50 Years of SIR

Episode Transcript

Recorded live from the Cook booth at SIR and featuring leading experts in the field of interventional radiology discussing a wide range of IR-related topics, this is the Cook@ SIR Podcast Series.

Hello, everybody. My name is John Kaufman. I am the Cook chief medical officer, and also an interventional radiologist by passion, by training, and by trade. And I’m here with one of my esteemed and inspiring colleagues, Dr. Vatakencherry, who will introduce himself. Then we’re going to have just an interesting fireside chat.

Well, thank you for the kind words. Yeah, I’m Geogy Vatakencherry. I’m a vascular interventional physician as well. Also, passionate about minimally invasive medicine throughout the human body.

So, Geogy, you are probably one of the most passionate people I’ve ever met about this, and whenever I think of “Who’s an example of an inspiring individual?” I think of you. How did you find IR? How did you get into this?

No, no, yes, great question. So, kind of the way it all started is, I was definitely on the route of surgery and probably kind of cardiac surgery. So, I went through kind of first to second years of medical school, and you know, kind of seeing the surgical side, went through surgery, and during that third-year surgery block, what I didn’t like—I loved the surgery, I loved the anatomy, I loved the pathology conditions—but what I didn’t like is the postoperative complications. And I’m like, “Oh, these patients are miserable. After we open them up or even laparoscope them, they’re not the same physiologically.” So, one of my patients went down to some area called IR, and I was pretty sure I was not going to do interventional radiology because of the word radiology, to be honest with you. I’m like, “No.” Someone said, “Oh, you should do IR, it’s really cool.” I’m like, “Uh, no.” And then I went there. He was the oldest person on our service, and these magicians who put a little band-aid at the end. He had a Klatskin tumor, a bile duct cancer. They stented it. He was eating breakfast the next morning and went home. The oldest person on our service, and he had as an effective therapy as any of his open surgeries. So, that’s when my mind was blown. I’m like, “All these other patients are miserable after these invasive procedures. He’s smiling, eating a full breakfast, like nothing happened to him.” And I had no idea what was going on in that suite. But I’m like, “I definitely have to learn more about this. This is the future.” That’s when I recognized minimally invasive medicine, and interventional is on the forefront of that. That’s what I recognized that day.

So what year was that?

That was in the late 1998–99, around that era, that time. Swischuk was actually an attending, James Swischuk at University of Miami. So, I was a medical student, you know, and just seeing and learning all that and going, “What is this?” Right? So. And then I heard of the work that Katzen was doing at Miami Vascular from my students, and they’re like, “Oh, you got to check this out. He’s doing aneurysm repairs and this and that.” I’m like, “What in the world is this?” So, as I learned more and more about it, I’m like, “Wow, this will kind of get my vascular itch and also provide minimally invasive therapy from head to toe, maximally effective, minimally invasive.” And that’s when I’m like, I got to like, definitely learn more about it.

You know, my own story is pretty similar. I knew I wanted to take care of patients, I wanted to do procedures, but I couldn’t quite find the right niche, and I actually tried a couple things first and ended up in radiology by default, because my father had been a diagnostic radiologist. And I just said, “I can’t figure out what to do. He’s a smart guy.”

Yeah, that’s fair.

“So let me just– I’ll try radiology,” and, man. To say I was not happy is an understatement. No patient contact. You would look at things and say, “Oh, I think that’s a this,” but then you wouldn’t do anything about it. And then at that time, at Boston University Medical Center, it was special procedures, and the first day I was on special procedures they put in that old Greenfield filter, which required a 24 French femoral venous access, and there was blood all over. You could smell the blood. And they said, “Okay, you can compress.” And I said, “What do you mean, compress?” They said, “Just hold pressure here.” And the hole was big enough, my finger kept going in the hole. And I said, “This is great. This is the best.” And they were real doctors and people would come down and talk to them and say, “What do you think? And what can you do?” And they were problem solvers. But again, I kind of just found it. How do you think it’s different today for people who might be interested in this specialty?

Yeah, well, now you can come out of medical school into this specialty, so it’s very similar to any of the surgical subspecialties that exist, or general surgery or neurosurgery or, you know, integrated cardiac surgery. You have a direct pathway for medical school directly into a minimally invasive surgical field. So I think that’s the fundamental paradigm shift that’s occurred. You don’t have to go, “Oh, I’m going to be just doing imaging.” I’m actually going to operate on the human body right out of med school.

