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Perseverance in Pediatric Rheumatology: A Medical Marathon | Kristin Graham, APRN

• Ashley Love • Season 1 • Episode 40

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Kristin takes us deep into the world of pediatric autoimmune disease, where conditions like juvenile idiopathic arthritis, lupus, and dermatomyositis affect multiple body systems and require tremendous coordination across specialties. With striking clarity, she describes the challenges of working with patients who've often spent years searching for answers before receiving life-altering diagnoses.

Our conversation reveals the remarkable complexity behind treating these conditions: from reviewing extensive labs and specialist reports before appointments to crafting treatment plans that families can actually implement at home. Kristin shares the emotional weight of fighting insurance battles for necessary medications and supporting families through the ups and downs of chronic illness management.

Perhaps most fascinating is Kristin's parallel life as a professional cellist and how she sees profound connections between music and medicine. "It's not a race, it's a marathon," she explains, drawing parallels between perfecting a difficult musical piece and the patience required when treating chronic conditions. Both demand focus on long-term goals without immediate gratification, a perspective that serves her patients well.

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Ashley :

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-health student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at shadow me next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests.

Ashley :

When Kristen Graham first applied to work in pediatric rheumatology and immunology, she didn't know much about the specialty, just a few glimpses from her time as a pediatric nurse, caring for children receiving specialized infusions. She thought her path was headed towards primary care, but that application and a little bit of curiosity opened the door to what has now been a decade-long career. Caring for some of the body require coordination between multiple specialties and demand persistence in the face of insurance hurdles. She talks about the emotional landscape of working with patients and families who have searched for years for answers, the patients required to manage chronic illness, and the importance of staying curious and asking questions, even when you are the expert in the room and there's another side to Kristen. She's also a professional cellist. The way she describes practicing for months to perfect a piece mirrors the long game of medicine focus, discipline and a deep commitment to the people you're showing up for.

Ashley :

Her story is a reminder that sometimes the most fulfilling careers begin with the jobs we didn't plan for and that our passions outside of medicine can give us exactly what we need to keep showing up inside of it. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. This is Shadow Me Next with Kristen Graham. Hey Kristen, thank you so much for joining us on shadow me next today.

Kristin Graham:

I cannot wait to chat with you.

Ashley :

This will be so fun. So Kristen and I know each other personally. I just adore Kristen and, um, there's actually a really great question that's come of that. So thanks for being here. Thanks for joining us, of course, yes, so Kristen's a nurse practitioner in pediatric rheumatology and immunology. Such a fantastic career. You are just insanely smart in my eyes, for working in that field, do you? Feel smart working in that field, I would imagine you do.

Kristin Graham:

It's been a lot to learn, let me tell you, and I didn't know, I did not know anything about rheumatology or immunology when I started the position I'm in now, 10 years ago.

Kristin Graham:

It'll be 10 years next month, which is kind of expected when you start in our field. Even residents that come through have had limited education and training in rheumatology, immunology and medical school, and so when they pass through and they do rotations, which are electives, they don't even have to rotate with us. So a lot of people don't get any exposure whatsoever, even in residency. But they come through and you know we expect them not to know very much. And so the same thing goes when we hire new nurse practitioners or PAs. You know, we know that they haven't had a ton of education or exposure in their graduate school programs, and so we were just ready to hit the ground running and it's going to be a huge learning curve for new people, just like it was for me, and I learned a ton, a ton, a ton in the first year especially, and it was a while before I started feeling like I kind of knew what was going on in the lay of the land. So it's been quite the journey.

Ashley :

I would imagine it sounds just like this hidden gem of medicine, and I think the first thing that I loved about you was just you as a person. And then the second thing was that you worked in this field that I knew so little about and, like you said, we get very little training on it. Um, let's just jump into that. Actually, I was going to go a different way, but let's jump into that. How, what drew you to it? I mean, if we don't get training to it, a lot of students will say, well, Ash, you know, why do you? Why do you? Why did you know you were interested?

Kristin Graham:

And well, I don't know. Let's ask Kristen, how did you know you're interested? Um, so I so, as I, after I graduated with my master's program and I was looking for jobs, um, I was working as an RN in the inpatient pediatric med surge unit and IMC unit and we had had a few rheumatology immunology patients come through for overnight admissions to complete, like infusion therapies and whatnot, like IVIG and biologic meds, and so I'd had very, very little snippets, little peaks inside that world, but nothing, not a ton. And so when I was graduating, my intention was to go into primary care that's what my degree is in is pediatric primary care and I was job searching, just, was going through the interview process and wasn't finding what exactly I was looking for. And so I was, you know, brought in my search more, just kind of like maybe I need to look somewhere else.

