Jesse Ehrenfeld: Doctor. Veteran. Advocate.
About Our Guest
Dr. Jesse Ehrenfeld is a doctor and Professor of Anesthesiology, Surgery, Biomedical Informatics and Health Policy at Vanderbilt University.
In 2014, Ehrenfeld was called to active duty and served a tour in Afghanistan at the NATO Role III Multinational Medical Unit, where he was constantly relied upon to care for wounded U.S. service members and coalition forces. He still receives messages from people he helped and saved.
"Science is a team sport. It’s not about an individual."
Dr. Ehrenfeld isn't your typical doctor. He is a also a veteran and advocate for LGBT patients.
A longtime advocate for patients, equality, and LGBT health, Dr. Ehrenfeld made international headlines on February 22, 2015, when he asked the newly appointed Secretary of Defense Ashton Carter his stance on letting transgender individuals serve in the military. (Also check out this article featuring Dr. Ehrenfeld "The Navy Doctor Who Pushed for Trans Troops to Serve Openly Pushes Back on Trump’s Ban")
He is a former Speaker of the Massachusetts Medical Society, where he was the youngest officer in the 228-year history of the organization.
"There definitely have been moments in my career where people have said to me, this is going to prevent you from taking the next step being successful."
Watch the Episode on YouTube
[05:00] What made you move to Nashville?
[06:30] How has your experience so far in Nashville?
[07:30] Tell us about your 2014-2015 military experience
[10:00] What are some of the differences and similarities of serving for NATO, and for Nashville or Boston?
[11:00] How was the support network when you were deployed?
[14:00] Can you share any particularly tough experiences that you can remember from that period (of military service)?
[17:00] In 2015, you asked a question to the Secretary of Defense, how what that experience?
[21:00] What are you doing today for LGBT health?
[24:00] LGBT health is not an easy topic. How has that impacted your life?
[28:00] How are you coaching and teaching young physicians?
[31:00] You are the youngest speaker at the Massachusetts Medical Society. How did that happen?
[34:00] Let’s talk about your high school (Phillips Academy)
[36:00] New Millennials like to take some time off before going to college (and medical school). What’s your take on that?
[07:00] Science is a team sport. It’s not about an individual, or doing something on your own in a dark lab somewhere. Particularly on clinical research, and I really feel lucky to have wonderful collaborators and support in the work that I’m doing.
[08:30] There are at least three service members that are at home today with their families that wouldn’t not be here if I hadn’t been there. That is a deeply satisfying to have been a part of.
[12:00] When you are eating, living, sleeping in the same tent with people over and over and over, you develop a level of comfort and awareness of the people around you that you just don’t get in any other setting. It’s really pretty profound.
[26:00] There definitely have been moments in my career where people have said to me, this is going to prevent you from taking the next step being successful. I’ve made a decision that if it was going to, then I just had to deal with the consequences of that. [...] I didn’t have a lot of role models, at age 19. It has been in some cases challenging, but I hope I’ve been able to be a role model for others.
Fei Wu: [00:03:11] You are currently based in Nashville Tennessee?
Jesse Ehrenfeld: [00:04:39] That's right. And in Nashville since 2010 coming up on seven years this summer.
Fei Wu: [00:04:44] Wow. When I Googled your name you know MGH just really doesn't give you what it says as can or has a number of building everything.
Jesse Ehrenfeld: [00:04:55] Yes the paper trail and the Internet that never goes away entirely. But I left them MGH In 2010 to take a position that Vanderbilt's was basically recruited to create research informatics division within the Department of Anesthesiology at the pleasure of building up that team over the last period of time and have taken on a number of other roles since I've been here. Admirable.
Fei Wu: [00:05:18] Wow. So yeah let's talk about you know what made you moved to Nashville and what are some of the progressions since then seven years you build a team. What is that like.
Jesse Ehrenfeld: [00:05:29] You know so I was not at all expecting to leave Boston. I was I was totally happy in my little fiefdom as over my corner of the world and MGG but my mentor got recruited to become the department chair at Vanderbilt. And I can remember being in his office and he said what do you think about Nashville. I said well I've never been to Tennessee. I said I think as long as I don't tell people that I'm gay and Jewish in the same sense it will be fine. And I have been just delighted at how easy the transition has been how warm and accepting everyone as has been. And then I want the best things that I ever have done both personally and professionally for me.
