Be able to introduce dr. Ricardo new zealand i am a big fan of bios because i introductions are a way of people their flowers in real time. Ricardo is a writer and practicing doctor. He is an associate professor of medicine, medical ethics and health policy. Baylor college of medicine, where he directs the humanities expression and arts lab, also known as heal the heal program. He is also a writer with pieces appearing in texas monthly, houston chronicle, the new yorker, the new york times, the atlantic, and of course, the england journal of medicine. His short stories have appeared the best american short stories anthology mcsweeneys and the new england review, which awarded him its inaugural emerging writers award. His debut book, which were here to talk about today, the peoples hospital, follows the lives of five uninsured houstonians, as struggle for survival leads to a hospital where insurance comes second to genuine care. Thank you for being here in san antonio and at the book festival. Thank you so much for. Thank you all for coming much appreciate. As we are in conversation and make sure i note for you all that we absolutely have time today to in conversation with everyone thats in this space and draw from the collective in the room. So please be flagging the questions that are in your as you listen to ricardo and well be taking an abraham specific lee in the yellow shirt over here that brilliant books shirt will be moving the mic around the room. I want to bring the book into the room by passing the mic to to just get us started with reading to bring your book to life. Please use so much. So im going to read from the very beginning of the book. This is from chapter one histories. The first page, this is from the peoples hospital, hope and peril in american medicine. Right. The rumor we heard was that patients arrived with handdrawn maps. Our hospital marked like treasure the stately nigerian lady who responded yes, doctor to everything. Metastatic breast cancer. The boy with the black curly wearing red converse. All in a judas priest tshirt that screamed mexico city acute lymphocytic leukemia. The grandmother, the saris snagged in the guardrails chest pain real chest pain might need bypass. We stood at these bedsides. We wrote down their histories. We said we were sorry for examining them with cold hands. We ordered blood tests, interpreted the ekgs scrolled their cat scans. We input diagnosis is we werent just doctors among us were nurses social workers xray techs. The who rode up and down the hallways the middle of the night waxing the floors. Some of us wore white coats with frayed sleeves and busted pockets, others tight fitting scrubs embroidered with our names in our bad moments, became tribal. We werent we we were ortho plastics. The foreign nurses. We only covered the unit more often though the needs of our patients were so immediate we found way to work as one. We ran blood, heparin drips a, morphine pump when norco didnt touch the pain when covid came we gave oxygen together, one of us twisting the knob on the valve while. The other inserted those tiny prongs into flared nostrils. We consulted one another when things looked dicey. Surgery. If we found boils, id for antibiotics and if anything looked like a seizure, a twitch, a rolling of the eyes. We paged neurology. If transportation was swamped, we wheeled them ourselves to mri, to special procedures, to the cath lab, even the icu. How downtrodden we looked when we did this, like beating dogs, we figured out ways make things work. Not enough money for your meds. We googled the 4 list at walmart. Muscles too weak. We dug up a refurbished walker from the basement, dying and homeless. And alone. We called in a favor from hospice that used to be a tutor style home. And when our work was done once, we could envision someone not dying within 24 hours of our discharge order. Once the first chemo had gone in, once, we could be sure their chief complaint was addressed, the thought still lingered in our minds. What them here . What are their stories . Ben taub hospital, the largest safety hospital in one of americas most diverse. We are heathrow. If we replace the emirates and the virgin planes with greyhound busses. There are no atriums with pianists here playing. Here comes the sun to welcome, you know, soothing of Running Water from hidden speakers or gasp from an actual waterfall. There is starbucks or cafeteria serves some form of barbecue. Most days for lunch and packaged salads topped with eggs or chicken strips. Thats unless you prefer the full menu. Mcdonalds located the hospital thats open 23 hours a day. We do have a gift shop, though. It looks more like a convenience. Heavily stocked with greeting cards, not the pun filled ones. Rather the kind that get the point across. Condolence is available in spanish to. If you type ben taub into google maps, find it crammed between the houston zoo and the 30 other institutions that make up the Texas Medical Center. The largest concentration of medical facilities in the world. Some of the fields most important innovations took place in this medical metropolis. The First Successful bypass, the first artificial heart transplant, the first meatless artificial heart. Imagine that. No loved hub, just a constant whirring. The first silicon breast implant. One of the first civilian helicopter. The bubble boy all here. Not that the patients at ben taub know this. Some may heard that md anderson is rated top in the country in cancer care or that at houston methodist. You might find yourself fortunate enough to have a robot operate on your prostate. The tv aired in spanish to. Its possible that at night our patients look out their windows and behold the sparkle of so many new glass buildings, some of them named the billionaire sheikhs who sell the oil that becomes their gas more likely, theyre looking out in the direction of the zoo toward the parking garage and bus stop