Episode 118: Masonic Children’s Hospital (ft. Dr. Gwenyth Fischer)

This week, we’re joined by Dr. Gwen Fischer, a leading expert in Pediatric Critical Care at Masonic Children’s Hospital. She shares how she and her team are navigating the intersection of compassionate, human-centered care and the growing role of AI in medicine.

“The amount of research and incredible breakthrough discoveries happening among my colleagues… I just don’t think we would’ve achieved any of that without the Masons supporting us.”

From Q-Rounds and building trust with families to complex cases like conjoined twins and the development of new technologies, we explore the innovations shaping care at Masonic Children’s Hospital and beyond. 

Gwenyth Fischer, MD, FAAP, is an Associate Professor of Pediatrics and Division Director of Pediatric Critical Care at the University of Minnesota.

Transcript

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Given all the work that you've done, what do you wish more people understood about pediatric critical care? So whenever I tell people what I do for a living, you know, I say that I work in a pediatric ICU. Inevitably, the answer I get is, oh, that sounds hard. And I think most people mean emotionally. It's hard emotionally to be around sick kids, and that is true. But I think the message that I'd like people to hear from that isn't so much that it's hard, is that I get to work with kids who are incredibly resilient and for the most part recover and I get to be part of that process. And so people who work in pediatric critical care, yeah, it is hard, but it is also insanely rewarding. And so I think that's a little bit misunderstood is kids are incredibly resilient and we get to see them recover and go back to their lives and live healthy lives. What are the most common conditions that you treat? What do you see? So the pediatric ICU starts at about the time that a baby is full term. So we have an entirely different ICU called the neonatal ICU, or nicu. Many people are familiar with the NICU that gets to take care of the premature babies. After they have gotten to that full term point, so they've gone home and then maybe they develop an illness, that's when we take over. And so we take care of kids who are about full term babies up to sometimes 25 and 30 year olds. So we get to see the full spectrum of ages. Um, some of the more common conditions that we see. Um, asthma, pneumonia. So a lot of respiratory diseases, especially around here in the winter. We take care of a lot of kids who have RSV, they have influenza especially. Babies are very susceptible to those. Um, we see kids who have diabetes. We see kids who have. Um, GI problems, um, severe, you know, um, norovirus is a big one. Oh God. Every once in a while we get, uh, you know, a nice rash of neurovirus going through the hospital. So a lot of the common things that kids that you see at home and many kids do just fine with those illnesses, and a few of them are just unlucky and end up with us. Dr. Gwyneth Fisher, you're the associate professor of pediatrics and division director of pediatric critical care at the University of Minnesota. Your work is focused on the developments, testing and use of medical technologies and drugs, particularly for pediatrics. what distinguishes pediatric critical care from adults ICU? Is there a big difference there or is it blur lines a little bit? Yeah. Re we actually have a lot in common. Um, we take care of a lot of the same illnesses. So pediatric asthma is much like adult asthma. Um, kids behave a little bit differently. Um, certainly. Toddler with asthma running around our unit and being upset that they're, you know, they're stuck with us is a little bit different than a third year old. Uh, but we do have a lot of the same disease processes. Um, one thing about kids is they tend to get sick a lot faster, and so having worked in both pediatric and adult ICU, that's one difference I've noticed. But the good thing is that kids also are very resilient and they recover a lot faster. we also have some different disease processes. So for instance, we, a large part of our unit is dedicated to taking care of congenital heart defects. So those are babies born or even later in life, discovering that they have a, a heart defect and we take care of them before surgery and then after surgery, right after they come back from the operating room. We'll also take care of bone marrow transplant patients. Um, much like the adult world. Um, same thing. We treat a lot of different conditions at Masonic Children's Hospital with bone marrow transplants. Um, and we do liver and kidney transplants as well, so, and, and heart transplants. So we do a fair bit of transplant just like the adult world. I think the biggest difference is, uh, we have really two patients in mind. We have the actual patient and then the family is a huge part of what we do. We have to take care of the family as much as we take care of the patient themselves. so you spend the majority of your time at Masonic Children's at U of M. The Masons who listen to our podcast are especially proud of all of the. Endeavors We have with university, the Masonic Children's Hospital, Masonic Cancer Center, Masonic Institute for the Developing Brain. We'll get into that in a second. Just the thought occurred to me, how do you communicate that complex medical information to parents or guardians? Does that make it more, how much more difficult is that when your patient is a young as a child and you have that family element