Kristin Graham:

And so opened up into the specialty world and there was a job posting for rheumatology and immunology and, I kid you not, I applied, not knowing very much about it. I was just, you know, I needed a job, I wanted to get a job and I had to do some Googling before I did the interview, just to kind of refresh my, you know, understanding of what that field was, and so I could know a little bit more about what I was going to be getting myself into. So it was really, I feel, like fate. There wasn't anything particular before that moment that drew me to it, but I couldn't be happier that this is where I ended up here on Shadow Me Next.

Ashley :

We like to talk about quality questions. This is a segment on the here on Shadow Me. Next, we like to talk about quality questions. This is a segment on the show where we discuss an interview question that you might see while you're interviewing for your health professional school, whether it's medical school, pa school, nursing school, et cetera. Now, kristen and I did not get a chance to discuss a quality question, but what she just mentions brings up a really good example question, but what she just mentions brings up a really good example.

Ashley :

Tell me about a time when you didn't know much about a patient population or specialty you were stepping into. How did you approach that steep learning curve? One of the most important things you can do as a future clinician is admit when you don't know something and then take action to learn it. Kristen shares how she stepped into pediatric rheumatology knowing very little about the field, but she embraced the challenge by asking questions, researching constantly and being open to what she didn't know. For you, this question isn't about having the right answer. It's about showing that you're willing to be vulnerable, to learn quickly and to earn trust. That's the kind of growth mindset admissions committees and future patients are looking for. Keep in mind that there's more interview prep, such as mock interviews and personal statement review over on shadowmenextcom. There you'll find amazing resources to help you as you prepare to answer your own quality questions.

Ashley :

You know, there's two points to that that I really want to remark on, and the first is that even a small exposure while you're working as an RN, on the floor with the kids getting IVIG and these really specialized treatments that you didn't always see, even just a small snippet of that, was enough to open the door for you to say, hey, I remember that you know, when you start, when you, after you've graduated, um, it's just amazing to me how such a small window of what we've seen can really can really looking to the future, can really expand and show us things. It's just very cool. And then the second one is the fact that you researched before you had to go on your interview. It's just amazing and it's so good.

Ashley :

I love getting to hear a medical professional say that they still do that. I would still do that. So if you have an interview coming up, get in there. Research, learn about what the job entails Maybe the people that are interviewing you, if you can. Those sorts of things. Thank you for commenting on that. We don't talk about that enough.

Kristin Graham:

Yeah, no, I think it's great to you know, be vulnerable and like, admit that you don't. You don't know a whole lot about something and I'm going to research it and I'm going to look it up. And you know, I'm not going to be ashamed that I don't know everything, because nobody can be expected to know everything you know. And even if my patients ask me a question I don't know the answer to, I'm not afraid to say, oh, you know, I don't. I don't know the answer to that right now, but I will definitely look it up and I'll get back to you and I'll let you know. So I think it's great to ask questions. I think it's concerning when we encounter medical professionals that are afraid of asking questions. I think that is a little bit of a red flag. So I really appreciate the vulnerability that comes with asking questions, which is so important for the learning process.

Ashley :

I'm sure when you first started, lord knows, you had enough questions. Um, when you, when you first started on this incredible job in rheumatology and immunology you've been there for gosh you said 10 years now. Yeah, 10 years, yeah, unbelievable. What. What does a typical day look like for you? I think a lot of people probably have many, many questions as well about this career.

Kristin Graham:

Sure. So when I first get into the office on a workday, the first thing I do is review my in-basket and get results reviewed. Our specialty is very lab heavy, so we order a ton of labs, we order a lot of imaging. So reviewing everything that's come in from patients you saw the day before or a couple of days prior, addressing anything that needs to be addressed. We also have an infusion room that's connected to our clinics for patients that are prescribed IV infusions for their treatment, so like IVIG or intravenous immune globulin for people who have immune deficiencies, and then biologic therapies which are immunosuppressants or immunomodulatory medications used to treat their autoimmune disease. And so we do have a large portion of our patients that get IV infusions connected to our clinic. So we have to ensure that they have all the orders they need and that their medications are correct and everything's lined up so they can get their infusion smoothly. So we kind of review that and then we get our day started with seeing return patients. So as a nurse practitioner, we see all the follow-up return patients, whereas the attendings will see brand new patients that have been referred to us. So we see return patients who are coming in for follow-up or for checkups and it depends. The frequency varies depending on what process or what point they're at they are in in their um journey, in their diagnosis, and if they're a new diagnosis they come more frequently versus if they're well controlled in remission they come less often.