wondering how theyll get home. If that is just the first three pages by page 14, i want to put the loot down. It was simultaneously pulling heart out and putting words to an in the American Health care system that ive had that i have witnessed, that i didnt know i needed words to be put to them. And even more so by someone whos a doctor. And the first question i have for you is then, i know what the book meant for me. I think im still processing the depth and breadth of what it means to me. And im curious to know who is the book for . I mean, book i dedicate the book to the people who work at ben taub hospital with me because we feel such underdogs. I feel like that because its a public Health Care System. So ben taub hospital is the flagship hospital, the public Health Care System in houston. And, you know, here in bear county, you have something similar. And i think that we working there, we can also we can be in the shadows of such you know, of the wealth of hospitals and but really we like were actually doing great work there. And the statistics show that the american mentality is is that the public Health Care System for everybody. And thats what this book is really about, is to dispel that is to show moments of where patients have been issued from the private care system and how Public Health care is of those ways that we can bring costs down, which is an enormous problem in. American health care, while providing basic Health Care Access to because we dont turn anybody away. We take care of every Single Person. And so thats this this is for is dedicated the people but its also for to know that we solve the Health Care Problem in america. We understand what were seeking and if we look at some of the great models that are out there, i want to pick up on underdog. Because throughout the book making, really the very many perceptions of of this that exist for the people who are not there and maybe should be there but also again underdog is a perception, right that might be exist more internally. And makes me curious about what the perception is nationally of the hospital evidenced by some of these deaths. But unpack for us a little bit about the perceptions given the very many actors that you talk over the course of the book. Yeah. So houston being a diverse city, the fourth biggest city in the United States and one of the most uninsured cities in the country, what you would find is a whole milieu of people there, including people who just cant afford health. Right. Or who cant get up. Who have their job and its an increasing amount of people who are left in the cracks of our Health Care System. And those people feel like underdogs. They look at the glass, they look at these large institutions of the of the Texas Medical Center throughout, you know. And they cant care there. So let me give you an example. One of the principal subjects, my book, stephen, he earns 75,000 a year. Hes a restaurant manager, but he elects four his the lowest plan because hes hes actually a real texan hes just like why in gods green earth would i pay for insurance . I think its a racket. Right and but at the beginning of the covid pandemic, he starts to feel a lump on his on his neck and. He soon realizes thats whats causing him fevers. He goes to an emergency. Well, his is so bad that they at the private hospital, they tell him, you have to pay 660 just to sit there. They take him through some, you know all. They shuttle him back forth between different hospitals of that network and then doctor finally sees him, has done the cat scan and says you have tonsil cancer. But then he says next word is. However, however, we cant do anything about it. You have to leave. And for stephen, thats punch in the gut. Social worker has to come in afterwards, say go to the Public Hospital to ben taub. And for stephen, that is even more punch in the gut because hes like, thats for people who are homeless, who are drug addicted. Those are. Thats for people in jails. But were finding what he his is told in the book. But what he finds is is that its his about the public Health Care System are different and you know, thats one of the things that i wanted to to, you know, about health care in america that Public Health care can be very good. And thats one way that we could come together and, think about solving it. So that people like stephen dont get in those situations. It also lays bare for us that. There are the ways in which local government can create interventions and i appreciated so much the history and information shared with me around the leaders and the policymakers that very persistently over. Yeah. Worked diligently. Combined with voters approving things like making the gold card happen. Right. Can you talk about the gold card is and it sort of shed light on the role local government particularly thinking i have in mind is again yes were, in texas. Yes. Were in the legislative session and the part of the book is just peeling the layers and layers and layers of of how much is play for someone to get care. Yeah. So here in san, you have something called carelink, which is very similar to the concept gold card, which is that its not a Health Insurance, but it is Financial Assistance to help people who uninsured or cannot afford health care. And in houston, that came about because, there was a voter referendum in the 1960s. It at that time, there was only one charity hospital. It relied on funds from the county, the city, and each of them were trying to dump it on other. It was called Jefferson Hospital and and it mostly africanamericans and immigrants were, the patients who couldnt afford health care at the time. And had to go to that hospital. Atrocious conditions, you know, to the point where op eds started to written about it. And then there is a voter to fund, a public Health Care System, the seed thats planted in the 1960s. And what comes about that is a Health Care System. A lot like what you have here in bear