So, the new training pathways, right. So, before that, if someone wanted to do IR, how did it work?

Yeah, so great. So the way I did it is I went through a direct– I did an internship, then I did diagnostic radiology for four years. But during that time, there’s a lot of elective time, but there was really no clinic and no ICU time, things that have been integrated or incorporated into the system. And then you apply for fellowship. So, you get a little bit of a feel from a procedural standpoint, but not what it is now. So, that’s the way it worked. There were some direct pathways and clinical pathways, but it was hard to find them on the website. It was not– like, it was almost hidden information. So I looked for them, but there was very few of them, and they were pretty competitive. So it was just hard to kind of find out about it or get into them at that time. But they were there, just hard to get to.

Yeah, we used to say that if you want to do interventional radiology, you first have to go through four years of getting clinical care beaten out of you–

Yeah.

In diagnostic, and then still be interested. And with the new training pathway, instead of 1,000 diagnostic radiology graduates that could potentially apply, there are 30,000 or 40,000 medical students.

That’s correct.

It’s kind of a different kind of group. When you kind of walked through this exhibit and looked at all the things and looked at that way back at the very beginning, when you see the tubing that you had to make your own catheters and that picture of the very first SIR meeting in Key Largo, and there were about 30 gentlemen, all very similar and a similar part of their careers and look at us now, and how do you put that together?

I think what we now have is a diverse cohort at this meeting. So you have students, residents, senior residents, so you have all levels, right? We have like pre-meds, premedical students are at the society meeting now. So they’re learning about it so early, and they are such a seasoned knowledge base that they have. I saw MS3s presenting on complex peripheral arterial disease yesterday, PGY2s that rotated with me that were quite frankly the level of a seasoned fellow, you know, 15 years ago. So, it’s a paradigm shift. And you’re getting a much more kind of– like, from a trainee standpoint, they’re bringing a lot of energy to the society. They’re bringing a lot of ideas to the society that if we just had the same batch of kind of senior leaders, you don’t get that thought process, right? We’ve already kind of developed a tunnel vision. We already are who we are. These are totipotential, right? They’re kind of like stem cells that are becoming different organs. They haven’t differentiated yet. So I think that’s probably the most exciting thing. Working with trainees you get a fundamentally different perspective than when we’re in our little echo chamber talking about how we do things or this is the way. They’re like, “No, what about this? What about that?” I’m like, “Oh, that’s a good idea.” So, I think that’s the paradigm shift that’s probably happened since, you know, RFS was developed and we really grew our trainee membership and their presence at this meeting. That’s what I would say.

Well, you, I just sort of, for the audience, let everyone know that you had a very influential role in the RFS, and we used to think of you as sort of the Pied Piper. And you’d be walking around and there’d be this whole trail of medical students following you. And yet how influential and important that has been. As specialties grow, being open, bringing people in earlier and earlier, bringing everybody in who wants to be in, how important that is. So, again, going back to this exhibit, there are just all these devices there. What surprised you the most when you looked at the devices that are in here and think about what we have today versus what our forebearers had to use?

I mean, some of these devices are still used today, right? So what’s old is new, is what’s new is old. So, I use—for our some of the aortic work we do—I’m using these kind of torqueable sheaths, and I just saw something here that’s very comparable. It’s a torqueable catheter. I’m like, “They thought about this.” You know, I saw them, like we were talking about, they were steaming them, and shaping catheters are kind of blunt and the wires and whatnot. But that is a torqueable catheter. I mean, again, now we go into microcatheter torqueable, but that’s 50 years later, right? So, that was a little bit surprising to me to see that they were talking about interventional as a, you know, they didn’t have the word radiology in some of the stuff. It was interventional angiography. I’m like, “Oh, that’s interesting.” And then seeing kind of the growth where, you know, Ernie Ring was sending him kind of a funny like email or letter, or probably snail mail back then.

Snail mail, yeah.

But to Dr. Becker to take over as JVIR editor and have an established journal for a new specialty was also pretty cool to see that letter, and then to see that other letter, which is Thomas Jefferson to George Washington, but it’s really Dr. Ring to the powers that be, “This should be a distinct specialty,” was something they thought of that long ago, was kind of something I didn’t recognize.

Yeah, that was 1989 as I remember, right?