Kristin Graham:

But, um, the bread and butter of what we see in rheumatology would be JIA, which is juvenile idiopathic arthritis, um, and there's multiple different types of JIA. There's about six different types, seven if you're getting fancy. But it all depends on kind of the character of their arthritis how many joints are involved if there's fewer. If there's four fewer joints versus more than four joints involved. If they have small joint involvement versus like axial or spine involvement, hip knee involvement. Also, if they have other features associated with it, like if they have psoriasis, they would fall into like the psoriatic arthritis category.

Kristin Graham:

If they have systemic JIA, which is the most serious and severe form of JIA, just like it sounds, it involves multiple body systems. You can develop interstitial lung disease with that pericarditis. You can have skin rash, flare, fever and then the most serious complication being like macrophage active activation syndrome, which is essentially like a cytokine storm where your body is in this acute hyperinflammatory state and can be life-threatening, so that would be the most serious form. So we see lots, lots and lots of JIA and people can have JIA in itself or they can have arthritis in association with other autoimmune diseases like lupus, like sarcoidosis.

Kristin Graham:

So we see arthritis kind of within a lot of our different disease processes and not always by itself. I would say lupus is probably the next big thing that we see Systemic lupus, also discoid lupus, just affecting the skin and scleroderma. So having skin fibrosis um is another big one juvenile dermatomyositis, so inflammation of the muscles and the skin which can cause severe muscle pain and weakness, where we see kids come in who were previously walking, running and cannot get out of bed because they have such severe muscle weakness they can't sit up in bed, they can't get up out of bed, they can't walk, they can't swallow. So some of these diseases have extremely severe repercussions. So you get a whole wide array of things that we see and you never know what you're going to walk into. It's always a mystery what your day is going to, how it's going to unfold. You just have to be on your toes and ready for whatever comes in.

Ashley :

It's incredible, kristen, thank you. Thank you so much. I really enjoyed listening to that. Some of those disease processes they do coincide with dermatology, which is what I do like dermatomyositis, for example. So I would imagine in rheumatology and immunology it's a really cool field because you are focusing on these very specific diseases, but they're affecting full body systems.

Ashley :

And so you really you have a little bit of all areas of medicine, I would imagine. So again, I've told you guys she's a genius, the smartest of the smart, to do rheumatology, immunology. You have to be so. It's cool when you mentioned labs and imaging. That's very digital, it's very technological and there's a lot of numbers there and a lot of decision-making there, but you also get the human real human.

Kristin Graham:

So many physical exam findings. Yes, you get everything which is so cool. So, like for lupus for instance, you can have so many different body systems involved, like the skin. You can have the arthritis, you can have the lung disease, pericarditis. You can have neurological effects, you can have cerebritis affecting the brain that can cause seizures or cognition issues. You can have hallucinations, psychosis, suicidal ideation. So there's just a ton to cover.

Kristin Graham:

Renal disease is a big one. We see a lot of lupus with kidney disease which if it goes untreated it can result in kidney failure and dialysis for these patients. So when we see like a bad lupus patient for follow-up, it takes a lot of time to go through their chart because it may have been three or four months from the last time you saw them, but they may in that time period have seen multiple other specialists like dermatology, pulmonology, cardiology, neurology. You know the list goes on and in order to get a good grasp of how they're doing you have to go through all of those notes. Hopefully you have them all. Go through all those notes and see. You know what's the status of their lung disease. What's the status? What was their most recent echo and EKG? What was their most recent PFT and you know, is their skin rash controlled?

Kristin Graham:

So it takes a lot of review before you even go into the room. You're looking at all this, all these documents and labs and imaging results that might be available to you before you even step into the room. So that's. It's very time intensive. And then once you get into the room, you know you're asking them about their symptoms and what they're feeling and what issues they're having with their medications and all that and then physical exam findings. You can see all sorts of things oral sores, rash, you can hear, abnormal breath, sounds, arthritis, obviously. But all of that goes into tailoring their treatment plan and coming up with the best modifications that'll help them. So it takes a lot to you know. I think some people don't quite understand how much time goes into seeing these patients, but it is very time intensive.

