Medically Speaking #19

Welcome to today's episode of Medically Speaking. Today, I am super excited. I have two very special guests with me today. I have Thomas and Ingrid Valente, two of our newest physicians who just joined our medical staff. And today we're going to have some interesting conversations and learn a little bit more about them and some of the skill sets that they're going to be bringing to the community. So, well, let's just dive in. I'll let you guys maybe introduce yourself a little bit, maybe tell us a little bit about your background, your education, and then we'll just have some conversations. So, Ingrid, why don't you start? Yeah. So, I'm Ingrid Valente. I did my undergraduate education at Charleston Southern University, small private Christian university in Charleston. And then I went on to do my medical school training at Medical University of South Carolina, which is where I met my husband, Dr. Valente. And then I went on to complete my pediatric residency training at Baylor College of Medicine, associated with Texas Children's Hospital. Awesome. Awesome. Thomas? Yeah. So, I'm originally, my family's originally from Brazil, but I was born here in the States and grew up in East Tennessee, in Bristol, Tennessee, and then went to undergraduate at Presbyterian College, just down the street. Yeah. So, I'm a blue hose. And then after that, I went to medical school at MUSC, Ingrid said that's where we met and fell in love, and then went to do residency in Houston, so also at Baylor, so in the Texas Medical Center, which is the largest medical center in the world. So, it was a really fun, really tough, and very, you know, challenging five years, but it was very fruitful and felt like we really grew a lot. Yeah. Thomas, you are more than just a PC attendee. You played soccer at PC, right? Yes. Yeah. That's how I ended up from, you know, East Tennessee to PC, is I was there on a soccer scholarship. Yeah. I heard you're quite the star. No, no. I was okay. I mean, I was a, you know, I was a decent player, you know, and it was an awesome experience, but, you know, actually, I sadly had a couple injuries that kept me out my sophomore and junior year, technically. I had tore both my ACLs 11 months apart. So, I was out for those two years, but then I came back senior year and played my last year, and I actually was captain of the team my senior year, which was cool. You know, it was really kind of invested in the team and the guys, and yeah, I loved it. A lot of great relationships, and I was a mathematics major at Presbyterian, so I have a big heart for the math department there. They definitely were, poured a lot into me and, you know, really helped develop my… The way I think. So, I have a lot to, you know, to thank them for, I'd say. Awesome. Awesome. Good stuff. So, you guys both have some international roots and speak three languages? Yes. Talk to me a little bit about that. That's impressive. Yeah. So, I was born and lived for a couple years of my life in Colombia, South America. Okay. I came to the U.S. when I was about, I would say, like, close to 11 years old and started school here, not knowing anything. Okay. I didn't know anything, any English. So, that was, you know, a tough learning curve. Sure. I still remember it. But, you know, I feel like it didn't stop me from achieving the things that I wanted to achieve in life. It was sort of that, like, that force that I needed to be able to come to a country and not know the language and the culture. And then, I developed a passion for learning languages. So, I first started learning English, and then I started learning Spanish. And then, I started learning Italian, and I loved that. And then, I met my husband and realized, maybe I should learn Portuguese because he, most of his family is in Brazil. And so, I would need a way to communicate with them when we travel to Brazil. So, I started learning Portuguese during COVID when a lot of things went shut down and were virtual. So, in between the hospital as a medical student, I'd go home and have a Portuguese tutor that lived in Brazil. And so, I was able to learn Portuguese, and she would tutor me. So, I did that for a couple of years and then became fluent. Wow. Yeah, her Portuguese is incredible. That's awesome. So, yeah, I have a passion for languages, but also cultures. So, I love to learn about everybody's, like, cultures and what they do in different parts of the country. Things like that. Yeah. Awesome. Yeah, we went to Brazil this summer, and it was the first, because of COVID and residency, it was the first time Ingrid had gotten to, we had been married already for three years. Three years, yeah. And it was the first time she had gotten to Brazil. It was the first time going to Brazil to meet the family, and everybody was, like, blown away that my wife could speak, like, perfect Portuguese. Probably better than you. Probably better than you, exactly. Well, because I was, well, because Ingrid's very detail-oriented. I mean, I'm a detail-oriented person as well, but she, like, you know, when it comes to speaking Portuguese, you know, I'm, like, very much, I'll speak slang and my grammar is, like, you know, not always the greatest, you know, whereas Ingrid really