It is a gift not to be abused. It seems that is not the case regarding Sherri Shepherd, former co-host of the popular show, The View.
The holiday season is a time of both joy and sorrow. Tomorrow a childhood friend will be laid to rest; one of my favorite artists, Teena Marie, died unexpectedly two days ago and at least six
other people have made their transitions as well. My own father died unexpectedly on Christmas Eve in 1981 leaving a great void in our family life. Why do people leave us during the holiday
season? It has been said because they want to be remembered.
While I lamented about all the transitions that occurred in the past two weeks, one of my best friends announced that she had a new granddaughter that was born on Christmas Day. She stated that this was part of the “Life Cycle or Circle of Life.” Her comments gave me reason to pause and reflect.
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Infertility or the inability to have a baby can be devastating and affects approximately 10 percent of the female population. There are many conditions that prevent women from having children including and Mayer Rokitansky Kuster Hauser Syndrome (or MKHS). MKHS is a rare disorder that affects a woman’s ability to conceive. At present, for every 10,000 women, only 1 to 2 will be affected. Both Sara Ottoson of Sweden and Melina Arnold of Australia have this condition. MKHS is characterized by the absence of a vagina and part of the cervix. Patients with this condition have normal breast development and functioning ovaries. Genetically, they also have female or double X-chromosomes and look like normal women. The problem comes to light during adolescence when a teen fails to have a period. The condition is also known as Vaginal Agenesis because they are born without a true vagina, a problem that can be corrected through surgical and non-surgical procedures. Unfortunately, they are unable to have children and usually adopt or use a surrogate mother. Those options, however, might soon change.
The MSNBC story, Wrong-Embryo Baby’s Parents Laud Guardian brings to mind a line from Tina Fey’s movie, Baby Mama: “Life is messy.” Fey plays the character of a thirty-seven year old woman who
was informed that she only has a million-in-one chance of conceiving because of an abnormal uterus. She hires a surrogate who unknowingly is not pregnant with Fey’s child but her own. When the
surrogate discovers the error, she must break the news to Frey who is of course, devastated. Art imitates life.
Carolyn Savage was a 40 y.o. woman who received in Vitro-Fertilization and on the third attempt, successfully conceived a baby. Unfortunately, it was the wrong baby; a nightmare no one should ever experience. Savage was carrying a baby who belonged to the Morrell family who had frozen embryos at the same infertility clinic.
So here we go again! First a dollar pregnancy test and now an ovulation test for the
same great price ($1.00)
Three cheers for SCI International, the manufacturer of these super products.
After the tremendous positive response to my earlier post regarding the $1.00 pregnancy test, I received a phone call from SCI’s Vice President, Mr. Abedi. He was delighted that the blog was well received and I in turn was delighted with his product. He explained that the company’s only makes a few cents above its production cost but that they deal in volume. It was so refreshing to hear about a company that wasn’t going to bankrupt its customers in order to make a profit. Abedi continued to describe the company’s array of products including an ovulation kit for $1.00. You can only imagine how far my jaw dropped. As a former infertility patient, I am well-versed with ovulation kits and could not believe they were being sold for . . . a dollar? Abedi quickly added that the ovulation kits were only available at the Dollar Tree store. So, off I went to my local Dollar Tree store to see for myself.
Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear
Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.
Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years. This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
I love my local dollar stores. It’s one of my favorite places to shop when I want to reward my sons inexpensively and have fun in the process. My husband often calls me the “queen of the deals”
because saving money always gives me an adrenaline rush. So imagine the rush I felt when I discovered that dollar stores now sell pregnancy tests and are giving name-brand competitors a run for
According to the August issue of Ob.Gyn. News (Volume 44, Issue 10, page 10), Dr. Sunaina Sehwani and associates at St. Luke’s Hospital in Bethlehem, PA. tested twenty-seven dollar-store pregnancy tests and compared the results with the early-response name brands that are commonly used in physician and clinic offices. The article states that the dollar store brand was 100% accurate. Can you imagine? These pregnancy tests were also evaluated to determine if they could be easily interpreted and passed with flying colors.
In Native American culture there is a premise that Nature thrives on order but it is man who creates the disorder. That thought came to mind last month when I presented yet another malpractice case for review with a panel of colleagues. A patient wanted to be induced at 39 weeks and inevitably had significant complications with a poor birth outcome. In my expert opinion, I suggested that the physician should have waited until the patient was 41 weeks before she attempted an induction and one of my colleagues thought that I was vehemently wrong. “She was full-term and entitled to an induction” he practically shouted in my ear. “That’s not the point,” I countered. There was no reason to do the induction except for physician and maternal convenience. I reminded him that most high-risks specialists will start fetal monitoring and nonstress tests (NSTs) at 40 weeks to document fetal well being and then induce labor at 41 weeks if it has not started spontaneously.