Ashley :

Absolutely, and there's again. There's a bunch of different ways. I want to go off with this, but I think I think the biggest thing that you mentioned is the fact that, because there are so many organ systems involved in some of these diseases, they have already been referred to many specialists from their primary doctor. And my question for you is these are pediatric patients. They've been bounced around. They probably feel like they're not being heard, but the conversation here is this is a bigger picture problem. How are they frustrated when they get to you? Are parents angry when they get to?

Kristin Graham:

you Tell us about that and how?

Ashley :

you manage that.

Kristin Graham:

That's a great point we do. We see patients who have had symptoms or complaints for years, sometimes before they're ever diagnosed, and so they've been passed around from doctor to doctor and they, you know, don't have any clear answers. You know they have a lot of different symptoms affecting different areas and you know there's not one thing that is being, you know, identified that can explain them all. So they come to us, and oftentimes it has been a while, and unfortunately that sometimes results in having patients who have chronic damage from inflammation that's been going on unchecked for a long time, um, like joint deformities if they have arthritis, um, and scarring skin rash, um, and failure to thrive, you know, not growing and developing, gaining weight like they should. So it's, you know, I think they do come in pretty frustrated sometimes, but the relief of finally having an answer, you know, is so it's exciting to be able to give them an answer, although you know it's not exciting to get a diagnosis of lupus, for instance, or arthritis.

Kristin Graham:

I mean, it's a chronic disease that's going to follow you forever. There's no cure. We have great medications to treat these things now and we continue to. There's still new biologics coming out all the time with new FDA indications. So it's really such a growing field. But our a lot of our diseases are perplexing and they're very much a puzzle and it's very mysterious. So, you know, for people who love mystery and puzzles and you know, figuring these things out, you know rheumatology is a great feel for you.

Ashley :

So if that's you, then come on in and you are an actual genius because the things you guys know and figure out, it's just incredible. I honestly forget Dr House. They need rheumatology and immunology. They need a show about you guys and of the.

Kristin Graham:

From what I've heard. I've never watched house, but from what I hear a lot of our stuff is on. It's featured in those episodes.

Ashley :

It's all such a mystery and it literally involves everything, so they can turn it into a whole.

Kristin Graham:

TV show because they have to do all the tests?

Ashley :

Um, yeah, let's let's talk about the chronicity of some of these diseases. You, you, um, you were in pediatrics and we've talked about that. Are your patients? Are they all babies? Are they mainly like? Does JIA affect all pediatric patients, from start to 18?

Kristin Graham:

So, yeah, so if they're diagnosed um under 18, or if they've had symptoms you know from before because, again, sometimes they have symptoms for years before they ever get into CS If they have symptoms that have been going on since before because, again, sometimes they have symptoms for years before they ever get into CS If they have symptoms that have been going on since before they were 18, they would fall under juvenile arthritis.

Kristin Graham:

But depending on the type of arthritis, we do see a more predominant age group, with some of them like an oligoarticular, which is involving four or fewer joints. Sometimes we'll see a lot of toddlers fall into that category. So we'll see kids come in with big swollen knees that are limping or they were previously walking and then regressed and didn't want to walk anymore, were crawling or just didn't want to bear weight on their legs at all. So we see a lot of toddlers in that category. I'd say psoriasis is probably more school-aged kids and adolescents, and then same with ankylosing or juvenile ankylosing spondylitis, which is more of an anthocytis-related arthritis picture. They would fall more into adolescence typically. But yeah, we do see a lot of young kids and some systemic GIAs that are very young too, which is scary.

Kristin Graham:

Um cause they sometimes come in with. They've had fever, abundant origin for you know, ongoing, ongoing, recurrent um for a long time and um by the time they come to us, sometimes they have very severe disease. But, yeah, so it can affect very young kids.

Ashley :

Yeah, and and and. Like you said, these are chronic diseases. This is something that you know. Perhaps one day they might hear the news that they're um in remission currently from this, but it's something that you, you walk through with them for a while, especially when, something that you, you walk through with them for a while, especially when they're seeing, you know they might see the attending first, but now they're going to be seeing the nurse practitioners for follow-up what to describe what the relationship maybe with these, these patients, but also their families, is like, cause, I'm sure you get to know their families quite well too.