added to it? It does make things a little bit more complex. So for example, the way I explain something, just when we talk about the patient to a 2-year-old, about their condition is obviously gonna be a lot different than if they're 17. So we have to take into account the patient themselves. Then families have their own personalities. So for instance, some families want to know every little detail. So, you know, maybe they're medical or sometimes they're engineers. We get a lot of engineer parents who are very, um, very wanting, very much wanting to hear every technical detail. So as we get to know families, we will tailor our approach to that. Some families actively tell us, you know what, just give us the bottom line. We trust you. We don't want to. Hear, um, you know, an hour long lecture about, about the physiology behind this. And so we really try to tailor that approach. Um, and then we also, we have to lean on our families also to understand how to interact with that, with that child, you know? They'll tell us that this is, this is the appropriate level that we should be speaking to that kid. This is their favorite things. This is how, um, we'll best be able to make them comfortable in our unit. So we, we do have to take some time to learn about that family and really interact with them. It's a lot of relationship building. Would you say more than a typical. Hospital setting or care setting though. Yes. Um, and you know, adult, adult ICUs definitely interact with families and they do their best to communicate with the patients. Uh, but children just are a little bit of a different beast. Um, I think, you know, anyone who's been in the hospital has probably interacted with the medical team and they try to give you the information. Um. As best they can and communicate as best they can, but I think that we have to hold ourselves to a little bit higher level when it comes to pediatric patients and their families and the expectations from those families are higher as well about how we're communicating with them. I've been looking forward to sitting down for this conversation because I'm so curious. How is technology changing your work? Is ai, how much is AI in the medical world right now? Is it just on on fire? That's a great question. Um, so this is probably the most exciting thing to me about medicine right now is. The technology, and as you said, ai, the digital world is changing so quickly right now that I can just see over the course of months how things are actively evolving in our unit. one example is that we are starting to build, um, smart diagnostics. So one thing that I think we are starting to build now, and in the next few years, we'll have, um, a very robust system of. So if your child is in my ICU, I'm gonna have a panel and it's gonna be measuring every little thing about your child every second. I'll be able to see that information. And then what they're doing now is developing those AI smart programs to take that information and give me warning signals like, Hey, over the past hour this child has had these 40 data points, and they're all shifting slightly to the point where. You need to go see that kid and make sure that everything looks okay. So I am excited about where the world of AI is gonna take us. I think there's going to be a lot of possibilities, um, in the future, both for diagnostics and therapeutics, honestly. You were born in South Carolina. Dad was a military vet. When he retired. What branch was he in? Uh, so my dad was in the Navy. He was a nuclear submarine commander. Um, so we spent the first few years of my life in South Carolina where he was, uh, his last post was his. And then he retired. So I, while I was born a military brat, I missed most of the excitement there. My sister got a lot more of the moving around. Um, but we moved up to Minneapolis actually, so he could work with Honeywell in some of their military, uh, research branches as an engineer, um, up here. So you grew up in Minneapolis, went to school all over the country. You were in Loyola for med school. Went to Dartmouth for pediatric residency and back to Minnesota though. I'm glad you decided to come back here. You did pediatric critical care fellowship and another fellowship in medical device development. I, um, I think like a lot of kids who grew up in Minnesota, I was curious about what else is out there. So I did do all of my training for the most part out in different institutions, and I'm glad I did that. I got a lot of great differing experiences that I might not have gotten had I just stayed at home, um, when I started my pediatric critical care fellowship. There were two reasons that brought me home. One, it was great to come home. Every good Minnesotan comes home eventually. Yes, is is what a lot of people say around here, and I think that's true. The second thing though is I knew that Minneapolis was a huge medical device community, and I had realized in my residency that that was gonna have to fit into my career in some way or another. And I hadn't figured it all out yet, but I knew that Medtronic was here. Boston Scientific was here. I knew that the University of Minnesota had this huge. Medical technology history, and so I was really excited to come back and figure out how I could be part of that. And you're the founder and director of the Pediatric Device Innovation Consortium. What is that all about? So the PDIC, the Pediatric Device Innovation Consortium, which is a bit of a mouthful, um, was something that I started one late night. Uh, I was in fellowship, and Fellowship is, um, some brutal hours. So it was two or three in the morning and I was trying to. Put this mask on this kid and this kid was in a lot of respiratory distress and I was very concerned that I was, if I couldn't figure out this mask, I was gonna have to put a breathing tube in. And I really didn't want to do that for this kid. 