learned very proper Portuguese with her language, you know, teacher. So, they were all amazed. How good she was speaking Portuguese, and then through her and her family, my Spanish has, like, tremendously taken off, you know, I think. I grew up speaking some Spanish in school, and it was always easy to convert from, I grew up speaking Portuguese at home as well, and it was always easy to learn the Spanish, but then after meeting Ingrid and, you know, spending time with her family, it's definitely taken off. And then being in Houston as well, because, like, I was telling you before, you know, there's days we go to the hospital, and the only English I'd speak is with the other physicians, you know, the patients would be, like, the county hospital in Houston, which is Ben Taub. It's an amazing place to train, and you learn a lot, see a lot, but the patients are, like, you know, it's very rare you have, like, an English speaking patient. It's, like, 95% Spanish, probably, and then the rest of it is, like, Vietnamese or Chinese or, you know, so it's a lot, a very, very interesting place to learn. Well, so, just top of mind, Spanish, super helpful in Greenwood, but actually interesting, we were chatting earlier, and you were telling me about, kind of, there, there's a number of folks, like, who speak Portuguese in the upstate of South Carolina that are, actually seek out, like, your services because of that skill. Maybe talk to me about that a little bit. Yeah, absolutely. Yeah, so, when we came to Greenwood, we were not aware that there was a need in the Brazilian community. We were not aware that there was a Brazilian community nearby, but we, we hired our Brazilian nanny, who has been incredible, you know, helping us take care of our son, and she shared with me that there was small communities around the upstate, specifically in Greenwood, I mean, not Greenwood, Greenville, Simpsonville, Anderson, Greer, all those areas around us, where they did prefer to have a Portuguese-speaking physician, and those are hard to come by here in, in the state. So, through her, we had been able to, kind of, share with the community nearby that we were here, and we would love to help them, and if there was a need. So, we now have a, a handful of patients that travel. I know I'll have a handful that come for pediatric care, because it matters to them to speak to a doctor directly in their language, as opposed to having an interpreter in between. I think that's awesome. Yeah, same. I've already had, like, several Brazilian patients come see me in clinic, which is awesome. You know, I've, it's like, who, who would have thought a guy would get to use us in that fashion, you know, in, in a small town like Greenwood, you know? So, it's really neat to get to utilize those skills, and even, and, and also, right, like, definitely even Hispanic patients with Spanish, you know, like, my Spanish is, I mean, both of our language skills have grown tremendously because of each other, and God's used, used each other in that way to, kind of, which turns out been super beneficial to, to patients. Which has been cool. You know, there's been several Hispanics in our clinic, as well, who are, you know, our, the PA or one of the other physicians will grab me, "Hey, we can't, can't talk to this patient. You know, can you go over their audiogram with them?" "Yeah, sure, no problem." But yeah, I've had, like, gosh, several, like, three or four Brazilians already who've driven from, like, Simpsonville or Greenville to see me as well. That's awesome. Well, talk to me a little bit about the transition from residency in a big city, one of the biggest medical centers in the world, to Greenwood, South Carolina, to Self Regional Health Care. Maybe compare and contrast a little bit. What do you really like about Greenwood? Just some, in general, just give me your thoughts. Yeah, yeah, so coming from, obviously, a big place like the Texas Medical Center, where you get, I mean, we're, we were like Texas Children's, and, and I know, like, MD Anderson and all those other adult hospitals where, where Thomas worked at, similarly to Texas Children's, we were the ultimate referral center. So, not only did we receive patients from within the state or nearby states, we received patients from all over the country that would come as, like, that was sort of, like, the last place where they were hoping to have that life-saving treatment or the top of the, the newest treatment available. I mean, international, even. Yeah. Because there were, I remember those programs with, like, TCH and Anderson, where there's, like, they have, like, partnerships with, like, the UAE and, like, Qatar. And things like that, where they would send, like, for, I think for TCH, their transplant service, which you, yeah, which you would, like, take calls and, like, cover all those kids overnight. And Ingrid and me, I covered all those kids. And some of them are, like, from, like, Qatar or something like that, you know, because the government has, like, has partnerships with those institutions in Houston. It did. And so, it just drew people from many parts of the world and people that spoke dialects and languages that I didn't even know existed. So, you know, big