Wow. Yeah.

Yeah, and the early trend in the thought that we were different was clear to everybody. You know, the original name of the society was the Society of Cardiovascular Radiology. Intervention wasn’t part of it, yet we were looking at the very first agenda, and the second item on the agenda was what you said, interventional angiography, and Stan Baum talked about GI bleeding. So right from the beginning, there was this idea that you could do things and maybe, maybe this grew out Dotter’s idea, you know, early on, that you can use a catheter to do things. So even though we were maybe heavily diagnostic initially, there’s always been this intervention drive, right.

A surgery without a scalpel concept, right, is really what he developed in 1963 in the, you know, which I thought was interesting that he went to Czechoslovakia, gave a talk at the Radiologic Congress where Rush was, right, and invited him to do there. And he had this like brilliant idea that, “Hey, maybe we can fix problems, not just diagnose problems, with the needle, wire, and a catheter,” which was mind-boggling at the time, right?

Yeah. It was–

It changed medicine forever.

Yeah, it’s amazing how it’s changed and created this gigantic specialty and all the companies that are around it.

Yeah. That came out. Yeah.

This is 50 years, as it says right there, “50 and forward.” So, as we go forward, what are you seeing as the big things for people to focus on for this specialty?

You know, to me, I think it really comes down, you know, we’ve had procedural excellence. We’ve really honed our skill sets from a technical standpoint. We’re growing the service lines that we treat. So, it used to be just kind of vascular, you know, and the different organs in the vascular system, like kind of vascular atherosclerotic conditions. But what I’ve seen is, from the endovascular side of our specialty, is really the blood vessels are our highway to do surgery from head to toe and treat arthritis, treat abnormal uterine bleeding or fibroids, treat pelvic pain, treat infertility, all through a vessel, treat knee arthritis, which, you know, back is now being looked at by some specialists is, can you take out the lumbar artery? So, I would never have believed that these things could all be fixed through a vessel, right? And now the extensive work we’re doing in venous disease, which has been underplayed for, you know, decades in the medical community, and these patients suffered, from superficial, which we’ve had a role in as a specialty for, you know, decades, to deep system, including the central circulation of the pulmonary artery and the right ventricle. And, you know, are historic, I saw the catheters that they developed for pulmonary angiography, Grollman, and those angled pigtail catheters were developed, and we were walking through this, right? And the flush catheters that they all developed 50+ years ago, probably. And to see it to now, where were you doing, you were saying 24 French. Now we have these closure devices that we can pre-close and get 24, 26 without having to hold pressure, right? And we’re getting big systems, and it’s like we’re doing with local in sick patients. So, I would never have like thought that we could do basically what would be the equivalent of putting someone on pump, cracking their chest, and taking out a life-threatening clot with a needle poke that you did when you were in training to put a filter in. And now we’re able to do heart surgery essentially, which is kind of where I started, right? That was my interest, and now we’re able to do arch work, right, and aneurysm work throughout the body from kind of the valve down. So I never would’ve predicted that, right? So, it’s pretty, I mean, it’s pretty impressive and pretty exciting as a specialty.

So, in your career, and I can say this, your brief tenure in your career, what’s been the most dramatic change in terms of procedures or devices? What to you has been like, “Wow, this just blows my mind,” this device or this procedure?

So, I mean, I have an interest in aortic work, and so I didn’t think we’d have solutions for paravisceral aortas. I understand infrarenal aortas from the days of Juan Parodi and Julio Palmaz and Volodos in the Ukraine and what they developed in the late ’80s and early ’90s. And seeing the evolution of some of that to now thoracoabdominal, which was done by a handful of people, is being done routinely, minimally invasively, and the rapid recovery. So, it’s basically leveling the playing field. But there are so many things. I mean, that’s just one of a countless number of innovations that I’ve seen, especially treating arthritis, which is a debilitating condition, and these chronic conditions. I think that’s exciting. So, there’s just a slew of events that we’re able to now treat that we didn’t historically.

So, why do you think embolizing an artery that goes to a joint takes away pain? And I’m asking you, not because I expect you to know the answer, but there’ll be a follow on.