Fei Wu: [00:06:14] Well I I must say I also sort of when I saw Nashville Tennessee and realized how open and transparent you are not only about your professional life but also your personal life you know there was a kind of deeply embedded question to kind of ask a you know what has that experience been like but it sounds like that transition was smooth. People were very friendly.
Jesse Ehrenfeld: [00:06:35] It has been and you know one of the things that has been great for me professionally is just the spirit of collaboration that I have sort of found myself in and I don't know if that's a southern thing or something unique to Vanderbilt but it's been a wonderful part of my transition here. And certainly it has facilitated the success that I've been able to enjoy both in the research space as well as in other parts of my life you know science is a team sport. It's not about an individual doing something on the road. You know in a dark lab somewhere particularly in clinical research outcomes versus kind of space. And I really feel lucky to have wonderful collaborators and support in the work that I'm doing.
Fei Wu: [00:07:23] I think the past seven years has been quite something for you. A lot of things happened as I was researching reading Wikipedia. Tell me about a little more of other 2014 to 15 military experience you had.
Jesse Ehrenfeld: [00:07:38] You know it was a little unexpected. I joined the Navy sort of towards the end of my residency and I always thought that you know if I deployed and won somewhere I rather be on a ship than in the tent in the desert. And you know there I was in Afghanistan because it was a NATO trauma hospital that I was staffing. But the way that things worked is as a NATO facility in the Navy was providing the personnel with their staff. So even though it was sort of an army run joint base with NATO allies there was a naval officer and anesthesiologist on the stand. One of the most challenging things I've ever done certainly one of the most rewarding things there are at least three service members that are home today with their families that would not be here if I hadn't been there. So that is a deeply satisfying thing to have been a part of. At the same time was really hard on my family. It's hard on me. You know I was very focused on the mission. You know I had something that I I knew I needed to do. I was engaged in making sure that we were ready to handle what was coming. And yet my now husband fiancé at the time was you know sitting home on the couch wondering when I would call wait waiting for the phone to ring. Not knowing when exactly just to hear from me and so stuff like hard on and it was hard on my family as well. I think harder now than it was on me just because I had that sort of you know with me that I was a part of it and very engaged in it. And the task at hand. But while I was there I got to do some grunt work both as a physician as well as trying to do some advocacy for health in general. And I certainly value all those things.
Fei Wu: [00:09:34] I was going to ask you what are some of the similarities between serving at inside Mayo versus at a hospital such as Vanderbilt or engage. But I guess a better question is are there any similarities or more differences.
Jesse Ehrenfeld: [00:09:48] You know the medicine doesn't really change right. Human physiology is the same no matter where you are in the world but the equipment that we had available was the same sort of standard equipment that you would have in any major U.S. hospital. The same monitors the same technology we didn't always have everything that you would have in terms of capabilities. But because of where we were the point in the war where I was serving there was tremendous infrastructure that had been built up the supply lines were fairly well-established and so by large we had most of the kinds of things that you would expect. We didn't have some of the advanced imaging technologies and those kinds of things. But we haven't had a CAT scanner that was available for us to use this at this facility. So always the case with all of the different places where care is provided out in the field. Before I was that was the experience that I had.
Fei Wu: [00:10:43] Wow I feel like the support network maybe slightly different. You know you can it’s unlike MGH where you could call up someone you know tech support right away. What was it like for you personally on the ground?
Jesse Ehrenfeld: [00:11:03] Well you know we had a very small team of physicians that were with us. One of the challenges that our rotation had while I was there was because of the drawdown in the force. They actually had had the same hospital staff with more people more physicians more nurses more technicians and so we were sort of in a transition period where they're trying to figure out how to maintain the same level of capability is a much smaller footprint because of the Department of Defense's efforts to get the total number of deployed personnel below 10000 troops in theater at any one time. So there was kind of that component to the experience was a bit challenging but I have to say in spite of having a small number of people there we were a highly functional you know all my career all my life as a physician. You know I've worked in teams as Nancy they all just in the operating room. You know we work hand-in-hand with are surgeons and our nurses and our technicians. But when you are eating living sleeping in the same tent with the same people over and over and over.
