The Dr Louise Newson Podcast - 139 - ‘How my life experience has influenced me as a doctor’ with Dr Naomi Jiagbogu

Episode Date: February 15, 2022

Dr Louise Newson met Dr Naomi Jiagbogu over a decade ago at Birmingham Medical School when Louise was mentoring students who were studying medicine as a post-graduate degree. Naomi subsequently qualified, began her GP training and moved to Manchester with husband, Aria, who was training to be a paediatrician. Louise and Naomi discuss their memories of the post-graduate course and reflect on how the students were older, from more varied backgrounds and had broader life experiences than you would typically find on an under-graduate course and how these factors enhanced the student’s skills and learning, especially when relating to patients. After beginning her GP training, Naomi’s husband Aria sadly developed a brain tumour and after surgery, treatments and a yearlong remarkable recovery, the cancer returned and Aria died in 2020.  During his illness, Aria wrote two children’s books for their young son about sickness, loss and family, and he also wrote a memoir for adults titled, ‘Broken Brain: Brutally Honest, Brutally Me’. Together, Naomi and Louise discuss the importance of looking beyond the disease and connecting with the person not just the patient, and consider how personal suffering can transform the way you communicate as a clinician. For more details about Aria’s story and books please visit his website https://www.ariatheauthor.com/ The books can be purchased from https://theendlessbookcase.com/authors/aria-nikjooy/ Or Amazon https://www.amazon.co.uk/Broken-Brain-Brutally-Honest-Me The royalties from Arias children's books are going to Brain Tumour Research, Royal Medical Foundation, Society for the Assistance of Medical Families and Royal Medical Benevolent Fund.  If you have listened to Naomi’s story and would like read more and donate to Brain Tumour Research, please go to https://www.braintumourresearch.org/stories/in-our-hearts/in-our-hearts-stories/aria-nikjooy You can follow Aria on Instagram at @ariatheauthor64

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based least information and advice about both the perimenopause and the menopause. So today on the podcast I have with me, Naomi, who I first met about 10, 11 years ago when I was working in Birmingham University. And I was working actually as a moderator for their GEC course, which is graduate

entry course. So these are for very highly motivated students actually who have done a degree already and then decide they want to do medicine. So I worked with Birmingham University for about a year or so before I got pregnant with my third child. And I was blown away, actually, with the motivation, the determination, the persistence, the consistency of incredible work by these really young people. And my role as a moderator really was to steer them in the right direction. And listen, they had a week to prepare work, come back and present it to their group. and Naomi was one of in the group, so I had a great privilege of knowing her then, and then you reconnected with me more recently. So it's lovely to have you on board. So if you could explain Naomi what you're up to at the moment, that would be great. Hi, Louise.

So yeah, that's right. So I did meet you when I was on the get course, which was great. Very stressful four years, but it was fantastic. Nonetheless, met lots of good friends and things. But, yeah, since then I worked in Birmingham for two years doing FY1, FY2. and then I started my GP training in Birmingham actually but then I also got pregnant and then I moved with my husband at the time to Manchester

because I was pregnant because he started his paediatric training so then we had a child and a lot of things in between then and I'm still currently GP training at the moment yeah so we'll get back to those things in between because that is really important to talk about so when we were doing the get course we had all sorts of diseases didn't we, that we spoke about. So I remember one week we did something about Parkinson's disease and someone would go off and learn about the anatomy, someone would learn about their

pharmacology of treating, someone would go off and learn about the ethics of how to talk to somebody and the consultation role. Someone would talk about the pathophysiology. So it was a really great, actually, multidisciplinary sort of bring everything to the table, learn from your peers. And it was very different to the way that I was taught at medical school, because in medical school, I would turn up, I hate to say sometimes hungover, I don't drink alcohol now, but as a student I used to be sort of half asleep listening to somebody and we didn't have PowerPoint then. There was just an acetate with a different colour sharpie, someone just writing things out and you'd learn by this sort of rope and it wasn't really that stimulating. So I was really