county right there is that theres count that theres, you know, outlying it there specialty clinics theres hospitals and its a its a its a its a local system that has been cultivated by public leaders over over years very specific to texas like the bigger tech the big texas cities have it for a lot of Different Reasons because the state doesnt want to take, you know, one want to give dollars to health care and allows the county to do that. But as the counties have grown in the urban centers, theyve something in order to keep people out of emergency rooms, you have to provide them health care. We just havent found that out as a nation right. Other countries have thought about this and put it together. Well, part of the book is well there is there is real incentives for that system of people in emergencies. And thats from medicine. So thats you know, its its really an its a model to think about when were thinking about how to piece together. Finally, a Health Care System. If we get to that level. I really hope we do. But its its its something that i hoped would something that we would think about. Theres this scale that youre for us throughout the book in terms of the ways in which we as individual exist within and are served by systems and institutions. Right. And that youre constantly bringing in the position ality of, for example, you as a doctor within the hierarchy of a hospital, or how race and class affect our position ality as showing for care within that very same hospital and another intervention thinking right the policies or Ballot Initiatives that allowed right property taxes to fund Something Like the gold card. At the same time youre showing things like policies that are more common when it comes to Maternal Health in california that we now see at ben taub unlike other areas of the country. And that to me also is another intervention and a policy change. Right. And youre talking to us very specifically about who those people are that are doing the research and making these policies happen. And it made me think about what you would say is the type of leadership that it takes at this moment that were in. Yeah. To identify and implement and and provide the data and bring everyone along as well. Right. Because im thinking about even just the pads and ill leave you to explain. But the way in which nurses had to be brought along in terms of making possible. Yeah. It, you know ben taub is is is a Teaching Hospital at its core and because of the fact 80 who work there who are interested in the academic and evidence based they can you know they can glean the studies and them you know at that the hospital level so that what the culture is like is utilizing the best of your resources which is a huge contrast to the working Health Care System which is really just designed to extract as much money possible from patients, you know, more, you know, just we have to we have to realize that like for instance, the funding of Like Health Care, the way its financed in the United States is fee service, very different from other places. And i mean, what that means is, is that, you know, doctors and practitioners are compensated for every service that they provide. So if you can bill for every service thats something that in 19 tens doctors fight through a lobby to hold on to that power. Right. And its different than in the in in in other european and. Thats one of the reasons why we such a disparity in how much we pay and what we get from our health care. 0. 18 of every dollar in the United States toward health care more than anything else. Okay. Thats compared thats more than thats around double what you know, the western European Countries spend and our outcomes in infant mortality Maternal Mortality are not nearly as high as as as as as they should be like the way that European Countries have. So were just even even president called it the illogical incentive of the American Health care system which to incentivize paying for sickness rather than like to prevent illness. And thats why costs are out of control. And thats one of the reasons why in an ever in an academic environment where you can have people think about like systems how to it how to prevent you know catastrophes like that. Thats why theres cost saving and thats why it helps patients right thinking about it both in terms of the data that were sitting on and, the fact that its Teaching Hospital. When you were unpacking what you call them and mess it up algo algorithm mania. Yeah so that right you are at that point a doctor as youre unpacking this as youre seeing the pitfalls of chasing that, could you talk to folks about a share, what that is . And then second to that, im curious how it changed your teaching. Yeah. Now as a doctor has that perspective. Yeah. So algorithm mania is what i call the practice of following decision without reconciling that with that, with the connections you make with patients, the histories. So its, its, ill give the example of chest pain. Somebody comes to the emergency room and feels chest pain and the practice in. Much of medicine is just to rule out a heart attack. And you can do that by a series of steps, vital signs, you know, a brief exam. But at the end of the day. So if youve ruled that out many of those patients are just discharged but they dont know why they have chest pain. And so maybe the next time they that chest pain or maybe theyre still feeling that chest pain, they have to come back to the emergency room. Right. Its not that if you algorithms become the practice when algorithms become the practice instead a tool like trust me, i use algorithms i have to use decision trees. I mean, it helps you but kind of understand how to like what diagnosis it guide your diagnosis but so much of our Health Care System is is based on like with billing to achieve these diagnoses its the algorithms the practice instead of talking to the patient connecting and saying, well, i think i actually