'cause I was pretty sure I was gonna be able to stabilize them if I got this mask to fit. But we just didn't have anything that would fit this kid. How old was he? Approximate two. Okay. Oh boy. So he is crying and trying to breathe, flailing, and his parents are crying in the corner. Um, flailing around and I could, we had this big mask that was too big. It was made for an adult. And then we had this tiny little mask that was made for like a premature baby, and I had nothing in between at that point. And I literally got duct tape out. We had some duct tape in a drawer. I'm trying to like. Finagle something that could fit on this kid's face. And I just thought, why, why can I walk over to the adult unit and have all the technology I need for this? But I'm sitting here and I'm using duct tape for this child of all people who, you know, is probably the highest impact patient that we have in here. Um, preventing them from having respiratory failure might improve their entire lives. You know, we're 2-year-old. Maybe it's another 70, 80 years. I, if I can avoid putting this breathing tube in, I might really affect what their health looks like for the rest of their lives. But we didn't have those tools. It was so frustrating. I realized at that moment that I needed to, I needed to dedicate my career to figuring out how to close the gap between pediatric medical technology and adult medical technology. They're about 10 years apart per the FDA, so, wow. 10 years. What's the pace of that gap closing? Uh, we have made some progress in the past few years, and part of it is because the FDA is beginning to realize that this is a problem. The reason we continue to be behind is because it's a smaller market and we live in a, you know, a, a world that is driven by markets. Um, and it's, it's no one's fault. It just means that if you have a pediatric, we'll call it a pediatric heart valve, and you know, you could make. $10 million if you sold this pediatric heart valve. Or you could develop an adult heart valve and you could make $10 billion as a company. That's, that is a for-profit company. That's an easy choice. that being said, the, when I started the PDIC, the. Companies around this town we're incredibly supportive. Everyone recognizes that this is a gap and everyone wants to help. So I've gotten a lot of industry support, a lot of support from, um, entrepreneurs in the area, scientists, engineers, everyone sees that, you know, kids are behind and wants to help solve this problem. So we're headed in the right direction. Are there recent advancements happening specifically at Masonic Children's here in Minnesota that have improved outcomes that you've seen? Absolutely. So the, the PDIC, um, is one of the larger avenues that pediatric medical devices get launched, um, from the University of Minnesota. And I would say that we are one of the big hubs in the country for us. We've been able to, uh. We've launched about 10 companies, uh, four, four pediatrics. Um, about seven of those have reached patient access, meaning that kiddos are now able to get those devices and technologies and, um, that's improved their healthcare. We, uh, have it, we've sponsored about 50 projects so far and are, uh, we've invested about $3 million into pediatrics using some scrounged up funds at times, but also getting a ton of support from the University of Minnesota, from Masonic Children's Hospital and of course the Masons. Um, and from that $3 million, we've been able to get about $28 million in follow on funding. Um, so that is something we've been proud of, but it's a long, it's a long process. Taking a medical device sometimes takes upwards of 10 years, and it's a high risk process. So we're proud that we've been able to get some, some great devices out. one example that I can give you, um, that I'm very proud of right now is something called Q Rounds. This has been, this was invented by a pediatrician at Masonic Children's Hospital, Mike Pitt, and it's an app that allows families to call in for rounds. And if you've ever been to a great Clipse, it's a very similar idea. Essentially families who might, you know, we round from 8:00 AM to 1:00 PM sometimes, so families don't know when we're coming. And pediatrics in particular, but also adults. we really encourage families to be part of that rounding process to understand what's happening with their, with their child. So Q Rounds allows families to know exactly where they are in that queue and they can see, oh, we're, we're third up. It's gonna be about 10 more minutes, we can go get coffee. Yeah. Um, they can also say, Hey, uh, we can't be here during this time, so they'll be blocked off. It's sort of a smart program. It also allows our translators to call in. It allows, um, our nurses to know when patients are gonna be rounded on. So it's made the process of rounding a lot more efficient and the feedback we're getting from families is just incredible about, about this. They don't want to go to any other units now because they want to be in a unit that has access to this smart rounding program. That just conjures up all the memories of being in the hospital with a loved one and not knowing when is