stimulated to be part of you guys and I don't know, how was it for you? Did you enjoy working in that way? Yeah, it was good. It was different and I think everyone on the course had different backgrounds. Most of them were kind of scientific backgrounds anyway. And then there were a couple perhaps that did other things that weren't related to science. But, you know, it was an opportunity to learn from other people with other kind of expertise and knowledge. Sometimes that was really good. Sometimes it could be a bit bad because they'd have too much knowledge in one area. And I guess, you know, being a scientist by background, it's quite hard with medicine knowing actually you're not going know everything in so much detail, are you?

You kind of got to know the broader picture and things. So that was a struggle, I think, with the problem-based learning. But actually, it was such a good way to learn because it made us independent. We had to go out and find all the information ourselves. We then had to kind of almost teach it back to our colleagues. So we had to find a way to break it down and teach what we've learned. Because in the medical world, you see what you do when you teach one, don't you? And then you're an expert.

So, yeah, I've got nothing but good things to say about PBS. I think I did miss the lectures at times, like you said, you know, if it's a day when you've gone in with a hangover and you have to be mentally on the ball, then it's not so great. But otherwise, I think it's put me in good stead for my career now and being a GP training. It has helped that method of learning. Yeah, and I think it's really good learning from other people

and learning different experiences as well. And I remember even actually the Parkinson's one, one of the sort of debates we had was you think someone's got Parkinson's disease, their daughters getting married at the weekend and you want to give them the diagnosis on the Friday. Would you give it on the Friday before the wedding or not? I don't know if you remember that one. And it was very interesting because half the group said, absolutely, I've got this diagnosis. I have to share it with the patient straight away. That's my duty of care. No la la la. And then others were saying, well, actually, it's her only daughter and it's really big that it's getting married and everything else.

So maybe I'd wait for a week. And it was actually one of the most interesting conversations I think we had then. It wasn't about the science. It was literally about how do you break difficult or bad news. And I think a lot of it was when you haven't got experience in talking to real people, real patients with real disease or real problems, then it's quite abstract, isn't it? It's quite hard to know how to talk to people. Can you remember what your views were then about? I can't remember what my views would have been then at the time, you know, I can't remember, but I know what my views are what I would do now in that situation, I would definitely wait for a week to tell her so that she can enjoy the wedding. But I think that's me being, you know, a GP training, looking at the patient holistically,

looking at them as a whole and looking at her as actual a human being, not just a scientific diagnosis or problem. But that's how I approach my patients and things. But isn't that important? And I think it was great to touch on that when I was with you lot. but actually when I was an undergraduate and even a postgraduate, I did a lot of hospital medicine before I went into general practice. No one taught me about that. No one taught me about not just the patient actually, their surroundings as well. So for this case, it was about the daughter and about the future son-in-law and about her friends who were going to be at the wedding and all of those things, but that's really important. And so there are a couple of things there really. One of the things

I was thinking about the get course is they, I don't remember one module in the menopause at all. And the menopause could have been in every single case. Even with Parkinson's, we know women who are menopausal have worsening of their Parkinson's. So, you know, I'm outraged. And actually then I wasn't a menopause specialist. And if I had, I would have gone to the lead of the course to say, hang on, we're doing a disservice here because the low hormones associated with the menopause have health risks that touch on every single module. And so I'm very sorry that I didn't teach you about the menopause. But did you get any other menopause training at all? No, nothing. Nothing at all. It's like you said, at med school, nothing. And then obviously,

when you start your hospital training, menopause doesn't really exist in hospital, does it? You know, it's not what doctors talk about. And then not until I started GP training, I've been really lucky to have some really good trainers over my time. And they'd always say to me, what's your weakness? And I'd say the menopause or anything to do with hormones. bones, all the different types of fills, that's my weakness. And then I'd say from then on, that's kind of been where my interest is developed. Because I've luckily had good trainers that have been knowledgeable in the menopause. So I then got my training from then, but that's, you know, three years down the line of graduating from medical school.