On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.
Those words were articulated by Lieutenant Brian Tobin, chief investigator of the death of 27 year old Jennifer Snyder. Snyder was a pregnant veterinarian technician who was murdered by the
father of her baby – a married veterinarian, Dr. n on March 16, 2011.
October is Domestic Violence Awareness Month; an uncomfortable topic and certainly not one that pregnant women would rather not discuss. But you must – because homicide is the leading cause of death for pregnant women in the United States.
The tragic death of Jennifer inspired filmmaker Tracy Schott to produce a documentary called Finding Jenn’s Voice. Fate connected Tracy and I because of a blog I had written called 7 Reasons Why Pregnancy Becomes a Deadly Affair. At the time I wrote it, I had no idea that homicide was the number one cause of maternal death. Before the production of Finding Jenn’s Voice, most of my colleagues didn’t know as well.
When a woman becomes pregnant, we immediately think happy thoughts: a new addition to the family, a new grandchild, the baby shower, what colors to paint the nursery and of course, the
challenging role of becoming a parent. We make the assumption that everything will be okay during the pregnancy but sometimes it’s not. Complications can occur during the pregnancy, during labor
and even after the baby is born.
The human body is a fascinating creation and it speaks to us if we have the wisdom to listen. The ability to recognize the “language” of the body can save our lives, especially during pregnancy. What are the symptoms that pregnant women need to recognize?
Erica Morales’ last Facebook message was dated January 15th and simply said, “Prayers please. 5 o’clock C Section.” Now, she speaks from Heaven.
Erica was 36 year old and wanted to become a mother after marrying her soul mate, Carols, in 2007. She worked at the University of Phoenix and was also a real estate agent. Carlos worked in manufacturing. Like millions of other couples, they desired a family but encountered stumbling blocks. Through infertility treatments, their dream came true. Erica became pregnant with four babies.
Being told that your body will never be able to reproduce is beyond painful – I’ve been there. But should procreation become a business at any cost?
In a recent New York Times article, we are introduced to a gay couple from Portugal who became parents through surrogacy because it was illegal in their country. According to the article, the United States is one of the few countries that allow paid surrogacy.
Blood clots are sneaky, deadly and unfortunately occur more frequently in pregnant women – especially after they have had a baby. In a non-pregnant woman, blood clots are good because they keep us from bleeding to death after we cut our finger or scrape our knees. However during pregnancy, the body produces many blood clots (a condition known as hypercoaguability) which increase the risk of having a stroke, blood clots in the leg (deep venous thrombosis, aka DVT) which could travel to the lungs and cause death. Pregnant women are five times more likely to develop a blood clot than a non-pregnant woman and there is a greater chance that this will occur after the baby is born as opposed to before.
The Washington Post recently published a story about
mammoth retailer Wal-mart’s new policy that allows pregnant women more options so that they can continue to work even late into their pregnancy. While this change of policy is a moral and
economic victory for pregnant Wal-mart employees, it did not come without a fight.
In 2011, the Equal Employment Opportunity Commission received 5,797 pregnancy-related complaints from women who represented all walks of life from a cashier to corporate executives who felt that they were discriminated against by their employers solely on the grounds of being pregnant. According to the National Women’s Law Center, almost 9 out of 10 women worked into their last two months of pregnancy which carries an increased risk of complications. Rather than allow the pregnant employees to change positions, work less hours or sit in a chair, many find themselves terminated or asked to take a temporary leave of absence that often times becomes permanent. Many are forced to use their Family Medical Leave time before having the baby and must rush back because they’ve run out of time.
Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain
meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP)
have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to
deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”
Why is this important? Because there are presently 143 birthing centers in the U.S. that offer underwater births to pregnant women. In fact, 1% of all births in the United Kingdom are immersion. While some research claims that these births are safe, experts think otherwise and state that the number of women studied was too small to detect rare but potentially harmful outcomes.
The contradictions of life can be maddening. On one hand, we have the case of Jahi McMath, a 13-yearold girl who is brain dead on a mechanical ventilator that her family fought to maintain and on the other hand, there is Marlise Munoz, a 33 year-old mother of a 15 month old son, who collapsed on her kitchen floor from what appeared to be a blood clot to the lungs back in November. Munoz, according to her husband and family, never wanted to be on life support but the state of Texas ordered it when they discovered that she was 14-weeks pregnant. Should state law override the wishes of a patient because of her pregnancy?