Yeah, no, I mean, it’s this whole, you know, I mean, I defer to the guys like Yu Okuno and I will talk to Sid Padia and these other kind of, you know, Bagla, and these others who have been heavily vested in that space. And the thought is it’s an inflammatory component. You’re reducing inflammation just like an NSAID, non-steroidal anti-inflammatory, or a steroid does, we’re essentially doing through a catheter and just kind of pruning that vessel that’s causing that inflammatory response to that joint. So, we’ll have to adjust the nuances because the challenge, and I think this has always been my challenge, is, where does our one tool fit in the grand spectrum of knee arthritis, right? Is it the injections? Is it physical therapy? Is it a knee replacement? Is it a PRP? Is it, you know, a hyaluronic acid injection? What is the– or is it a partial knee replacement? Like, where do we fit in that area of space? And that’s always one of the challenges I face when we kind of have so many procedures, but where does that tool fit in that disease process? And it is something I’m still trying to figure out.

Well, what you’re pointing to is the importance of being a content expert. Not just a procedural expert, but if you’re going to treat arthritis, even though you have one tool to treat it, you need to know all there is to know about arthritis. You need to know what your colleagues and other specialties know about it to understand where you fit in and how to manage the patient. Yeah, one of the things I was thinking about is, who would’ve ever thought to go ahead and embolize arteries around a joint? And that kind of points to just this: woven into the fabric of this specialty is this innovation, this willingness to think outside the box, to be innovative, to sort of do things, try things in a different way that later on everyone goes, “Oh yeah, obviously, that’s how you treat that,” right?

Yes.

Because if you are a medical student walking through here for the first time, you’re going to say, “Oh, okay, well, that’s one of the ways you treat joints, obviously, because I see it, it’s in front of me.” But why do you think we attract people that want to do crazy things like embolize joints for pain, right? And think that people’s knees aren’t going to fall off.

I mean, that’s something I always kind of ponder. Like, what is it that makes interventional so, like, the innovative specialty? I think what happens a lot is sometimes there’s no options for patients, and so they come to us and go, “Is there anything you magicians can do?” So that is not infrequent, because everyone’s kind of signed off, like, “Oh, there’s no options.” And then either the patients seek an option, like Laura Shaw did, right? In 1964, she knew you had no options. So Dotter’s like, “Well, I thought about this. Let’s do it.”

Give it a shot.

Yeah, and it worked, right? She lived for two more years. She didn’t have to have an amputation. That’s a big deal. He was the original CLI fighter. So, in that same vein, we are in the hospital or we are in a situation where patients will come to us for unique problems that no one has a solution for. And so, we are kind of the problem solvers. And I also think that since we’re not a single organ, we’re kind of working head to toe, whether it be the neuro space to the toes, to the different organs to the spine. We use this technology in various conditions. So, if you have a scope, a GI doc may only use it endoluminally or certain places. We’ll use it potentially anywhere, right? Maybe in the thoracic cavity, maybe in the bladder, maybe in the ureter.

Maybe in an abscess cavity.

That’s right. Exactly. And we may take a technology that’s a large-bore thrombectomy device and say, “Hey, I can do a necrosectomy with this large-bore vascular thrombectomy device. Granted like an off-label, but we can use it.” And then that’s how the world evolves. So, I think we’re like almost like chefs, right? We have so many ingredients, and so they ask us to make this dish, maybe, you know, a South Indian dish one night, a Thai dish another, an Italian, and we’re very good at grabbing all these tools, putting it together, and coming up with a beautiful–

You’re making me hungry. I love all those, all three of those cuisines.

There you go.

Yeah, I’m trying to understand why we get people who want to make new devices, that they want to innovate. There’s something about this specialty. If you’re a person who likes to do something the same way every time, and the patient comes in: “I want to follow this protocol, and if there’s something that’s not on this protocol, I don’t want to have to deal with it.” As opposed to what you said: the problem solvers. My favorite situations are someone says, “You know what? We have no idea what to do. So anything you all can do for us,” and oh, we love that, because then you’re the– Everything’s churning and you’re thinking, “I saw this, I heard that. I just read about that. Maybe we could bring that together.”

Yes.

Yeah. What is it about, when you walk through here and you look at that picture of Charles Dotter in Life magazine and he’s blowing up, I think he’s either injecting, I think that’s all he is doing, is doing an injection, with this wild-eyed grin on his face. What do you think it is about this that kind of makes it something, it draws those kinds of people in? And I don’t know, maybe there’s no answer.