And now you're, because I know you've done a lot of self-directed learning as well, haven't you? You've done various courses and you've read a lot. And I don't know, you're flattering me, but you said you'd have listening to some podcasts as well, which is great. But now you know what you know, do you see how it would have impacted in other patients or, you know, ways that you could have, or you wish you'd known before? Completely, completely. And I almost feel like I've given all the patients that I've seen before I had my knowledge about menopause, a disservice. Because, you know, I believe that we should be offering HRT to women that need it. And I feel before, it was one of those things that you'd wait for somebody to come in to ask you for it, but it wouldn't

be something that a doctor would necessarily offer because I think, you know, a lot of people were scared because of these headlines, et cetera, and not understanding it properly. So, yeah, I just feel a big disservice for patients that I've seen prior to me having the knowledge. Yeah. Well, if with any consolation, you've only been a doctor for a few years. I've been a doctor since 1994, so a long time. And I have missed so many more patients than you because I didn't realize. And I, like you say, waiting for them to know. And so that leads me to the other point when I reflect about the get course is looking at the patient as a person in a whole, like we've already mentioned, but also about patient choice as well. And there's various people who feel that women

shouldn't be given HRT because of the perceived risks. But then my sort of pushback to a lot of things is, why don't we listen to what people want? And there was someone recently that wrote an article to say that she felt that women were being forced and persuaded to take HR. that perhaps they didn't want to. And I felt really sad actually when I read those words because I thought, actually, we would never force anyone to do anything or to take anything. And I'm completely overwhelmed with my work

because the demand from women to have their own hormones is huge and they're often not being listened to. And I think for me, the most important thing in anything in medicine is to be listened to as a patient, regardless of whether it's menopause or not. And the other thing that I thought was very interesting with Geck was that there were, like you say, a whole array of young people who were wanting to be doctors, but from very different backgrounds. When I was at medical school, it was very much with done our A level. Some had taken a year off for a gap year and that was it. We were all from the same level, if you see what I mean.

Whereas you guys, like you say, a lot of you were scientists, but some of you had arts degrees. And there were different ages as well with different life experiences. And those life experiences actually probably worth one or two A levels because that's really important. And, you know, I spent a lot of time thinking, gosh, you guys are going to be such different doctors to the way that we were because we were churned on a conveyor belt being very young. I started at 18. I was literally 18 and one month when I started my medical degree. And I had no idea really about life. I was very selfish.

It was all about me. What am I going to do? Who am I going to meet that night? when am I going to get my essay done? It wasn't looking at other things. And so I do feel life experiences enrich all of us wherever we are, but certainly as doctors, I think it's really important, actually. And I think if we have two cushier lives, I don't think we can be a really good doctor. I don't know. That sounds a bit harsh, doesn't it? But I don't know what you think about that, Naomi. Yeah, no, I think I agree. And, you know, the majority of my friends that I'm still friends

were today, my housemates were a really good set of friends, we're all completely different, different graduates, different degrees. Some did pharmacy, science, art, English, all different things. And they're all incredible doctors now. And I always kind of knew they would be because they've lived life before they chose what they wanted to do. You know, they worked for a couple of years, perhaps in an accounting sector or, you know, the city or something.

So they've, I guess they just lived life. before they chose to do their career. And then that affects how you are as a doctor. Absolutely. But you've had something in your life that has affected you more than anyone would expect and something that you would never predict. And certainly when I first met you, there's no way on earth that you knew what was around the corner, which probably a good thing, to be honest. But I'm sure that's going to shape you insurmountably as to how you're going to be as a future. And I know it's really hard for you, but do you mind explaining what's happened to you over the last few years? Yeah, so three years ago, it was November 2018.