place, right? So, but, you know, it's interesting because the, what the community needed there is not much different than what people here need, even though it's a smaller place. It's, it's, the needs are still the same wherever you go. You know, they want, they want a physician that truly cares about them. They want a physician that can explain things to them that they don't understand and that can provide them all the options available. So, it's, like, you know, just bringing down to, like, the basics of what we're doing. And so, it's, it's been really, really nice to be in a community where I'm not, the limitations are very little in terms of the quality that I can give patients despite the size. So, yeah, it's, it's been, it's been definitely what we needed. Yeah, I think that's a big, I think that's a huge thing in terms of just, you know, just, like, kudos to you, Matt. Yeah. Yes. No, I'm serious. The job you've done is, like, you know, I think moving here, I felt incredibly supported. The hospital purchased a lot of, you know, newer updated equipment, things like that, that I agree with Ingrid, you know, it's a small town, but I feel like I can provide world quality care, you know, world class care here in Greenwood. Like, you know, there's, you know, I've had several, I've had some cases already where, like, the things I've done have been, like, the first time it's been done here. But that we were doing, you know, daily over in Houston, and it went super smooth. And it was partially because of the things that the hospital was, you know, invested in knowing that I was coming, you know, and so I definitely echo that, you know, it's smaller volume. But, I mean, I've been incredibly busy and seeing the whole breadth of the head and neck pathology here that I saw in residency and praise God for the volume that we had in training feel comfortable managing it. And but yeah, I mean, the Texas Medical Center is crazy. I mean, Texas Children's, the biggest, biggest pediatric hospital in the country in the world, actually. And then it's the biggest hospital in the world. I was working in operating at like six different hospitals across the Texas Medical Center. So it was very busy. It was, but it was super fruitful. You know, you leave feeling really prepared. But yeah, I was at Texas Children's, which is the biggest peds hospital in the country, maybe the world, I think there might be one bigger in China, but I can't remember. But and then the VA, which is the biggest VA in the country. So like all of the really crazy stuff that ends up within the veteran systems ends up in Houston. ventab which is our county hospital st luke's and methodist which are both enormous private hospitals and then md anderson you know we spend a lot of time there as well doing head and neck cancer so very diverse which is the biggest cancer center in the country and so uh it definitely was a really really uh busy five years uh but very very fun you know very fun i'll tell you one of my dreams that i strive for here is i want us to be able to do as high quality care with good outcomes right here in greenwood south carolina for these folks that live in our community as what you can get in the hospital like where you guys trained and it takes people like you both of you coming to our community to bring those skills and investment from the hospital all the folks that give money to the foundation to help support the hospital and advance care closer to home um you know thomas i don't know the number but it was a significant investment to get the equipment that we just needed to update all of our ent absolutely equipment and um well if we're gonna do ent here in greenwood let's let's take it up a notch and you know dr uh dr russ and dr skates do a phenomenal job they love those guys they've been doing it here a long time but you know bringing a fresh perspective just finishing up residency and bringing in new ideas new techniques and new technology it's it's it's really invigorating to me to see kind of some of the things we're able to do can you maybe talk for just a second about some of the things that you're some of the procedural things that you're bringing to our community that maybe we haven't done or maybe not at the same level before yeah um so let's see some of the things i mean i mean gosh like you're saying that those guys are i mean they're phenomenal doctors phenomenal surgeons i'm bouncing i'm at poor dr russ dr skates known dr eisenhower what he's a gem you know he's they're they're phenomenal men that's one thing i think has been a huge impact on me and i think it's been a huge impact on me and i think it's been a huge impact on me and i think it's been a huge impact on me and i think it's been an amazing blessing to me is coming into a place with mentorship like that you know um i guess some of the new stuff i think one of the things that's been big is that you know obviously one thing i really have a passion for is i really do enjoy doing a lot of the head and neck cancer stuff so i've been doing you know i've been kind of uh spearheading the efforts with our head and neck tumor board which honestly is something that i've been incredibly impressed with that self-regional is that you know our medical oncologists