someone coming by, and if I do run to get coffee or a nature break, will I miss them? Yeah. It's so frustrating as a family and then you're trying to call the doctor all day. Um, you know, and from a doctor's perspective, it's great too because we don't wanna be chasing families all day long, either feel like we're not being good communicators. So that's one of the pro, that's one of the, um, technologies that PDIC had a small role in, in getting out that we're very proud of. We're pretty mission based, so we don't, we don't just work in digital technology, we don't work just in hearts. Uh, we're focused on anything that's gonna have direct impact on pediatric healthcare. So we've worked on growing pediatric valves, um, that's a company that's been launched. Uh, we've worked on dentistry products, we've worked on, um, kidney products, heart products. Uh, so really we've spanned the entire realm of pediatric healthcare as long as it's mission based and we know it's gonna impact kids. You mentioned that 10 year gap between pediatrics and adults. I would imagine you spend a lot of time thinking about developing how you can close that gap. How do you manage the stress and avoid burnout in this? I would imagine you could get caught up in the excitement of this and suddenly 18 hours later, maybe I should take a break. Well, I think it's, it's really important to keep your eye on your North star, right? Um, we all have a, a compass that we're following, and there are definitely days where I have to remind myself what my mission is. My mission is like the other 250 pediatricians who work at Masonic Children's Hospital. My mission is to improve children's healthcare, and sometimes it just comes down to that. If it doesn't fit in that mission, then I shouldn't be spending my time on that. I think we've all developed recovery mechanisms as well. So, you know, for me, I love to travel. Um, I love to work in global health, so that's an area where I can go do a very different kind of medicine, um, and feel like I'm making an impact in a very different way, and that really does help me reset. Do you do medical ventures when you, and sometimes in some of those travels, do you, are you out treating patients when you're. Some more broad. I do. Yeah. So we have an amazing global health program at the University of Minnesota. It's one of the top ranked programs globally. So we have a lot of that infrastructure built in place already. Um, for the pediatric ICU, we have a number of partnerships. One is with a children's hospital in Cambodia called Chela. Hospital. They do amazing work there. So we send people regularly to both, um, do education. Most of what we do is education on pediatric ICU topics. Uh, but we also do research with them and they, they run the research. Um, it is their project, and so we just help fill in some of the details. Sometimes we help them find the right technology. We have a team out there right now who's working on setting up, um, an infectious disease lab for them, with them in partnership with them. So that's been really exciting. another place where we've, uh, had a lot of work partnership with is, um, in Rwanda. We have a, partnership with Butaro Hospital, which is up in the mountains. Very beautiful, amazing, amazing doctors there. And they came to us and said, we. Do a ton of cancer work. We do. We see a lot of really sick kids. We're up in the mountains, there's dirt roads. It takes five hours to get back to Kigali. Can you help us set up a pediatric ICU? So we've been working with them for a couple years on that, and we have an open pediatric ICU. They've saved a bunch of lives there, which is incredible. It's incredible to work with doctors there. We're so knowledgeable, um, and just, you know, fighting the good fight, if you will, out there. So those are two of the partnerships that just bring a lot of joy to a lot of us who are able to go out there. And, um, I honestly feel like I get more out of it than they get for me being there. Um, I feel like it really helps me reset and just remember why I'm in medicine. These are the stories that don't always make it on the news. These collaborations. That's amazing. I've always wondered what the information sharing looks like. If you have a breakthrough on research at Masonic Children's or our Masonic Cancer Center, I have to believe that isn't just sitting there in a vacuum. How do you collaborate or share that information with other medical professionals or facilities around the country, around the world for that matter? Yeah, it's all about team science these days. So I think, you know, a few decades ago, scientists and physician researchers were maybe a lot less collaborative. There was a feeling of. Acting like a solo individual doing your research and making a name for yourself. It's impossible to do research like that anymore. You need a team and the more collaborators you have, often the more impact you're able to make. So, uh, we collaborate across multiple universities on a lot of big projects. So for instance, clinical research. Especially in pediatrics, almost always needs many, many different sites to do a pivotal trial. So we'll do drug trials at Masonic, um, where we're part of 34 sites across the country. Wow. Because in order to get the numbers that you need to prove anything scientifically, you need to have that many partners. So we work really collaboratively across the country. And more. Also, we're becoming very multidisciplinary with other colleges at the university. We're discovering