Jesse Ehrenfeld: [00:12:14] You develop a level of comfort and awareness of the people around you that you just don't get in any other setting. And it's it's really pretty profound when I would be in the trauma bay and we would have a casualty brought to us to see the level of experience that was brought to bear on any individual patient and the teamwork and collaboration was extraordinary. You know there are just very few circumstances where you would have you know five senior attending physicians simultaneously at the bedside caring for a patient anywhere in the world you know in my hospital at Vanderbilt's. You know you may have one or two you may have console's come in and seen the patient individually but to have everybody there at the bedside all at once bringing all of that knowledge and skill together was really something that I've just never experienced. Prior to that and I and I have experienced since and it was it's certainly a unique thing and pretty incredible to see and be a part of the fleet together.
Fei Wu: [00:13:20] You all live in the same place and eat together I never thought about that. I never had a professional experience like that. We just we just go home and we come back and we want to check their emails late at night. You know that sounds like that the level of synergy can never be understated. And well I just I feel like it's almost so profound that for anybody to even experience that I think your life and that would be the same.
Jesse Ehrenfeld: [00:13:46] Really. No. And as I think about you know the military certainly has brought a lot to civilian medicine in terms of our understanding about techniques and acute blood loss and the way that we can approach trauma surgery. But there's also a whole component around team based care. And in her professional approaches writing you know the best that we can that I think we still have a lot to learn on the civilian side.
Fei Wu: [00:14:15] You know I interviewed a few guests we have been in military service I notice that sometimes they do tell me a lot of that experience feels they feel traumatized by their moments that they find it hard to reflect. And I'm really thankful that you're able to. And I wonder. Out of the you know. And many more people you have three in critical condition who would have now are reunited with their families if you weren't there. Do you remember maybe one instance of what that scene was like what that moment was like for you.
Jesse Ehrenfeld: [00:14:48] And there were many instances of patients that took care of that that you know I'll never forget. And I remember in fact one of the most poignant things that I remember was a soldier an Army soldier who had been shot through who came in pretty beat up and we took care of her we got him in the operating room got him stabilized in in and I'll never forget watching him walk out of the hospital with you know his arm you know holding on to one of his battle buddies. But more or less of his own force being able to leave and go back in. And I know that he would be back in the fight it wasn't going back to the U.S. He was staying with his with his unit and knowing that you know we were able to sort of help him and so many others you know maintain their ability to contribute to the mission and was just incredibly warm and is also usually you know sort of poignant and impressed in my mind. Some of those that did not survive and we had incredible success at saving people. But not everyone. And those were challenging moments for all of us. I attended several funerals while I was overseas. Remembrances of those that had fallen and the bravery and courage that was witnessed and described to me by those who had served alongside those who get taller and was just extraordinary. And those actually are some of the memories that I know will stay with me for the rest of my life.
Fei Wu: [00:16:44] Thank you for sharing that I know it can be challenging. And what I find particularly intriguing is the fact that you know in 2015 I learned that you were asking a question to I believe at the time 2015 secretary of defense.
Jesse Ehrenfeld: [00:17:18] So tell me about I want you to share the experience of so shortly after I got to Afghanistan one of the Air Force docs called me and said that they were sending an airman over that needed some assistance from the hospital and she then said that this gentleman was transgender and I was a bit surprised because at the time there was a ban on transgender service in the last place you would expect to find a transgender airman was deployed because of all the reasons you can imagine. And yet here was this person who showed up in our hospital. And so fortunately he didn't actually need a whole lot of medical care. I'm a little bit as distance news. He was basically good to go. But I stayed in touch with him and we kind of became friendly and it became clear to me that here was just an incredibly courageous person who all he wanted to do was to be with his unit family in the mission. And frankly was stressed by what he was going to find out. How is it going to impact his career was that to be able to stay and do what you've been trained to do to perform his job. So a few months later. We had one of these kind of unannounced two town halls in the new secretary of defense it was I believe his sixth day on the job you've just been sworn in arrived.
Jesse Ehrenfeld: [00:18:55] I was present at that true town hall and this transgender airman was next to me. And I sort of recognize that literally this was a person who had no voice right who could not stand up in and ask about this issue because of the situation that he was in. And so I turned to him and I said if you could ask any question what would it be. And so I stood up and asked the secretary of defense in front of the press pool his thoughts on open transgender service in an austere environment like Kandahar where we were in Afghanistan. The secretary gave a very favorable response. He apparently had not read the talking points that his staff should have given him. It was only days. And so that led to some very positive steps at the time of the moratorium on discharge review and also the decision by the previous administration to end the ban on transgender service. June 30th of of 2016 were a little over a year after I had the opportunity to ask that question was deployed.