Me and my husband moved to Manchester. We were looking to buy houses, you know, doing normal kind of married couple things. And my husband started to get headaches. We put it down to stress because we were buying a house. We had a 15-month-old baby that didn't like to sleep. It was never quiet, just cried all the time. And my husband was working on neonates at the time so he was working on night shifts and he started to get some slurring of his speech on night shifts so he came back from work telling me this and i said look how are you're getting these headaches you're getting this slur speech it's not normal i think you need to go to the doctor and go to a and e so and in my head i kind of thought what the worst case what it could be but i was like it'll be fine

let's get it sorted in matter of fact it wasn't fine and he was actually diagnosed with a brain tumor. Yeah, so it was diagnosed with brain tumor in November. Subsequently, kind of two days later after that, he went under the neurosurgeons at Salford oil, who were fantastic. But they operated on him. It was like a seven, seven or nine hour operation. And the part of the brain that it was affected was his cerebellum. So after they removed the tumor, it basically took him a year to recover. So during that year, he had to have chemotherapy, radiotherapy. He had to relearn to kind of walk, talk, eat, do everything, do completely everything again. And, you know, so during that year, that was probably the worst year of my life, just the worst year.

So I had to kind of juggle work, having a baby, being in a new city. But Aria actually, we learnt to do all those things and kind of got back to normal after a year and he went back to work for three months. This is incredible. Yeah, because he was actually, when he was, you know, after his surgery, he was bedbound for months. He couldn't move his eyes or his head without having the severe dizziness and nausea. So he literally was, he re-learned to just go from being bedbound to being able to walk again.

And he eventually got back in the car, got back to driving. Amazing. Got back to being a dad playing with Elias for a child. And that was his main motivation. His main motivation was, I'm going back to work. I'm going to be a pediatric consultant. You know, I'm going to be a granddad to Ellis's children. He was always looking for the future.

So he did go back to work, which was fantastic. And then three months later, at the start of the pandemic, his tumour returned. And then he had a second generation, knocked him. It returned, I think, two months after that. And then after that, it just spread completely everywhere, his spine and his brain. And he sadly then passed away in February, this February, actually, so almost a year, He passed away. Yeah, so it's been a challenging, challenging three years.

I mean, he's really hard last year. And he wrote a book, didn't he? Yeah, so during his recovery, as a way of therapy for himself, he took to writing. And I think it was partly because he wanted to relearn to actually physically write and read again, because his vision had gone, and his grip had gone. But it was also, for him,

It was a process of dealing with all the issues and everything that had gone on because, you know, most men don't talk about how they're feeling or their worries or their concerns. You know, he rarely spoke to me about what he was worried about. And it was always, no, I'm going to be better. I'll get better and do this. So what he did was he started to write down all his feelings, all his emotion, all his anger, all his everything. And it basically turned into a memoir that he wrote. And he talks about, you know, being a patient in the NHS. being a young doctor.

You know, the fact that I remember him saying that he's on this bed surrounded by curtains, yet everyone's coming in speaking really loudly and those curtains don't make any difference. Yes, absolutely. And talking about, you know, having med students in the room when he was getting told the bad news and relating to that feeling that, you know, God, two years ago that was me.

I was the med students sat in that room, you know, listening when someone else was getting told this bad news. So, you know, he was writing all this down, talking about the challenges he faced. And he was still making it really. funny the story so he'd done that written basically his memoir and he just worked his way through that as things came up and arose and then he also wrote a story for our child the children's book at the time so that he came up with the idea when he was waiting for an outpatient appointment

in the hospital so that he could explain the concept of illness to our child because he said what you know what am i going to say to him when he's older when he asks me all these questions what what can I say? Because, you know, he's probably just seen me in bed for the first year that when he was poorly. So we wrote a children's book called Eddie and the Magic Healing Stone, which he absolutely loves our son and all his friends at nursery love it. And it's lovely. And then when he returned to work, he started writing a second children's book.