that, um, working outside of our own little universe and pediatrics and pediatric critical care is actually benefiting our research. So I have multiple colleagues who are working with the, um, public health college. I myself work with engineering college, not surprisingly, but also with the design school. Uh, the design school is actually one of my biggest partners. We have people who are actually working with the vet school quite a bit. That's a great area of synergy that's really, um, you know, created a lot of amazing research. Uh, but we're finding that more and more in order to do really good science, we need really great partners across, out and outside of our own disciplines. Is there something you're most proud of that you've done with Masonic Children's? A, a breakthrough, a project. a specific case with a patient. Wow. Uh, so I, I can share one story. I can share stories that, um, families have given me permission to share. And I'll tell you one from a few years ago, and that was the conjoined twins. Um, we had a set of conjoined twins and we have, again, we have permission from the family to share this story. And it's been in the news, and this was several years ago. We did some amazing innovation around taking care of conjoined twins in our hospital, one of whom needed heart surgery. Very significant heart surgery shortly after they were born, and a lot of things came up that you just wouldn't think of. So for instance, we in our computer system, we have one room, one bed. How do we put two? The babies are connected. How do you make the computer system realize there's two babies in one room? How do you keep track of which baby is which in the room? Um, so we ended up painting one's s nails red and one nail's blue, and there was red baby and blue baby. Um, and they, you know, each had had names and the names were quite close together, so we had to be very, very careful about giving drugs and, um, you know, doing any medical procedures to make sure that the right one was getting the right therapy. Um, also it was. Very interesting to see, um, some of the thought that we had to put in around, so if you give a patient Lasix, which is a diuretic that um, helps us remove fluid, the other child's also getting that. Yes. So how is that gonna affect the second baby? So the innovation around that was incredible and, and certainly other people have taken care of conjoined twins. Um, the. The piece that I'm most proud about that particular story is that the surgery was going to be extremely complicated because of the way the girls were connected. Um, they were connected by the heart as well as by the chest, and so our cardiac surgeons and pediatric surgeons had to figure out how are we going to safely disconnect the girls? So in order to do that, we set up a virtual reality system and took all the surgeons over there. We 3D modeled the girls using CT scans. Wow. And we were able to, we had a huge screen. We were able to put 3D glasses on, all the surgeons and the cardiologists and the rest of the team. And we were able to rotate the girls around. And actually during that session, we discovered two things. One. There was a small piece of the heart that was connected, which changed our entire plan for the girls about how we were gonna disconnect them. And the second thing we discovered is that our original plan of having the girls on their bellies for the, for the disconnection surgery was not gonna work. And so we actually flipped them over. And I honestly think that, that using that virtual reality technology is in part why those girls survived. On top of having. World renowned surgeon experts who were able to disconnect them. Um, so really just the power of technology and being able to review that surgery in great detail with our virtual reality tools and our 3D modeling ahead of time, um, made a huge difference. And I'm excited to say both of those girls are doing great. They're both still running around in the world. How old are they now? Oh man, they're, they're getting up there now, 6, 7, 8. They're, um, fortunately we don't see them nearly as much as we used to because they're so healthy. Um, so that was, that was really great and a fun, very innovative project to be part of. What are the hardest parts of your job emotionally? you can imagine, it's, uh, it's very hard even if you've been doing this for a long time, when you have a death, um, when you have an outcome that you didn't want for a patient. So I think, um, when you've been in the ICU long enough, you start to develop ways to deal with that, but it's, it doesn't make the emotions of that go away. It just helps you mitigate the effect of those emotions. So that's definitely part of it. Um, I think one of the more. Challenging pieces of of ICU is that there's always something that's gonna roll through the door that I have not seen. Just when I think I've seen everything, something comes through that door and I don't know what it is, and I have to figure something out quickly. Um, and so that's, that's, I mean, in one way, in some ways, that's. Part of the fun part of that job is, uh, it's always gonna be challenging. Yeah. You're never gonna feel completely comfortable in that unit because there's always gonna be something that happens that you are a little bit unprepared for. The spontaneity of that has to be. An adventure and yet terrifying. Yes. As my father used to say about his nuclear submarine, you know, for him it was hours of patiently waiting with minutes, you know, interspersed with minutes of pure