think that your chest pain is due to. You know, esophageal reflux, you and and making that connect you know i think that that is an example of when we are trying to rule out thats what i call algorithm mania rather actually trying to diagnose and how does it show up in our teaching oh in teaching i we i, i have bedside rounds we try to listen to the patients. You know, we i, i practice that like first of all, i think that we need to improve our attention for i mean, we all feel this, right . We all like, are wanting to, like have our phones around, you know, our attention is being bombarded at all times. But theres i, my students think about it from the perspective of the patient. Theyre sitting. And if you look up and theres a and everybodys kind of like doing their own thing. I mean, its just like you dont think theyre thinking cohesively about your problem right. So we try to practice attention. We listen to words that theyre spoken and. You know, it can make a big difference in the relaying of a when somebody says, you know, i cant breathe or i breathe in, for instance, you know like, okay, breathe in. Maybe thats more like that. That can target me more toward asthma. I need to for crackles, you know, things like that, you know, that we are really trying to focus in on the language, avoid the algorithm mania so that we can also communicate to you to to people, you know, so that they understand what what it is that their diagnosis is. Maybe they dont have to come come to the back to the hospital unnecessarily. Theres such a myth that you talked about in the book as well, and im feeling it of me as i listen to you speak. Is that that sounds expensive right, that there is you talk in the book that the reason universal coverage is still being debated these are your words isnt because most americans oppose it in principle if you do yeah its because americans fear the costs. Yeah. And and and rightfully so because we an extraordinarily expensive Health Care System. I think that money is the problem. Our its its not that we lack of money its just that theres too much it it greased so much by money it so transactional that have to start dampen that down and think about actually like utilizing resources that we have and you know we its fee for service right so i give the example in my hospital that we have three working mris its not like a hospital where i push a button and there already wheeling the patient to mri. I think thats a good thing. I its a good thing for a couple of reasons. Number one is, is that sometimes you actually dont a mris when i when i have a patient who i feel needs an mri stat like if theres if i feel theres spinal cord is being compressed and think its like absolutely time sensitive i will call the radiologist myself and say i need this stat and we end that. Thats a conversation that happens between, me and the radiologist, to prioritize that patient. Okay. Thats in contrast to you have a a wealth like these machines available you hit a and you get a lot of unnecessary tests. Thats how things start to amount and you know i think that we need to go back to being more precise in medicine and not rely on just the excess of it. You know theres so much waste, you know, if in if you if theres a figure out there about like in the hundreds of billions i have it in my book but i dont have it on the top of my head about how much it would cost to Everybody Health care in in the United States. And its the its the exact amount of how much we waste in the American Health care system. So its like we have to think about curtailing our waste in order so that we can be more equitable and give people and allow people to have better care access. I appreciated way you wrote it is we are paying somehow. We all pay somehow that all of us are affected by this. Whether we can see it most immediately as a crisis in our life on any given day or not and, theres a question i really enjoy asking people like you who clearly really think deeply and think about their work as a vocation, as youve written about. And it is what do we have to risk and a towards the end of the book you use the word re relinquish and you put it side by side with this we are all paying somehow, but we also are sacrificing. We also have to sacrifice the in which its not fair. Were sacrificing fairness in our system. Were sacrificing equality, were sacrificing even quality of care because even what i am considering costly is myth. Right . Or i think. You talk about privacy. Yes. As something i felt very seriously myself to. As you were describing a nightingale ward. Right. Right. That sounded and i thought, oh, please can i have pay for my own room . Yeah, right. And but what are we can talk more about this idea of relinquishing. Yeah, i think we do need to consider how much health care become more and more private, not just in the way that we are, you know, deciding that every has to pay more and more for their health care. But its also like how it unfolds in the hospital is becoming more and more private. And that leads to costs. I give the example of the nightingale ward, which is like Florence Nightingale in the crimean war, invented this ward, which is like that the patients are on the on, the periphery, the nursing station is in the middle. And that allows the doctors and the nurses to look at all the patients and its ventilated. Right. But if you go to an emergency room now, a private hospital, its labyrinthine youre put into like little hospital rooms and little rooms and its very difficult to for the doctors and the nurses to monitor unless you have like electrodes, thats more and more costs and everything. So its, you know, the ward that i kind of like ben taub main ward many years was in the emergency room, a nightingale ward and i think it was first of all, you know, florence, at nightingale showed like the mortality was shown to plummet. It went to like 80 mortality went down. So and it was it was helpful. It