Kristin Graham:

Oh, yes, very well. Yes, yes, quite well too. Oh, yes, very well, yes, yes, um, yeah, they, you know, we see them for so long, um, and their disease there's ups and downs and they may even evolve over time, like they may have started out as one type of arthritis and they kind of evolve and change, especially when you go through, like puberty hormonal changes oftentimes can cause um, can kind of shake the boat, um, but yes, we do. We do get to know the families very well, um, and just life in general. You know you have to roll with the punches.

Kristin Graham:

There's always going to be changes in these, in our patients, families, lives, um, they're going to have, they're going to move, they're going to lose a job, they're going to lose insurance, and so you kind of have to navigate all of those hurdles and barriers with them. We see a lot of families that have low income or limited resources, and so we have to work with them, with social work, to try to figure out what the best care plan is for them that they're going to be successful with, you know, treatments that they can afford, that they can do at home if transportation is an issue, versus if they need to come in trying to find transportation for them, and so there's constantly barriers, there's constantly kind of things changing. It's almost like a moving target. You have to be ready to make a change to their treatment plan, because just because they respond well to one thing when they're first diagnosed doesn't mean that's always going to be the treatment for them either. So a lot of times we do see that they kind of become immune to certain treatments and what was working for them really well is no longer working for them.

Kristin Graham:

So we have to switch classes of biologics or try something that's longer acting or add in another medication, and that all you have to take so much into consideration when you're making a treatment plan, take so much into consideration when you're making a treatment plan and this is probably one of the most challenging things is just coming up with a treatment plan that the patient will adhere to, that the parent will adhere to and that they will be successful with and won't they'll be able to afford and all of those other things, and so that can be very challenging. It's just picking something that they'll be able to do, cause a lot of our treatments too are unfortunately injectables, are subcutaneous injection shots that they have to administer at home and who wants to give their child a shot every week or every two weeks, every four weeks? I can't imagine. Um. So that is incredibly heavy, especially when you're introducing that option for the first time. A lot of parents have a hard time imagining like how am I ever going to give my child a shot, an injection? So it's a big.

Kristin Graham:

It's a big task to kind of overcome and to determine what's going to be best for that patient's circumstances and that family. And then you just add in another layer with insurance and you can come up with the most perfect plan for them. And then you have to get a prior authorization, because 80 to 90% of our medications that we prescribe needs a prior authorization. And then insurance says no, we don't want to do that, that's not preferred. So that adds in a whole nother layer of challenge. But we're very much used to it. It's a big part of our job to do appeal letters and peer-to-peers with physician reviewers. That's a huge bulk of our job. We do those every day. So we're ready for the fight.

Ashley :

Ready for the fight, that's exactly what I was just about to say. There's been a lot of info about peer-to-peers popping around on social media, right, now and ensuring them. I know you've seen them and well, I know it's frustrating, but is your experience shine a little bit of light on it for us and your experience? Are these always so dramatic and terrible I know they it feels that way when they don't approve something you've worked so hard to develop, or is it? Is it more symbiotic sometimes?

Kristin Graham:

Yeah, I tell you it's really luck of the draw. It just depends who you get on the other line and like what. If you know, sometimes it's really luck of the draw. It just depends who you get on the other line and like what. If you know, sometimes it's it's fine and it goes so smoothly, and sometimes they're they're just like tell me about this patient and tell me what I need to know so I can help you get this approved. I mean, that's not, that's not the norm by any means. That is a more of a rarity.

Kristin Graham:

But I really appreciate it when you get that um, so yeah, they're just looking for information. They want to, almost like they need some more education to be able to determine, you know, if this is justified or not, whereas other people it's like it doesn't matter what you say it and they don't even specialize in your field and it doesn't matter what you say or what articles you throw within, what evidence is behind your decision-making. It's like they just have a to-do list and they're just checking a box, that they did a peer-to-peer and they're going to deny it, so you never know what you're going to get. Honestly, we do use a lot of biologics and therapies that are off label, so we run into it a lot. But it is a challenge and we do have, you know, usually we have a lot of support, either personal experience or, you know, clinical trials or case studies to support our decision-making, but sometimes it just feels like it doesn't. It just doesn't matter.