terror and, and there's a little bit of that in in the pediatric ICU as well. I keep thinking about the relationship factor of medical professional caregiver to patient and family. You can't substitute the relationships with technology or AI or all of these amazing things you've described. How important is it to you in general in the world? That we maintain relationships as people or that community factor? Yeah, when I think about ai, you know, there's all these tech billionaires going on, uh, on the media telling me that I'm not gonna have a job in three years. I don't really believe that, honestly. Um, I. Very interested to see how they're gonna deal with the FDA. First off is they have to clear a lot of regulatory hurdles before that happens. And then secondly, they have to gain the public trust. It's sort of like an airplane. I mean, we have all the technology in the world to fly a plane autonomously right now, but people still want a pilot. I won't get into the Waymo either, by the way. I personally love Waymo, but that image of the car that was right next to the train did make me a little bit nervous. I hope to say the one on the, uh. The roundabout was terrifying. Yes. So, uh, I, I think that I, I don't see how you could replace the human component. I do think AI will be our partner in, maybe it's 10 years, maybe. And, and it will, it will integrate into what we do. And I think that's actually a really good thing. I just don't see how a parent, at least in the ne, at least during my career, uh, is gonna come in and want to talk to a computer about how scared they are about their child and how are they going to have those conversations about. What should they do? Should they, should they put that trach in? Should they not put that trach in? Should they do the big Sur surgery? Should they not do that big surgery? Uh, I just don't see the technology's going to be able to take over that part. But what I do imagine is I'm gonna have an AI tablet with me that says, you know, here's, here's the exact percentages based off the data we know about your. About, you know, your potential outcomes here is exactly where your child is right now based on all of their data and everything we know about them. And I think that's actually gonna be great. We're gonna be able to personalize medicine a lot more than we currently do. We can use AI as a tool to really get into the details, but the balance of maintaining the human to human connection and incredible technology to ensure that the care is of the highest rate. Exactly I, for those of people who are concerned, I really don't think we're anywhere near Terminator, at least for the healthcare industry. You've read my mind. The Masons of Minnesota and Minnesota Masonic charities are so proud of our heritage and long support that we've had with Masonic Children's, the Masonic Cancer Center, the Institute for Developing Brain. So many great breakthroughs, advancements in technology. It's really special to hear directly from you as a physician. The impact being made by those that are, are donating in some way, whether that's with time or financial donations. Sometimes we maybe lose sight of all of the things happening literally in our backyard at the university with this relationship with Masonic Charities, our Grand Lodge of Minnesota, and specifically with you with Masonic Children's. It's just fantastic to hear about this. I have to give a huge shout out to the Masons. Uh, I really don't think my career would've been possible without the Masons, the amount of research and just incredible breakthrough discoveries that are happening amongst my colleagues. Uh, it's just a really special place, and I just don't think we would've achieved any of that without the Masons supporting us. So we, we continuously appreciate that support, so thank you for that. You're currently living in South Minneapolis with your husband who is a food scientist. What is that all about? He's a big nerd, really. Uh, he, uh, is, his background is in chemistry, and he has worked in a number of startups as well as. Larger companies really focusing on how to develop food, um, which sounds scary, uh, but really he's looking for ways to make food healthier. And right now he works for a company called Fairlife. Uh, they make Core Power, which some people may have heard of. Yeah. To milk product out there and, and also some great milk. And the great thing about that product is they've come up with a way to. Make it healthier, essentially, it's still milk. Um, and it's lact, it's okay for lactose intolerant folks, but uh, it's got more protein than most milk and a little bit less sugar. And so he wants to optimize food so that it's the best it can be for the human body while still maintaining its taste. He's really, really, feels strongly about tasty food. So it's not turning into astronaut food or in the military. We had the meals ready to eat. They were right. Not, not that, but it's avoiding that. Yeah. The best quality possible. Absolutely. And he is a big chemistry nerd. Uh, he uses that chemistry knowledge to set up very complex salt water aquarium systems in our house. And so. He has, you know, a, a very complicated dosing, micro dosing system for our aquarium. So the, the chemistry continues in our house. We have a lab in our basement. Uh, it's a little frankensteinian, so nobody wants to take care of your aquariums when you're on vacation because it's too delicate of a equation, right? It's, it's extremely complicated. We were talking about this in the office earlier. Curious on your take on this, what TV show is everyone obsessed with that you just cannot get into Seinfeld? I don't really understand Seinfeld, which maybe is the point of Seinfeld. 