was it was it was something that helped patients. It was also cost effective. But in our American Health care system, we do things differently. We try to privatize privatized privatized so that we can charge more and more and more. So thats something that we need to think about relinquishing if were to the point where so many people are still left uncovered and were paying so much for health care. And i mean, theyre intertwined. The more that each you know, the the more that were paying out of it, the more its going to be difficult to achieve equity for everybody. Right. Another scale that is in this book is that are writing to us as a person who also has been on the receiving end of care or help to facilitate your family to access care and to consider care. And there was such a deep vulnerability in the stories you brought in specific to im thinking of your family, your grandmother, your dad, your wife and. Im curious to know the choices and sort of moving into process as a writer, the choices of of bringing in that vulnerability. What do you think it does to the your Overall Mission with the book . Well, i think that was like the hurdle that i mental hurdle that i had to make in order to get this done. I my initial behind this book was like, i just want to depict these peoples i, you know, nobody knows how difficult it has been for these individuals to health care their odysseys and its just like i was confronting i was like i want to just depict that journalistic glee and it became clear that it was just like but its hard for a reader to understand that if if they dont have like my lens of like realizing doesnt have to be like this oh and so i felt like i had to bring it. I did not want to write a medical memoir. I did not want my stories to overshadow any of the peoples stories out of respect. But i, i, i really like that, you know, my lens important. And so i had to figure out how to make it so that my story fit the argument that im making also like this greater narrative arc of like these patients stories and how they like, you know, are are, are unified. But i realized that it was just like a resistance that i had and i had to go through the process learn because, you know, for instance, one of my early readers was like, you know, i it wasnt until page 222 that you told me your dads a doctor and he like, i feel like youre withholding information. And i was like, yeah, i think i was like, yeah, i think i am. I dont know why. And i just and so i just i had to go back to the drawing board and really come up with a structure and allow myself be a part of the story. But in the right measure, you know, i think any book worth reading is one that i have a sense of only. This person could have written this book. And as i read the way in which you wove your own story within the story of, the five people that you share your patients and then put it within context of this larger system, i thought, oh, only person, but not to mention because you also shared with the reader that if you werent going to be a doctor, you were maybe going to be a writer anyway and then and worked Public Health in many different ways right through. Writing and otherwise. And it it so much of that makes complete sense in the way that youve brought full self into this book and what youve shared with us. I theres a component of the book hope in the is in the title and you you evoke imagination and evoke vision. You use words like bold and say our imaginations are constrained by the reality of what has been rather than perceiving could be or that at a Public Hospital the patient becomes communitys customer and the doctor serves society immediately just that sentence forces us to to to think a minute about what could be and you were also talking about something called the disaster syndrome and which is just about theres a general sense that we collectively know that it is not working and that its bad. Yeah, right. And theres, theres a stuckness in that did the process writing this book and ill also add the the burnout of doctors that you address as well, that the process of writing this book shifts something for you in terms of how you think about disaster syndrome or how you face burnout. Yes and no mostly yes, it did shift just because i feel like i got you know i one of the important parts about writing this book was something that, again, another mental hurdle i didnt want to write about history of it sounded. So terrible to me to be like reading history books about Like Health Care in america until you find the right book. Right. And so i across like paul starrs book, the social transformation of american medicine, i think its like an astounding and it situates historically this you know this of like doctors in america gaining power and hope and wanting to hold on them. The inner conflict is like theres a part of it that its like they want be able to determine. They to be able to keep that relationship between patients and doctors, you know, a bit pure. But theres also this other side to it which is like the incentive portion, the fee for service portion, which is like they want to be able to build directly. I mean, think about that we we dont go to a garage we dont go to a mechanic and pay the garage and the mechanic. We pay one entity. But in medicine you go to the emergency room or you to it, you get bombarded by, you know, all the bills come from everywhere. Right . But its like doctors lab every its because of that sort of holding on to power that that has become like that right and so you know thats one of confronting was just like it made me think, well, you know, things are changing with the lobby of the american medical association, things. Its not as homogenous. People are, you know, in obamacare, the lobby relinquished and said maybe we should have Health Insurance for everybody. And so there was, you know, knowing the history and knowing what are sort of the changes brought about more