Fei Wu: [00:20:07] It's not just the word open mind it can really cover it. But like he said you know how courageous that is to step forward and to serve the country. And you know that somehow is overlooked. And instead people are focusing on you know something in my opinion they're completely irrelevant. And there we are and we're having this conversation and it just so refreshing and encouraging to hear that from someone like you in addition to your military service. I know this that you are strong. And you know advocates for LGBT I you know for patient care possibly for other physicians and doctors as well. So I want to learn more about you know what you're doing today and really in the past decade.
Jesse Ehrenfeld: [00:20:59] You know you know unfortunately LGBTI health is just not something that historically has been taught in medical schools. And when I got to Vanderbilt's there was a desire on the part of our students to learn more and be better prepared to serve patients. And so the school institution embraced that and said you know we ought to be doing better is a disservice to our students and to our patients to not provide the right kinds of opportunities to integrate this content into our training programs. And so we went through a kind of a systematic exercise of try to figure out where we can integrate content into our existing curriculum. And we pretty quickly discovered that you can teach something in the classroom but if you don't then model that behavior in the clinical learning environment or clinics or hospitals then you will be successful. And so it was not long after we embarked on some curricular reform efforts that we recognize we really need to start building our clinical programs. And so it was really that it drove the creation of that interval program for lesbian gay bisexual transgender and intersex health and the acronym a bit of a sticky issue because you know patients know what LGBT means. And I and others have moved to language that gets away from letters and they talk about sex and gender minorities. But patients don't know what sex in general minorities are. People on the street don't think of themselves as sex expert minorities so we were stuck with LGBTI and we have a a clinic for intersex or disorder or patients with differences of sex development at Vanderbilt and so while intersex patients are quite different than transgender patients a lot of the medical considerations are are similar and so is the expertise required to care for those patients. And so our programs decided at the outset and we continued to include those patient populations and those that we are focused on.
Fei Wu: [00:23:14] I think you're really good at picking difficult subjects you know and I don't think most people can imagine what you have accomplished at a young age. And I couldn't print out your CV with literally 63 pages long. I was so I have so many questions. Many of these pages but in particular you are in the medical field. You are already seen as being very successful and on top of that you've picked a topic it may be difficult to approach maybe turning some people on or off. It's in a in a way a quote unquote that they are safe topic for you to go after. How has that impacted your professional or personal life?
Jesse Ehrenfeld: [00:23:54] Great question. I mean certainly LGBT health is definitely not as safe as calcium channel signaling or other research areas but something I'm passionate about and I made a decision early on that it was a place where there were I could have an impact and I needed to have an impact. And I do remember going to my department chair shortly after I got to in the role in having a very frank conversation with them and saying you know there's an opportunity here and I really want to pursue this to work in the field of LGBT health. And without hesitation he said I will support you the entire way. And he has as has held true to that and made it much easier than it could have been if I were at a place where there wasn't that kind of support. You know Vanderbilt has a long history of advocating for equality. And if you look at the steps it's taken as an institution that has been very progressive out in front of those issues for any institution let alone an institution in the south. And I know our leadership has been very proud of the fact that we have really led on a lot of these issues. We were the second academic medical center in the country to have a program for LGBT health after in our university of California San Francisco.
Jesse Ehrenfeld: [00:25:23] And we're very proud of that and continue to be there definitely have been moments in my political career where people have said to me this is going to prevent you from taking the next step being successful. And I made a decision that if it was going to the I would just have to deal with the consequences of that. And thus far that has not been the case. I feel very lucky. I think you know that when I was growing up and I came out at age 19 I didn't have a lot of role models to look too successful. How gave physicians who were making an impact. And so it's it's been in some cases challenging to figure out what that pathway is and what that looks like and I hope that I've been able to be a role model for for others. And certainly you know I really love the opportunity to to mentor trainees and students and other people in this working field and I think that that's really how we how we create change and get to a better place across the country.