I will never forget the patient or the day it happened. Assigned to my residency team, we had watched her vigilantly because she was 39 years old and pregnant with her first baby. Although she spoke no English the love that she had for the miracle growing inside of her could be understood in any language.
She had begun to have premature contractions at 33 weeks and we were trying to prolong her pregnancy for just a little bit longer to allow the lungs to develop. For approximately one week, we monitored her blood, her temperature and fetal movement. One of her tests ultimately indicated that she was developing an infection so we decided to induce her. We would then transfer the baby to the special care nursery where, under the watchful eyes of the neonatologists, he would continue to grow. My team was not on call that night although, in retrospect, I wished the heck that we were. We signed out the patient to the on-call team before we left. We gave them explicit instructions on how often to monitor the patient and discussed her complicated history. She was having, what we, in obstetrics called, a “precious baby” meaning that an older woman was having her first child. When we went home that evening, the baby was alive. When we returned the next morning, it was dead.
A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.
Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists.
Team GroovaRoo and GroovaRoo.com Presents...
KangaGroove: Moms Adorably Dance to Sugar Ray's 'Fly' While Wearing Their Babies.
The world of obstetrics and reproductive health is rapidly changing with topics such as the Zika Virus, gene editing and pregnancy and exercise taking center stage in the print and visual media.
Congratulations! You’ve reached a defining moment in your life. You’ve decided to have a baby. Although not yet pregnant, there’s a lot of work that has to be done in order to achieve your goal of having a healthy baby. Unlike the 2 million women who have unplanned pregnancies in the United States each year, yours will be different because it involves strategic planning, so let’s get busy.
The old saying “fail to plan means plan to fail” holds true, especially if you have decided to have a baby. The decisions you make will not just involve what color to paint your baby’s nursery or who to invite to a baby shower. You will have to decide whether to see a midwife, a family practice doctor or an obstetrician for prenatal care. Each one of those providers has a different level of training and education.
One of the most important decisions you will make as a pregnant woman is where to have your baby. Most women will select a hospital although other options for birth include delivering at a birth center or for others, to deliver at home. Should you decide to give birth at a hospital, it is important for you to select the right one because they are not all made equal. Some look very pretty on the outside but have some patient safety concerns on the inside. Others might not look attractive externally, but you’ll receive the best care possible.
So, you’re having a baby and need to select a healthcare professional to take care of you. Selecting the proper healthcare provider for your pregnancy is an epic
event, not a minor detail.
Sadly, some women invest more time in selecting a dress than choosing a physician. Everything worthwhile in life depends upon the choices we make; the challenge is to make the right ones. One of the most important choices you will make during your pregnancy is which health care provider will attend to you. If you live in an urban community, you might have lots of providers to select from. But if you’re in a rural area, your choices might be limited.
The last few weeks of a pregnancy is both a time of excitement and caution as you approach the sacred date of your baby’s birth. In the last four weeks of the pregnancy, it is important to make certain that both the mother and baby are free from infections and the baby’s in the correct position before delivery. It is also important to make certain that you will be diagnosed properly when you go to the labor room for potential problems, including labor pain.
May is Pre-eclampsia Month, a time to empower all women about the dangers of this very deadly disease. It has claimed the lives of many women, including the grandmother of Vanessa Williams.
Although it has been described as far back as the days of Hippocrates, we still don’t have a cure in the 21st century.
Pre-eclampsia is a condition that involves high blood pressure, swollen feet or ankles and protein in a pregnant woman. It can occur anytime after 20 weeks but usually develops in the third trimester and affects up to 7.5% of pregnant women worldwide. Why is it so dangerous? Because the blood pressure can reach such high levels that a woman can have a seizure or a stroke and die. It can also reoccur for up to 6 weeks after the baby is born, is frequently and regretfully often misdiagnosed. How is it treated? By delivering the baby and therein lies the dilemma. Sometimes it occurs so early that some healthcare providers will either miss the diagnosis or are hesitant to deliver the baby because of its prematurity. The baby has to be delivered because the placenta is abnormal and must be removed.
On April 22, 2015, I witnessed the official induction of my dear friend, The 19th U.S. Surgeon General, Dr. Vivek Murthy. He and his fiance, Dr. Alice Chen have been part of my journey through our activities in Doctors For America (DFA) and it has been an honor knowing him. Well done, Vivek!