radiation oncologists pathologists our cancer navigators the radiologists you know we come together every tuesday and talk about all of our new head and neck cancer patients in a multidisciplinary fashion which is the way we did it in houston and i think it's the way that it should be done and uh and i've been really impressed by all of those folks i mean they're they're incredible physicians and an incredible team so i think that our patients are getting really good cancer care in that sense and then now i think i i bring a little bit of i mean i just more i have i have an interest in that so a lot of the stuff that you know previously maybe the my other partners weren't wanting to do not as they weren't wanting to do just that they're so darn busy that you know they were sending out to one of the other you know academic institutions i think we're going to try to try to keep some of that stuff here more so now um other things like they're a little different is like uh for my one thing the hospital was like surgical navigation for endoscopic sinus surgery that was a really um you know an awesome thing to think that we could bring to the community the way i do my sinus surgeries as i do them navigated and so if it's going to be ultimately sinus surgery it sounds pretty benign and for the most part it is very routine right but i mean but it's routine because you have folks like skates and rust and myself who've trained years and years and years to to do it in that fashion but the reality is you know the sinuses are between the eyes and under the brain and so you're always on the skull base you're always working around the eyes and so the navigational system that i use when i'm doing my sinus surgery is to do it in that fashion and so you're always on the skull base you're always working around the eyes and so the navigational system that i use when i'm doing my sinus surgery is to do it in that fashion and so the navigational surgery kind of helps uh identify the landmarks that you would know that you're approaching those locations and so my my instruments are you know it's in real time i have a ct scan with the patient's anatomy and i know exactly where i am in three dimensions with their ct scan while i'm operating within their sinuses so cool so that's that's new that's something new we brought um for things like i think the indications for are expanding within head and neck malignancy uh but uh like set in a lymph node by biopsies um in lieu of like full neck dissection it's already the standard of care in europe for like oral cavity cancers even they're doing sentinel lymph node biopsies for oral cavity cancer we haven't quite gotten there yet here uh in the united states with our mccn guidelines but for melanoma and things like merkle cell carcinoma which is really rare for merkle cell but for melanoma certainly there's a well-established role in sentinel lymph node biopsy and so uh that's new that i'm going to kind of start tackling is our head and neck melanoma cases here i've already had one uh where we had a very successful sentinel lymph node biopsy performing the head neck and and that went really well praise god i think that patient's uh doing well um and uh it's a really important thing in terms of prognosticating the patient and so that's something that's new that i'm doing um i do my head neck cancer cases uh with neuro monitoring and so that's something new the the hospital invested in um which is like a nims machine which ultimately for thyroid cancer or parotid surgery where you're operating around the facial nerve or the recurrent laryngeal nerve um i have equipment now interoperatively that can help me identify and preserve and keep those structures safe um uh and so yeah those are some of the things that come to mind i guess that are more recent changes yeah recent changes um for the clinic as well that was a big thing too for the clinic we got you know scope towers uh which is new technology so you know previously uh scopes were done with like fiber optic cables and things like that now we have distal chip which is essentially like digital imaging so when you scope a patient and you're looking at their larynx or their you're looking at the throat the voice box the nose their sinuses whatever it is you know now it's projected onto a screen it can be recorded those images can be uploaded to the patient's chart for comparison at later dates and also you can show the patient what you're seeing you know so it's like you know if i scope a patient and i see a laryngeal mass i can be like hey look this is what we're going to the operating room to biopsy and they can see it with their eyes and there's a lot of value in the patient knowing what you're seeing as well you know uh picture's worth a thousand thousand words so um so there are like a couple of the things that really come to mind uh i've done a couple of uh laryngeal injections already which is new to town for like vocal fold paralysis or atrophy um which is new you know our the other guys weren't weren't doing that they were sending previously sending some of their paralysis out so ultimately if someone has like a vocal fold that is immobile from a prior neck surgery or cardiac surgery you know they can