Fei Wu: [00:26:27] While I love how daring that decision is and I mean this isn't any career change or impact to a career you know medical fields and study. It's just a long drawn out full commitment. Every doctor I interview said you better love it wholeheartedly because there is no turning back. You know I just love those moments. And I've spoken with many people on this podcast I feel like I love going after people who make decisions that are sort of out of the ordinary for a decision that many other people simply wouldn't choose. When I said there's one area that I absolutely love. I personally feel very strongly about Lisa Leffert feels very strongly about is coaching young physicians. And you are also young which I find that probably very easy for them to relate to that I have heard things that you know physicians after training internship by the time you come out of school you're ready to be a doctor. You were often I don't know timeline wise in your early 20s 30 and you have still very little experience kind of interacting with the real world even how to market yourself as physicians so there are a lot of questions that are unanswered that people are struggling with. Could you tell me a bit more about how you are coaching and teaching goes in that domain area.
Jesse Ehrenfeld: [00:27:51] You know I think that a couple of things that I always try to advise you know others that I work with on this is one is you have to find something that you're passionate about. Or you know it's going to be impossible to have a 30 plus year career that's sustained and fulfilling and that doesn't really being burnt out if you know really true of what you're doing. And you know I think a lot of people are multi potential and they end up in a specialty or field because of up a mentor or some you know rotation that they did. But that doesn't mean that people can't change direction. And I've seen a lot of very successful people you know make decisions about change in direction. My primary most longstanding mentor you know was a basic scientist doing crystallography with a very early success and that had good NIH funding and decided one day to basically hang that up and pivot into Health Services Research and informatics and then had a very successful career in the operational space. He's done some other interesting things. Totally different than where they started out so I always try to tell people that I think it's important to keep an open mind because you may have spent you know every ounce of energy up to a certain point or focused on one area.
Jesse Ehrenfeld: [00:29:19] But there may be something else that may be related and maybe synergistic or maybe totally different. But I think it's important particularly for early professionals to sort of maintain their minds though. The other thing I always advise people is I really can't emphasize the level of importance of mentors. And you know I have lots of mentors and lots of people that I look to for advice way I really try to surround myself with people that can help guide me and you know you don't always have to take your mentors advice. But I really believe that getting a variety of perspectives on decisions that you're making is helpful and that can be a very formal thing it can be a very informal thing. And there are plenty of people that I have met along the way that I have stayed in touch with that you know probably don't consider me their mentee but I'll reach out to them from time to time more or give them updates or ask them for advice. And I know that I get mentorship from them. And so things sometimes don't have to be labeled. But I think that recognizing that you know surrounding yourself with with bright motivated successful people is certainly something that I've tried to do and I think that can be helpful.
Fei Wu: [00:30:39] I love that message and I see an ad elsewhere outside of hospitals and personally for me it's a marketing consulting where how you know how helpful that to have a program can be but oftentimes overlooked you know people organize and devised to be a mentor or a mentee. And even as a mentor and as a role I played. I learned so much from the people that I interacted with. I know I mentioned age several times I notice there's something that I capture that the top you were a part of an organization or a speaker that I believe a message she said that's been around for 228 years and you're the youngest.
Jesse Ehrenfeld: [00:31:35] The Massachusetts Medical Society you know I was elected by Speaker and the speaker and I had the distinction of being the youngest person in that role in the 200 something year history of the organization. And that was in spite of doing work in LGBT health. And in one of the fun things for me is that I was the vice speaker for three years and then I became speaker. And why was the vice speaker the speaker of the society who became a good a good friend and also mentor Dr Rick Peters who is a radiation oncologist in Massachusetts. Know I graduated from the same high school. And over in the fields Cowdrey except he graduated exactly 30 years before I had him. It was just a wonderful thing to work with him. And then the person who became my vice speaker and then also my speaker he and I were at the same high school at the same time. Dr. Rossman are a radiologist in Boston. He was your how did we get into her.
Fei Wu: [00:32:42] Wow. What was it like for you to maybe speak in front of an audience and you know among other speakers belonged to the same organization and be someone who is so young. I mean how does that make you feel. Do you feel that there is just this insane amount of pressure that's been put on you.
Jesse Ehrenfeld: [00:32:59] There definitely is a lot of pressure. Fortunately people really like what I did so that that made it easier. I think I was pretty well-received. I think like with anything else whether you're young or old white or Asian or black gay trans whatever. If you can prove yourself and you can do the work that you are assigned or set out to do then those things shouldn't matter. And I really I really firmly believe that. Unfortunately I think that underrepresented groups those who have been marginalized by society often find themselves in a position where they have to prove themselves to get the opportunity to get that chance. And that's that's unfortunate they're not given the benefit of the doubt. The way that the others are for me that's just made me work harder. And I found that you know fortunately I've been able to you know have a successful career and a lot of different spaces but that's been my kind of perspective on it.