'cause it's, it's this show about nothing, right? Nothing. Yeah. I've noticed that a lot of the old shows are coming back and I don't know if that's for, you know, just comfort reasons, which I get. Uh, but Seinfeld is a show that I never completely understood made. There just weren't any moving plot points. Did you ever get into Curb your enthusiasm? I, I think that one was a little bit more up my alley a little bit more, uh, I don't know if it's just a little bit more snarky. Larry, David is a, the master. No doubt. What's in style right now that you can't stand smash burgers. I don't understand them. Why, why do you smash food into like a two dimensional f? Hideous thing when you could have like this nice fluffy cheeseburger. Uh, I don't get it. I've never stopped to look closely enough. Is it real? Is it lost? Its continuity. They're literally smashed. It's like a pancake. It's just falling apart. Yeah, it's flat. That's kinda defeats the purpose, right? It's not very aesthetic either. Was just in Dallas recently and of course in and Out Burger. So wish we had it here. Yeah. And we never will. I know we won't, but what a why not why in an out burger. If you're out there, come to Minneapolis, we, we will appreciate you. I, I think we're gonna be stuck with what we have. And they like to be in the warm weather climates where you can sit outside and stuff. Well, they're definitely not gonna get that here. Right. So I've been told, I just dream about that, that day coming. What do you have? Way too much of. Fish. Uh, we, we have a lot of aquarium in house. How big is this thing? Yeah. The most we've ever had is about 800 gallons of salt and fresh in our house. We had a 600 gallon aquarium in our basement for several years. We used to host the Twin Cities Aquarium events at our house. So we got very deep into it, and then we went on vacation for a week, came home, everything was dead in our 600 gallon saltwater aquarium. What happened? Uh, my husband was literally on his knees in tears. Uh. They're very sensitive. And so, you know, he has a huge program on his computer where he's dosing magnesium and calcium and controlling everything. And the sensors in the aquarium broke. Oh no. So when we came home, he had been told by his programs everything was great and everything was definitely not great when we got home. And if you've ever been into Saltwater Aquariums is what happens. Eventually they crash. Um, they just tilt out of, out of sink a little bit in the whole, the whole house of cards falls. So now we're down to an 80 gallon salt water and a couple of smaller, fresh water tanks, which feels a little bit more manageable. We can go on vacation without there being tears or catastrophe. That was my question. Did that ever lead him to think we're done, never doing this again? I led him to think that. I said, this is the last time we're doing this. Well, that's a good segue into my couple more questions. What is both a blessing and a curse? Wow. A blessing and a curse. Um, I'm gonna say this, Minnesota weather, it's a blessing because, you know, seasons are great and change is great and it gives us all something to complain about nonstop. It's a very neutral topic at cocktail parties when you don't know someone. Yes, but let's be honest, I mean, if we could all have beautiful weather all the time like they do in San Diego, or, you know. Any of the West coast or south, um, we probably would choose to do that. We wouldn't appreciate it. We wouldn't appreciate it. I think you're right. My friend was golfing in San Diego recently. He was a walk-on with a foursome and one of the gentlemen who lives in San Diego, retiree scratched his head and said, what month is it? Anyway? When that can you, I can't even imagine. You know, I have more conversations about the weather with people I share grants with across the country. It's just like such a, you know, forgive the pun, but an icebreaker, uh. they delight in making fun of me for our giant snowstorms and our horrible weather. And so it's to say it's a great, it's a great way to get sun, get to know someone on very neutral, easy ground. Always invite them to visit here in July and August. 'cause they can never believe the full spectrum of misery that we gets. And in those months we're, I'm still ready for fall by August. Oh, absolutely. It's too hot in August. Never happy. We're never happy. What is your favorite emotion? Does gratitude count as an emotion? I think gratitude is something I continue to work on that I feel like has to be a daily practice for me. Going back to how do we survive challenging times and challenging jobs. it's, uh, it's something that I feel like is integral to me focusing on mission and then also being able to appreciate, uh, things both inside and outside of work. So, you know, daily gratitude practice. Um, and, and maybe what. As an emotion. The gratitude is really the thing that brings me to joy. So I guess joy is the true emotion that that results from, that. Your work is bringing a lot of joy to a lot of people, both locally and quite honestly around the world. Ah, well thanks Reed. Thank you for visiting the studio today. I know you have quite the schedule. Dr. Gwyneth Fisher. Thank you for the work you do at Masonic Children's. Oh, thanks for having me. And thank you to all you Masons who are supporting us.