And that was called Eddie and the Last Dodo on Earth. And that's actually about personal loss and family and how you kind of get through loss with family. And it doesn't matter what your family look like. And he loves them, our son loves that book as well. Oh, good. So powerful.

What incredible gifts, not just to you as a family, but to others as well. And certainly I now want to read both his children's books because I haven't seen those, but I have seen his book. And, you know, he wrote so well and so clearly.

And I think having a perspective of as being a medic and a father and a husband, and a friend and everything that he was to so many different people is incredible actually that he and just showing the determination for so many people they would have given up at the stage where they couldn't move, couldn't, right, couldn't see, couldn't, you know, whatever. But he didn't and incredible. And, you know, it's such a big hole for you. And when you reached out to me, because you emailed me a few months ago now,

and I have lots of emails that I've sort of skimmed, between patients and various other things. And I read your email and it really made me stop in my tracks. And obviously I felt very tearful, not just because of you, but then as I did explain to you, my father died of a brain tumour when I was nine. And so I was older than your son, but my brother was only two. And it's, obviously, I'll miss him all the time. But he's made me who I am. I would be very different if I'd had two parents who gave me everything I wanted with no worries. And, you know, as I said to you at the beginning, when you're really sad and you've really missed something that you can't control, your emotions are very different. And then I often don't expect

to be happy. So if something really good happens, I feel really happy. Whereas before, I would have spent most of my life more happy because I didn't have this loss. But the other thing that I remember very clearly, my father was at the Royal London Hospital and exactly the same as you, actually, he presented when I was about three or fours of a few years before he died with headaches. And my mum was told, oh, don't be silly, he's distress. And she said, I think he's got a brain tumor. And this was in the 70s where it was really hard to get a scan. And they all said, oh, come on, Mrs. Newsom, you've got two young children.

And he's busy, you know, in his job. He wasn't medical. And anyway, when it was diagnosed, obviously. And then he managed to get better, have a few years and then went downhill. and Professor Watkins, who sadly died now, was the most amazing neurosurgeon and was very, very kind to my mother and let her stay up at the hospital, which is very unusual in the 70s to have relatives that actually stayed. And the senior registrar was a really cold person. He did his job very well, but he had no bedside manner at all. And the day before my father died actually, my mum, or three days before, it was my brother's birthday, he was two.

And my mum said, I really don't want him to die on that day. And so the registrar came in and said, well, he's very ill, matter of fact. And then Professor Watkins then came in later that evening and gave him an injection. And I think it was probably a steroid to reduce some of the swelling. I've got no idea because I was too young to ask. And he didn't die on that day, which was lovely. And my mum said to Professor Watkins, why is your senior registrar so cold? Why is he like this?

Because I'm finding it really difficult. And he said, well, Anne, it's because he hasn't suffered in his life. But he will. and he'll change. And at the time, I remember my mom telling me this many years later, and I thought, that's weird. Why do you need to suffer to be kind? That's the weirdest thing I've ever heard.

But actually, I don't know what you think, Naomi, but the more people I talk to, the ones that have had some suffering, are the ones that see things very differently. And, you know, obviously it's very raw for you, but I think what's happened to you is going to not really help you because you can never replace your loss,

but it's going to help all those patients that I'm sure you will already be seeing and speaking to in a very different way. Yeah, it does. And you're just saying that story now is kind of sparked off those emotions again of what you almost have gone through when you're going through as children as well, because that's my main concern about, you know, our child. But I think completely and weirdly we had an amazing neurosurgeon who was compassionate and kind, and his face I remember I think Rari wrote in his book just said he had a nice smile

and he just put us at ease although he was telling us the worst news possible he was lovely and he didn't fill us with dread every time we'd see him it was a nice, not a nice experience but he had compassion and you could see that in his eyes and he cared

whereas perhaps the oncologists were different and it's almost like you know, I think the surgeon saw Aria as a person, as a husband, as a dad, as a son. And it's almost like the oncologists just saw Aria as a number or a figure and a fact. And that broke my heart, seeing that, particularly because we were both in the medical profession. You know, the neurosurgeon knew that. And he said, look, if you've got any questions, any time of the day, you can call me, text me, email me.