Fei Wu: [00:34:01] You may not see yourself or might not even enjoy to be called an overachiever. And so looking at your profile and for people outside of Massachusetts you know Phillips Academy is Ivy why would say one of the most competitive schools in the country and I know people graduate from there from Commonwealth schools at over BBN and all within the network. I remember reading a story about a Chinese woman who graduated from Philips moved on to Harvard and wrote an article about how easy Harvard seems to be her. So what was the transition like. I want to talk about high school I think it's that.
Jesse Ehrenfeld: [00:34:39] Oh yes I will I will concur with that woman that I have never worked as hard in my life and not in college not in medical school and residency as I did when I was at and over. It was intense. It was a time where I was incredibly focused. I was managing my time down to the minute get everything done. But I walked away from that incredibly well prepared to do so much later in my life. I feel incredibly indebted to the experience because I know that God set me up to be where I am today.
Fei Wu: [00:35:23] Wow. You know a lot of millennials these days as they're thinking about it because a lot of the listeners are younger and they some of them might never become doctors and there may be particular interest in this path not knowing what type of doctors they're going to become just yet some don't like to take time off or kind of explore other interests. What's your take on that. Because what I've heard recently is if they decide to take some time off that might actually take away the opportunity. We're sort of the momentum they build from undergrad to medical school. You know it's hard to go back to school.
Jesse Ehrenfeld: [00:35:58] People do it but I have I have seen time and time again whether it's advanced training after one is is done is in practice to come back to school or go back and get another degree or after you graduate college to then come back into a structured program which if you're you know making some money and you've got kind of a life that you enjoy. You know every year we have a number of kind of nontraditional students that don't go right into medical school through college at Vanderbilt. And I think that they bring a really helpful and unique perspective. But it can be it can be a challenge. But when I was graduating from college you know I had friends who were going to Wall Street and work for Goldman Sachs you know investment banking and other interesting things like that and for a little while I was kind of jealous. I was like wow. Like they're going to do with all this cool stuff and you get like a real job and making money. And then when I when I got to medical school I realized that suddenly I had all kinds of opportunities both with individual people a window into their lives as well as beyond that that people just don't get without being a physician.
Jesse Ehrenfeld: [00:37:18] And so my second year of medical school I had an opportunity to go to China. And it was the China medical board of New York wanted to have a conference on the ethics of human subjects protection. And they were looking for a handful of US medical students to come into to be a part of that. And so I kind of raised my hand and applied and was selected and I got to go to China and have just an incredible cultural exchange just sort of here and learn about the different perspectives that people have on you know how do we really engage patients in consent. And what does it mean to have to do medical research. From that perspective. And in those kinds of opportunities whether it's an advocacy or service have just never stopped since I became medical training. And also this. And so I am no longer jealous of my friends. I have discovered that that going through my training pathway has given me different opportunities but opportunities are just extraordinary beyond belief and I really value that. Wow. I get asked a lot questions sometimes from my mentees about work life balance and family life because it's hard. It's hard for me it's hard for a lot of people because you know coming to work doesn't feel like work.
Jesse Ehrenfeld: [00:38:42] I love it. I love what I do. In so making sure that I have some sense of making sure that things are where they need to be with the rest of my life is important. And so my husband I talk about that fairly often. And we have not always gotten that right but we've gotten to a really good spot with how we kind of treat a gate and manage that. Most days I try to be home at five o'clock with my husband and we take our dog for a walk and we were cell phones at home in and for that hour. I know that that will be there with each other and no matter what happens afterwards or what happens before we always have a time to kind of reconnect. And we do other things like that. I think that making sure that there are mechanisms in place regardless of whether you're married or having significant other or not to ensure that you can always kind of have a restorative of this sort of moments. Because I think frankly those are kind of what sustained me and the rest of the work that I do.
Fei Wu: [00:39:47] I love that advice because it's very easy to engage I think it's practical and also very achievable. I I hope I go to Nashville one day and that this just has been such an incredible experience for me talking to you.
Jesse Ehrenfeld: [00:40:02] Jessie I really should definitely come down as a great city and a lot of check out.
Fei Wu: [00:40:06] Yeah for sure. A lot to learn. So thank you so much.
Jesse Ehrenfeld: [00:40:11] It's a pleasure.
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