You know, I really heartily think it’s that problem-solving requirement that’s, you know, that we face as a specialty when no options are available for a patient, we’re going to be sometimes the last line of defense before the patient has no options. So, I think there are options, and we develop options. And I do think that, even if I wasn’t innovative, right, I may have been like, okay, algorithmic. You have to be innovative because you’re trying to fix problems minimally invasively. For example, I was just talking to someone yesterday and, you know, a filter got stuck. A balloon got stuck. You know, a surgeon would just cut and open it. He figured out an innovative solution in a minimally invasive fashion to fix it and close the groin with a couple of suture devices and was able to get out. And I was like, “How’d you do that?” And we all were just, we were so excited about problem solving, you know, outside of the main hall. So, I just think when we face these situations, and we talk to each other about at these meetings or nowadays Twitter or, you know, or through WhatsApp or Facebook. So, we communicate this and go, “Oh wow, that’s cool.” So we’re always thinking outside the box. It’s just something we do as a specialty. And you’ll see that at Extreme IR, right? And you can see that’s one of the most, like, attended sessions because like, oh wow, okay. Because we’re all going to face that issue, and we want to keep the patient safe by knowing that, right? Techniques is another example, right? Techniques is– the book is basically looking at, from technical, kind of tips and tricks and pearls, right? When I, you know, pick your brain, I pick your brain about kind of the evolution of our specialty and how we became our primary specialty, but I’m also picking your brain about the history, which I didn’t know a lot of this until I came through the booth, right? I’m like, “Oh, I didn’t know that,” and I’ve looked it up. I love history of, you know, medicine and specialty, but I didn’t know some of this until you see it in front of you. So, I think all those discussions that we have, all those cases we see here, all the, you know, ultimately, it’s, how do we keep the patient safe, right? And if we get into trouble, how do we get out of trouble while keeping the patient safe? So, these M&Ms that we see here are very important because they problem-solve to figure out, “Hey, why did this happen? And how do we prevent it from happening? Or if it does happen, how do you fix it?” So that’s all part of it. Ultimately, I think, is to solve a problem. Solve the patient who’s in front of you’s clinical condition to make them better and primum non nocere, do no harm. So, if you get into trouble, how do you fix it without opening them up? How do you fix it without cracking their chest? And I think that’s what it comes down to.

So, that’s like a great encapsulation of what we are. Innovation is our beating heart. Always towards a minimally invasive approach. And although I work for Cook, I say innovation is the beating heart of industry as well. And I have to sort of mention, none of this, we wouldn’t be anywhere without devices, right?

Of course, yeah.

And so, there’s this very interesting partnership that we have to have going forward. The idea is the ability to make these devices, you know, when Dotter was starting, we’ve, you know, I worked at the Dotter Institute, and we have all these handmade things that he did and sterilize and put in patients, and that’s not how it works anymore. It’s this long, long process, but you got to be patient. But that collaboration is–

Critical.

Really critical. You know, we were just joking. We’re sitting here in Nashville and an ambulance went by and we took a cut so that we wouldn’t have the ambulance, but we were joking that if you don’t love the sound of an ambulance, it doesn’t get you excited, like, “Oh, that’s probably a great case coming in,” IR may not be the right specialty.

That’s right.

You never know.

And I think that’s been the paradigm shift. Like now we’re recruiting surgical types, surgical students, that love that. Like they get a dopamine release when they’re in, you know, the endo suites fixing a problem, or patients, you know, crashing, we’re able to save their lives. So that’s been probably the biggest paradigm shift from outside of the, now diagnostic’s become more and more remote reading. So, it’s really two different personalities, you know, and we’re seeing that more and more so.

So, as we kind of wrap this up, what do you want to tell those very early med students, even maybe college students? We have college students present here. To keep them excited about our future, because it’s not easy. This is a hard specialty. It’s a lot of work. There’s always uncertainty about things. You never know. What would you say to them to keep them excited and really kind of wanting to do this? Because they’re– It’s so invigorating to see them around. You just think, “Oh, this is awesome. These people are the future.” But what do you want to say to them?