And he was just lovely. and we just had the opposite experience with the oncologist. And like you said, whether that's because, you know, some people just don't have those life kind of, I guess it's a life trauma, isn't it, for someone to go through, something like that? And it does change you, completely changes you. Whether that's for the good in some things.

It has to be. I think it has to be, doesn't it? Because I always strongly feel that somebody said to me, actually, a while ago, you can glance back, but you can look forward. And I wasn't sure that she might. meant and then I realize actually you can't change your past as much as many of us have done things that we wish we hadn't done or said or whatever we can't and there's no point dwelling on the

past I think we have to move forwards and we have to make the best of what we've got because who knows what's on the corner for any of us and we have to live as happily as we can but as positively as we can I think that's really important and I think we also have to learn not by our mistakes but things that when they happen badly, how, you know, we wouldn't necessarily want that to happen to us. And I think also when you've been a patient or a relative of a patient, you learn from that because you think, well, I wouldn't want to be like that oncologist, but I would like to be like that brain surgeon and I would like to pick those things up. And sometimes it's those little things I find in consultations, I'm sure you do, where you might, if you had a script, be exactly the same

for one doctor to another, but it might be just a way you look at like you're saying, look, or just a smile, or something very small, but that's what those people remember, the patients remember. And I know in 1992, a long time ago, when I was a medical student, we had a, there was a whole series about breaking bad news. And this sounds really awful to think that. But in the 80s, no one knew how to tell someone they've got cancer, it's just that was, or what it was. And this lovely psychiatrist called Peter McGuire in Manchester, actually, at Christy Hospital, he did this whole module. And he very much said, before you just go in and say, this person's got cancer, you say to them, what do you think's wrong with you? Or what do you

think's going on? And actually, you'll be surprised. Some of them will say, well, I think I've got cancer. So when you say, yes, they say, oh, it's a relief, actually, because they're expecting. Whereas others might say, well, and I think I've just got, you know, a little obsess. And then you know what you're dealing with and you know you have to maybe not make that diagnosis or tell them the diagnosis on that first consultation. You can build it and you work with the patient. It's a team that you're doing here. And I feel that so much sort of just to come background, obviously, my selfish way to the menopause. It's very much about working with our patients and even not in the menopause. I really feel so strongly, but we're there as patients'

advocates rather than their dictator. We're not telling them. and what they should and shouldn't do or what they can and can't have. And this whole HRT debate, I'm not saying every woman should take HRT regardless of whatever they've got in the past. Some women who are really fit and well do not want HRT. Some women who've got metastatic breast cancer want HRT. Both those women need to have their views listened to and they need to have their treatment adjusted according to their beliefs

when they know the benefits and any risks. and that's the same with everything. And so I think the beauty of medicine is that we don't have to treat everyone the same, isn't it? Yeah, definitely. And I think that's something that you get from life, knowing that everybody's different. And we learn a lot about communication skills

and how we communicate with patients. But actually, it's quite a hard thing to teach, isn't it? Because every person is different. And you kind of tweak or change your communication skills depending who you're talking to, don't you? Yes. But that's what I love about medicine, And it's such a privilege, isn't it, to be able to change the way that you approach things very differently.

And, you know, when I set up my menopause clinic, I thought, oh gosh, would I be a bit not bored because I'm never bored, but would I be a bit frustrated because it's the same diagnosis often? You know, it's either the perimenopause or the menopause. But absolutely not. It's such a thriller and a no, because everybody's got a story and everyone's got something else to say. And I think the other thing is you can't judge anyone, can you? because you might see somebody and think, gosh, aren't they lucky? They've got on the outside everything that they could wish for. They've got a professional job.