Ashley :

Thank you for sharing that. It's such a mystery, I think, to so many people in medicine, but also at home. They think that this approval process is maybe something different, and this is where your clinician is going to bat hard for you. Um, you know cause?

Ashley :

we're invested in our patients, but we're also invested in this plan that we have developed and for you after these appointments and all the lab work, all of the data you've collected, talking to the patient about what they're going to be able to afford, what they're going to be able to actually dispense to their child, and then somebody say, no, it's you know it is, it is a fight, yeah Cause.

Kristin Graham:

Then you're back to the drawing board and you have to contact the patient and say, well, this didn't pan out. We have to kind of go back and talk about our options. So, but it just comes with the job better options.

Ashley :

So, but it just comes with the job. Kristen, you I found out so I've known you for a while and I found out when I was doing research for this interview that you are a cellist, a professional cellist. You have, um, you're not just I saw you side eye my piano when you walked by it when you came to my house. You're not just a musician, you are extremely, extremely accomplished and, first of all, bravo. I think playing the cello is incredible, but do you see, do you see any overlap in music and medicine? I know there's been plenty of discussions about this, but I'd be interested to hear, to hear, your thoughts on the subject.

Kristin Graham:

Yeah, I think so. I mean, I've been playing cello since I was in elementary school, since I was nine. I started on violin first and then switched to cello. But I, you know, over that period of time you're in lessons, private lessons, you do different courses and performances, rehearsals, you're constantly working on new pieces and kind of perfecting them. It can take months and months and months just to perfect one piece, and let alone you know one line. That's giving you challenges. You can go practice one line over and over and over again, and so it's a very slow process sometimes.

Kristin Graham:

To prepare for performance, and I find that you have to be focused on the end goal and there's not immediate gratification. So you have to be patient, you have to be determined to reach the same goal and have that slow progress over time to be performance ready for something. And I find in medicine, especially with kids with chronic illnesses, it is a long haul. It is not a race, it's a marathon. You're constantly you might come into bumps in the road. You have to be patient. When you start a medication, sometimes it takes weeks or months to become effective, so you're not going to see results right away. So you have to be in it. You have to be patient, you have to be just determined to, you know, meet the end goal. And that's kind of, I think, one thing that overlaps a lot with music and medicine that I've, I feel like I've experienced.

Ashley :

That's beautifully said, and I'm so glad that you described it that way, because I think for a lot of us, you know that medicine is a long haul, but when you put it that way and you think about how somebody practices to perform, suddenly it becomes a lot more tangible, you know. So I love that. And, of course, god, just hearing you speak, there's so many connections. It doesn't surprise me that you ended up in rheumatology and immunology, because there's so many connections. You know you play. You play with a symphony orchestra sometimes as well, is that correct? Yeah, so you are one piece, one beautiful, perfect, sometimes soloist piece in this giant orchestra of moving parts. It's just like what immunology is. You know, you guys are like the shining star of medicine, in my opinion. So, um, there's so many different ways to pull from that, but, um, you've got to, you've got to bust your instrument out at some point. I would love to hear it, I would love to see you in action.

Ashley :

And I do want to say just one more thing, and that's I'm so grateful for my friends in medicine, especially for you, and I think that even as a medical person, having friends in medicine too, it's just such a gift, and I'm so grateful for you, and just knowing that you're out there taking care of our kids and our teens it's comforting. So thank you so much.

Kristin Graham:

Oh, thank you, Thank you. Thank you for that. Yeah, I love medicine. I'm so glad I ended up here. You know there was a point where I was considering pursuing music but I decided I didn't want to be a starving artist and I wanted to have a little bit of a normal schedule. A nine to five sounded a lot better. So I initially started college as a dual major and then decided that was a little insane. If you've ever done a dual major with music, performance and nursing, you know that it's pretty crazy. But I'm sure somebody who's done it but it it wasn't my cup of tea. So I decided to go with the more reliable tract and at the time it was a very kind of unemotional decision. But I'm really glad I ended up here and I still get to play music all the time, which is a great outlet, and it's so necessary when you're in medicine because it can be so stressful. So you need to have those outlets. So I think it's been a very nice compliment to my my day job. I love that.

Ashley :

I love that. Kristen, thank you so much for taking the time to share your story with us. Thank you for joining us on shadow me next. Of course, thank you for having me. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram Access. You want stories you need. You're always invited to Shadow Me Next.

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Ashley Love

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