have a weak voice and so and a lot of that can be related to unilateral vocal fold paralysis so what i can offer them is like an awake injection in the clinic where you do like an awake trans oral vocal fold injection and the idea is there is that you can't restore mobility but you can add bulk to the immobile fold and so which will improve glottic competency and where the vocal folds will meet in the middle and you can get the voice maybe louder you can provide a stronger cough you know help perhaps with some aspiration if it seems to be related to glottic incompetence and so um that's something new we've already had like three patients who we've done that too just in the last you know i've only been here for like seven weeks so um it's been really it's in a it's hit the ground dr russ like you know we got we're gonna keep you busy son so uh really hit the ground running and um it's been really neat to kind of see those things taking off that's awesome awesome well ingrid talked to me a little bit about your peds transition from residency to practice yeah um so it's been a joy it really has been i um i could not have been more thankful more blessed to have the team that i have um you know coming in and fresh out of residency it's i would say it's its own steep learning curve when you go from being a trainee where you have um you know you you're taking a lot of that uh you're taking charge of the care that you're providing to the patients but you're not the end of that line um per se you know you have an attending um where you can kind of bounce ideas off of but coming out of training and and being that attending um takes takes some used to you know getting used to um but i was lucky enough to come and be able to have the group of women that i have um from you know dr fuqua dr hughes gallman polanco um uh i dr jacks um who i was actually friends with uh in medical school so um being able to have them and then having um nurse practitioner beth nurse practitioner mandy who have been there a little longer and kind of know how to navigate the system as well um in terms of referrals and the logistics of those things um a lot of those things that you kind of have to learn um on the go when you start any new job not just you know here but any new job and so i've just been in incredibly blessed to be able to text any of those women and say hey what do we do about this hey this is my thought process like normally i would have done this if i was at texas children's like what are my options here and they're so quick to answer um i called dr polanco uh last week at 7 p.m um because many times because i i had a result that popped up and um i wanted to make sure that i uh took care of that while i was still it was still in my mind um and i said hey can i can i call you real quick and you know she was quick two seconds she said yes and so i i just you know it is a blessing because not everywhere where people go do you have that kind of support system so all that to say is that the people i get to work with are incredible the nurses um have been so patient um and just like showing me how to order different things you know oh it's inpatient or it's outpatient like all those things right um the mas are incredible i mean i just i can go on and on um the team there is really really supportive um and then the other thing is is um you know just being able to have you guys the hospital where if i say hey you know i have an idea maybe we could look into doing uh bringing this type of um things into our epi our emr to maybe expedite um certain things in our visits better and to have the people that are interested in hearing what i have to say as somebody who's been there short a short time you know i i think this will be my my fourth week um since i've been here um and so just uh it's been it's really been incredible um and of course i i can't speak um more highly of the community here um i can't tell you the amount of times that i walk out of the room and i hear thank you more than three times um to me that makes any bad day any any good day just 10 times better and because i know that that patient um you know they said thank you well you're making a difference for them so it makes a huge you know just it brings a lot of impact yeah for them to be able to say those things that's awesome yeah good ingrid always has a lot of good new ideas she's always full of ideas she's a go-getter i'll tell you what she's like hey we need to do this to this i'll think about updating this or she's very like almost like engineering brain like optimizing always optimizing efficiency optimizing efficacy that's awesome i mean that's exactly she's way fat in residency she would always i should have like how many patients do you see a clinic i'm like how do you do she's very very efficient so it's very impressive and i think it's cool how much we've had to lean on each other in a small town which is very that's new that's really cool yeah yeah a lot actually i'll call him he'll call me yeah yeah it's great that would be handy i guess having a pediatrician in the house or oh my gosh yeah doc in the house i think i think i asked her way more than she asked me i mean she asked me things here and there probably like hey love i got this