So, you know, I really do think it comes down to the patient and the patient’s family. So, what I tell trainees is like, listen, “Patients fight hard, so we have to train and fight harder.” And so, the training is going to be difficult, and it should be, because ultimately, that patient on your table or patient in your clinic deserves that. They need you to be at the top of your game, and that means you got to know your stuff. Your first couple years of basic science are important in medical school. That third year is vitally important, especially that surgery rotation and the medicine rotation. And you’ve got to learn your organs, right? Because it’s a human, right? The human is not just one procedure. It’s the cardiac situation, the pulmonary situation, the renal situation, right? It’s a heart, lung, liver, kidney, and the brain. You have to know really well, because they’re so fundamental to how that patient works, and what does the patient want, right? It’s not what you want or what you think. It’s like, how do you learn who the patient is in your clinic visit to guide them appropriately to do that? And you need to know clinical medicine, but you also need to know how to interact with the human at a kind of granular level, like a conversation. So, you need to know who they are as a person—married, kids, grandkids, what their hobbies are, where do they live, where did they grow up. And once you understand who they are and what their family dynamics are, now you can guide them to what you think is best. Because all I am is a guidance counselor at the end of the day. I do play with catheters, wires, and balloons. I love technology and I’m blessed to be able to use some of the latest kind of tools. But at the end of the day, my role is to guide and counsel a patient through their trials and tribulations. You see them sometimes at their worst, and their families at their worst. And we just have to help them through it. And so that’s the ethos of being a physician. Never ever lose that and you’ll do fine because you’ll always try to do the right thing.

Is AI going to put us out of business? I got to ask that question.

I don’t know. Well, so I think it’ll put, like, the world will be different, right? Abacus was there, calculators came. So yeah, of course, AI’s going to make everything smoother, right? AI’s going to be able to, we’re going to have simulators, we’re going to get better. It’s going to be an evolutionary change, and I think there’ll be kind of logarithmic changes. When that will happen, who can predict? No one can predict. But yes, AI will make it different. Will it put us out of business? No. Humans will continue to exist, and we’ll have some role, whether it be a guidance counselor, it’ll be something. It’ll make us better, though. I do think AI is going to make us better teachers, better operators. It’ll recognize our, it’ll go, “Hey, you’re doing this wrong. You know, or maybe you do this because 1,000 operators did it this way. Hey, this is a wire, this is the shape that would make that curve.” So yeah, I think there’ll be a role in AI, but it’s an evolution, right? It’s just like we’ve been evolving and we’re going to continue to evolve, and I think AI is just a part of the process, so we have to embrace it. I think it’s good for healthcare.

Yeah, IR is a person-to-person experience and it’s going to continue to be that way. It’s been a great conversation. Thanks for taking the time to chat. This is a great exhibit. I’m personally just so excited for the future. I think if you look at what’s happened leading up to this and you think about where we’re going to be in 50 years, it’s going to be unbelievable, but it’s up to all the young ones to make that happen, right?

I’d like to ask you a question. I mean, you’ve been so heavily involved, and, you know, we innovate, right?

Oh, no asking me questions.

Oh, no. Because I did appreciate the innovations award yesterday, right? You know, so the leaders in the field who really brought this, including you, brought this to effect, right? It’s not a small task, right? I’ve studied and analyzed, and I’d love to learn more about it from you. What you guys have accomplished to make it a specialty is something I’m awestruck by. So, what gave you the– And I think it had to happen and I agree with that, but like, what gave you the impetus in that group of SIR, of kind of thought leaders, to make this a reality? Because I know it was a lot of work and I know we met early on when you were promoting this at APDIR and I was like, “Wait, half the group doesn’t even believe in this.” And you were like, “Hey, don’t give up hope. We need you to drive the engine.” So, what made you have the impetus to make this reality?

Well, first of all, it wasn’t any of our ideas originally. When you look at this exhibit, you can see this idea has been percolating for a long time. That we just sensed that IR is different and it deserves a recognition to be different because it’s better for patients in the long run to be that way. This wasn’t about just being able to claim we’re different, but really seeing this as allowing us to go forward, to train, to practice in a way that’s going to be better for patients. You know, I think it’s like everything else, it just comes down to if you really believe in something and you just know it’s the right way to go. You have to accept, you may know it’s the right way to go and you may be wrong, but that gives you the drive to just make it go forward. People were beating us down and I said, “I’m not going to let them win.”

Wow.

Anyways.

That’s amazing. Thank you.

So, thanks for the conversation.

Yeah, this was great.

And this has been a great exhibit, and thanks to Cook for bringing this together for us. Thanks for giving us and us a chance to talk.