optimism for. Me and so and i think that even in a very sort of like you know we are going to have to reckon with this were going to have to reckon with this because doctors are leaving the field. Were having like i mean, i can tell theyre either leaving the field early because theyre fed up with how medicine is. And im not i dont mean just doctor, i mean practitioners, nurses. I mean, its its there there comes a point where people are like, im done with this transactional nature things like that of dealing insurance is and so we have to were getting to the point where were at least finally having to reckon with that, that even burnout is like a symptom of the medical system. I think its time to pass the mic around the rooms. What questions do i have . I see a hand over in the far back. Hi, i wondering if you could talk about heal. Yeah. What it is, why its important you think it can do for us. Wonderful to see. Thank you for that question. So heal is the humanity is expression and arts lab and what that is a attempt to bring Arts Humanities into medical education. So in the in the in the middle of the pandemic december 2020, the association of american medical colleges, the amc released report saying that arts and humanities are fundamental to medical education and we should be teaching doctors with tools like, art and philosophy, history and that might seem like really out there, but thats really the roots of medicine. But whats happened is is that we the pendulum has swung much more to the science for a lot of good reasons. Theres been a lot of scientific progress over the last like 100 years, but in doing that. What have we lost. Well, what they were trying to address is a, like i said, burnout. The trends, you know, just how people are not able to gather meaning from their work, you know, like they theres theres attrition because people go in, they think that theyre just helping Insurance Companies rather than helping that person, that patient, theyre not Building Structures of meaning in their life. But its also just communication. You know, how many people feel like their practitioners speaks with them in a way that is satisfying and that they understand, you know, the arts and humanities have something to also also even decision making. You know, i think that if you select for doc doctors to be who are more kind of like scientifically inclined when it comes to the gray zone of medicine where you know those of us who practice it know that like so much as in the gray zone its like its really hard for people to make, you know, judgments when its like when it feels like it should be a choice answer, you know . So thats Fertile Ground for the arts and humanities. And thats why we, for instance, take students to go, you know, art viewing at the museum of fine in houston to understand taking, you know, we have reflective writing workshops have a medical humanities hours where where you know the medical are able to kind of like listen you know humanness people who are working in the field to kind of understand and build the further that those ideas of like meaning that like they can become more resilient going through the their their profession and their practice, you know, beautiful i have a question. Yes. So im a Public Health nurse and. I was with the University Health system when the started to make a tremendous. So thank you for mentioning it. But my question is over over my lifetime social movements have happened. You know, the Civil Rights Movement many in i think it was 2017 when there was a movement to replace obamacare and there was seemed to be a movement where people did not want that. So wondering is going to take a social movement for us to really rethink and restructure health care, health and health thats a thats a really good that i im one of these people that hopes that it doesnt that we can like we just pound the pavement people like let people know that theres unity to large extent. You know, in people knowing that the Health Care System is broken, people knowing that theyre paying too much for it people, recognizing that interests are above patient interests and that spreads across both parties. You know, now going to be like whats going to catalyze that . Thats a great i hope that at the grassroot Level Education and like coming with alternatives, like showing people that there are alternatives because think all of us feel stuck in the stranglehold of like corporate medicine and. So im hoping that it doesnt need to be so. But i agree with you that. Its like its it feels like if you look at it historically. Its like the social movement. Thats what happened in the uk for like the National Health service to be born. It needed that it it was in large part due to the to to to war to the, you know, in 19 the world war two. So hopefully, you know, we can find way out of that, but it might need that if we run out of time for questions. But however theres a book signing that you will be available for. I want to wrap us up with one last thought, which. The moment in the book, which you talk about how often you were asked speak when you were attending funerals of former patients who have since passed and you said a very specific perhaps i am asked as often to speak because these families need to hear that you your one was worthy of our attention and, our care and i, i, im that out loud to bring that into space. Also to say thank you for your practice and this book. Oh, thank you very well. I mean, every Single Person deserves to be cared for and we have the capacity do it. We can it. We can take these models and build on. I feel very fortunate. I feel to work in a system that allows to focus on that. All right. Thank you, ricardo. Thank you to the attendees. A round of please. A reminder. Also, the nowhere bookshop outside in the festival marketplace has book sales and signing the next event will come in shortly. And so theyre asking us to boogie out of here pretty quic