little kid like what dose should i do for this man what do you think of this or well blah blah you know small things yeah no but i mean i've a lot of my patients have benefited from the fact that i'm married to you you know which is cool that's really cool but um um i think that's really cool um so the community in general do you guys feel like greenwood's been welcoming to you guys as you've transitioned here absolutely yes making some friends and yeah for sure for sure we've been like we've been getting plugged in we've been going to south main here okay something baptist church just right down the street and doing that with dr because dr russ i'm a partner and he would teach a sunday school there okay come on to church we found a community very quickly yeah we've had lunch with some of the friends from there like noah's been our son we have a son who's i guess we haven't talked about that it's like our whole life like is noah's he'll be three in december so like next month and uh he's been making a bunch of little friends in his his school and he's learning english here in greenwood oh really yeah he's a lot of english now he's like he's like tri-lingual because we only do like portuguese and spanish at home you know and then we're like i don't figure out the english and lo and behold it's like he's figuring out the english really fast so we're asking him like hey no how do you say i'm hung how do you how do you say it in portuguese like how do you say i'm hungry in english and i'll go i'm hungry and they're like well how do you say it in spanish just say in spanish like how do you say in portuguese you'll say in portuguese so he'll like he'll he'll uh he can spit out he's a bright little boy that's awesome it's crazy it's crazy to see so he's been loving his school you know and playing with kids in the neighborhood you know in houston we lived in this like tiny little apartment because it was so close to the medical center yeah it's so close to the medicine there's a tiny little apartment and like you know and the little boy a poor guy and he would say hey dad let's go run out outside and we wasn't like okay yeah sounds good so we do laps around the sidewalk on like concrete you know and uh and now we have a neighborhood where we ride bikes around the neighborhood and runs in the backyard and there's plenty of space and he just gets to be you know a healthy little boy and it's just that i think it's been just great to see it is a great place to um raise like to have a family raise your family yeah um we've been blessed it was very we found our family and i think it's been a great place to have a family in houston so i'm glad that it's been a great place to have a family and i think it's been a great place to have a family in houston and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place too have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place to have a family and i think it's been a great place but it there is a lot of um good things in in being in a small community where life just moves slower and you get to actually meet people and who they are um yeah so all that to say is that i i feel um that we definitely have made the the right choice good so i feel like you're in the right place yeah absolutely i mean yeah i mean we guys we've been talking with you guys about coming here for years now so you know it's been um it's been a couple years a couple years yeah because we we met talk to me about that remind me say you just for for whoever may be listening to this how how did you guys hear about south regional and greenwood i'll let you take that so my really good buddy from medical school who's davis reed who's one of the family docs in town we were really good friends in medical school we were like in the same bible study he as well as uh zach gray zach gray and helen gray says helen and i were like in the sack or helen and davis and i were all in the same class and zach was like a year behind us maybe two zach gray was in my two years behind us he was two years behind us um but helen and i i mean we were in the same we were in the same group in anatomy lab you know so we did anatomy together helen and i did who's who's a hospitalist here you know so we had heard a little bit about greenwood from them but then really davis was rotating as a resident at the time through the ent practice and dr russ like hey do you know any ents and he's like actually my buddy thomas is an ent resident in houston and so uh it was through davis you know that he was like well you know he's like give me his number give me his number and i was give me his number and so davis texted hey man the ent group here in town you know they were wondering if you'd be interested in chatting with them uh a little bit about the practice in greenwood and i was like sure i guess i'd never thought about going to greenwood sure you know but uh turns out god had plans to bring us here you know which is cool so then you know dr russ called me and we're chatting it up and i was like man this guy's really neat you know he's he's a hoot if anybody knows that i mean now people watch this probably know dr russ he's a hoot and so um man this guy's a really cool man and so you know we really got along really