They've got whatever, lovely family. And then you listen to the stories about the symptoms that they have or the way something's happened. And I think people are very more open with us because we're medics as well, aren't they? But then sometimes that's quite hard, isn't it? Because when we take their emotions and they thank us because we've listened and then they feel a lot faster. And then suddenly you're like a spund and you're like a spund. you've taken their weight of their emotions onto you. So I think part of learning as a junior doctor is learning how to compartmentalise those

emotions because I've never wanted to not be emotional and empathic, but I don't want to take everything home and never sleep at night. No, yeah, that is completely true. And I feel privileged every day with my job, the fact, like you just said, people tell you, you know, their secrets, they're things they've never told anybody before. And it is such a privilege to do. but on the other hand, it can be hard as well, like you said. And I think learning to be able to compartmentalise things,

because I'll find I'll be in the bath thinking about, oh, did I do the, I even woke up this morning thinking, oh, I forgot to send that patient such and such. And then I think, right, I need to write that down. I'll do that when I go in on Monday. And also particularly in GP, dealing with the uncertainty of not knowing, not actually finding a diagnosis. You know, these are things that I'm still kind of learning

how to manage and kind of cope with and get through with us. I'm training. I do feel I'm improving, but it probably, like you said, it is quite hard. Yeah, and it's a journey. You know, I don't think we ever get to the stage. If I ever spoke to anyone who thought they knew everything, then they're either lying or ignorant because there's always things to learn. And yeah, like you say, it's an absolute privilege and it's been a real honest speaking to you. It's obviously quite an emotional podcast for both of us, I think, this one, but I hope it's made people think about how as clinicians, it's beyond the disease that we're always thinking. And so I'm really grateful, Naomi, for you to share your time and also share your

experience with others. And we will put a link to the book in the notes at the end. So just before we end, I always ask for three take-home messages, really. And I know this is going to be hard, but can I ask for three things that you think are going to make you a different and better doctor to perhaps you would be if you hadn't gone through the tragic loss of your husband? So I think obviously going through what I've done, you know, what's happened with Ari and my husband has completely changed me. And I kind of threw myself back into work straight away because I had to keep going for earlier. I had to keep going. Being a mum, being a working mum as well. So I think that would have changed me.

Being a mum has changed my outlook on, you know, patience. And combining those two together, I can't really think of a third one really. It's just because that's been the major trauma in the last three years. There's not been anything else going on apart from that. I think making you, I think I would say the third thing is, so you're making you stronger. Yeah. Having a child absolutely changes what you do in medicine.

And I think the third thing is empathy. Yeah. Actually, you're going to have more understanding and less judgment on people. Yeah. Which I think you probably would have that anyway, but I think those skills would be even more. Just your lived and experience with what you've gone through

will make you consult in. in a different, and I'm sure a lot better way. Yeah, and on the same lines of those. With Aria's books, actually, we've been lucky enough to send out copies to most of the medical schools in the country because we're actually hoping the memoir, the broken brain, brutally honest, Bruce,

and me, is going to change the way medical students kind of approach medicine and patients and, you know, not only I think the book is for anyone that's experienced can be a family member or themselves, but also, you know, for junior doctors or anyone in the profession, I'm hoping that that book will open their eyes, basically. Yeah, it's so near for mine when I read it.

And I think he's left an amazing legacy. And, you know, for any one of you who is thinking about reading it, it's very easy to read, isn't it? It's written in such a clear, lovely way. So I feel that he's always there, even though he's not here with us today. He's there somewhere, and he'll be very proud of what you're doing with you and your son and your career. And I just look forward to hearing how things go over the next few years for you

and also want to wish you good luck in your exams that are coming up soon. Thank you very much. Thank you ever so much for your time. Stay, Naomi. It's been great. Thank you. For more information about the perimenopause and menopause, please visit my website, balance, hyphen menopause.com, or you can download the free balance app,

which is available to download from the app store, or from Google Play.