well and then i was like well you know russ you know um i'd you know i'd be willing to come you know take a look greenwood see what it's like see what the practice is like but you know my wife is a peds resident so you know you you know we we need a job for her as well you know so give me a sec let me call somebody let me call somebody yeah let me call somebody and he calls me back like you know five minutes later hey i got an interview for your wife too i guess he called you it worked out it worked out so you know we came interviewed and you know fell in love with it it was just it felt you know i was like oh my god i'm gonna go to greenwood and i'm gonna go to greenwood and i'm gonna it felt right and um and then you know that was my starting my fourth year of residency so that was you know two years ago and ingrid had like i was starting my second year you're just starting second year exactly exactly and so and then we're like all right well let's let's let's do it and then um after that for me i mean for both of us really i think it really takes your training to another level in residency when you know a community is depending on you that was i think i think i noticed a big change in myself after we decided to come here i mean i was already focused in residency obviously to be the best search i could be but when you know that you're when you have like i have okay i know that it is the town of greenwood that is depending on me it's like you have a a face that you're working for you know or people that you know are like depending on you i think my residency really i think training really took off to another level because i would be like okay every single case was like this is what i'm going to do and i'm going to do it and i'm going to do it and i'm going to be me in greenwood you know i'm going to be doing this in a smaller community so i'm not going to have as much support like it's game time and so i think once i really knew where i was going to end up i think my training just really took off to a whole nother level because every single case it was it was it was for this place it was for this community you know i wanted to be the best i could be for not just some random location that was theoretical in the future but i wanted to be you know i had like an actual solid idea of where i was going and what i was going to do and what that may or may not look like and so it really changed my training and um it also i think made me much more well-rounded at a laryngologist because i was there was no like oh this case isn't that big of a deal because i'm never going to do this it was like i'm going to greenwood and there's no one else i'm going to do this and so uh i'm going to do i'm going to you know some folks are going into a fellowship in doing plastic surgery or laryngology or head and neck or pediatrics they can appropriately so tailor their focus to that subspecialty but for me being a little bit of a jack-of-all-trades when it comes to head neck surgery there was no like focusing on one thing it didn't matter if it was like something i necessarily had a great passion for or love for or not it was like i need to know this well regardless of whatever subspecialty within otolaryngology it fell into so i think that was a really cool thing i saw in myself and i think i grew tremendously once i knew i was coming here yeah that's awesome you know honestly if you guys think about it um in the next five to ten years you guys are the senior leaders of these practices don't think about that and what you just said thomas is exactly right um you know i'm so glad to hear and i knew you're like this but taking advantage of that opportunity at texas where you are because those you will carry that with you and when you're the senior partner both of you a few years from now wow wow um what an impact you guys are making here and already and um and certainly down the road and i hope you guys do your career here i really do i truly do i plan to be here i hope you guys will stay with me and keep doing the great care that you guys do um but um i speak on behalf of the whole entire hospital when i say this and that we are extremely thrilled you guys are both here and i thank you so much and um you guys are going to do great things for this community you guys are going to save lives you guys are going to make an impact on people that will carry with them for for their whole entire lives and even to the future so i'm just just thrilled as i could be to have you here so thank you thrilled to be here thank you so much good anything else you guys want to say to the audience today just uh thank you yeah thanks for having us thank you so much for having us and um it's been a pleasure i hope to you know make you all proud yeah yeah and uh just uh come see us yeah come see us i'm sure you will all right well um gosh what great two two great guests today um certainly had a great conversation and um i want to thank you all too for joining us for today's episode of medically speaking and um again just a great conversation with thomas and ingrid valente and uh we hope that you'll check out our pizza practice and our ent practice and um like i say uh thanks again for joining us and we look forward to the next episode