Aarati Asundi (00:12) Hi everyone and welcome back to the Smart Tea Podcast where we talk about the lives of scientists and innovators who shape the world. I'm Aarati. Jyoti Asundi (00:21) I'm her mom Jyoti and ⁓ just a heads up, everybody, I'm recovering from a nasty cold or cough or who knows what the heck it is. But my voice quality will probably be not up to par. I'm sucking on lozenges to tide myself through this whole thing. But please bear with me on this one. Aarati Asundi (00:41) Yeah, you sound much better. Our whole family just got wiped out by some sort of cold or flu in the last week and I bounced back really fast, but you've been taking a long time to recover. Jyoti Asundi (00:51) I have taken more time than I expected. Absolutely. I don't know why. But hey, I'm on my upward curve, so... Aarati Asundi (00:58) Yes. And we have a nice story to get you through the next hour or so. Jyoti Asundi (01:03) Awesome. This podcast will definitely bring my good moods and good vibes back. Aarati Asundi (01:09) Yes, definitely. I'm actually curious if you've heard the name of the person we are doing today. I had not heard of her name. Her name is Virginia Apgar. Have you heard of her name at all? Jyoti Asundi (01:22) I have heard of an Apgar score. Aarati Asundi (01:25) Yes, yes, that's exactly it. Jyoti Asundi (01:27) Apgar Score. Is it about intelligence or is it about... Aarati Asundi (01:25) No. So it is a score that was developed to help assess the health of newborn babies. Jyoti Asundi (01:40) Oh that's... See, you guys were many, many, many years ago. That is why I don't remember this. But yes, now I remember the Apgar score. Aarati Asundi (01:48) Yes. I was wondering because I, of course, have not had any children. So I have not really done any research on pregnancy or like what it's like to have a newborn the way that any mother I think would. And so I was wondering if you had at some point just because of the that you had had children had somehow vaguely heard of this. But yeah. Jyoti Asundi (02:10) I had heard of Apgar score, and all I knew was everything was nice with both of you. You both had good scores. And that is why it didn't stick with me, I basically, oh yeah, all is cool and well. Enjoy the babies. Aarati Asundi (02:21) Yeah. Yeah. I figured if it was something you had heard, it would be very fleeting. So today we'll be talking about Virginia Apgar, who is the doctor who came up with this scoring system. Jyoti Asundi (02:38) Wow, this already sounds very exciting. I did not know that the whole thing was set up by a woman to begin with. That itself makes me very happy. Awesome. Aarati Asundi (02:47) Yes, so let's get into her life. Well, actually, before we get into her life, we need to get into her father's life. Her father was named Charles Apgar, and he was married to Helen Apgar, and they lived in Westfield, New Jersey. And he actually had his own fascinating bit of history that while I was researching this story, I was like, maybe I need to drop Virginia Apgar and do him instead. Jyoti Asundi (03:19) Oh, he is that fascinating? All right. Aarati Asundi (03:20) He's very interesting. So yeah. Jyoti Asundi (03:22) Okay, maybe a back to back? Aarati Asundi (03:25) I thought about that too, but I decided just to shoehorn him in here. He was a business executive for various insurance and brokerage firms, but he was also an amateur radio operator and astronomer. And between 1913 and 1915, he built and operated a wireless amateur radio station from inside his own home. And this is at a time when the technology is still very new. So he's a trailblazer. Jyoti Asundi (03:56) Oh wow, and these are fun times to have wireless radios. You could intercept all sorts of interesting messages... Aarati Asundi (04:05) Yep, that's exactly where we're going. Jyoti Asundi (04:09) ⁓ really? ⁓ this already got exciting, okay. Aarati Asundi (04:12) Yes, yes. So this time period where he's built this radio is during World War I and initially, the US tried to stay out of the war. However, Charles became interested in the transmissions that were coming and going from a big wireless station in Sayville, New York, which happened to be owned by a German company. And so the Sayville wireless station claimed that even though it was owned by a German company, it was not at all related to the German Empire. It was not sending messages. There was no connection there. But the US government was still suspicious. Jyoti Asundi (04:56) Absolutely. Aarati Asundi (04:57) And so they were kind of probing into this and they found that this station was sending some weird transmissions in Morse code. And they were transmissions that said things like, "Myra has diphtheria" or "Send always invoice before shipping knives." Jyoti Asundi (05:16) Oh. Oh! Aarati Asundi (05:17) And they were like, these are weird phrases for a radio station to be transmitting. Jyoti Asundi (05:23) Yeah, this is definitely code for something else. Who talks like that? Aarati Asundi (05:28) Exactly. And so the government was like, there has to be some sort of cipher or code, but they couldn't pin anything. Jyoti Asundi (05:33) Yes, break it down. They couldn't break it down basically. Aarati Asundi (05:36) Yeah, they couldn't crack it. Yeah. Jyoti Asundi (05:37) Yeah. Aarati Asundi (05:38) So Charles is sitting at his home and he's listening in on these transmissions. Jyoti Asundi (05:44) He's able to intercept these wireless transmissions from Sayville. Aarati Asundi (05:50) Yes, and he finds them suspicious also. Jyoti Asundi (05:53) Of course. Yes. Aarati Asundi (05:53) He's also like, these are weird. And so he contacts the chief radio inspector in his area, and he told him that, "Hey, in my house, I actually have the ability to record the messages if that's helpful." Jyoti Asundi (06:09) And they're like heck yeah. Aarati Asundi (05:10) Yeah. Yeah. The radio inspector was like, yes, that's awesome. Jyoti Asundi (06:15) Yes, please. Yeah. Aarati Asundi (06:16) So he put him in touch with the US Secret Service and the Secret Service paid Charles to record about 175 of these messages totaling about 11 hours from Sayville and send them to the men in the Secret Service who were then able to use those recordings to break the code. And it turns out that what the Sayville station was telling the German operatives about in these coded messages was the movements of US ships that were supposedly neutral. Like, you know? Jyoti Asundi (06:51) Oh right. Aarati Asundi (06:52) So either civilian shipping or Navy boats. But even though, even though the US is neutral, they're telling them about the U.S.'s Marine movements. Jyoti Asundi (07:03) But those ships carry so much cargo. Aarati Asundi (07:07) Mm-hmm. Jyoti Asundi (07:08) And in war times, that cargo is very precious. It doesn't matter what it is, right? You absolutely can use the cargo held in these monstrous ships if you can deploy it for your own purposes. Aarati Asundi (07:21) Yep. And not just cargo. Also, there was supposed to be an agreement that any ships that were carrying American citizens would not be touched because they were not involved in the war. So you cannot bomb any ships that have US citizens on board. Jyoti Asundi (07:39) America was basically like the Switzerland of that time. Aarati Asundi (07:42) They were trying to be. Jyoti Asundi (07:43) Yeah, neutral. Yeah, they were trying to be at least. Aarati Asundi (07:45) So these messages are being relayed to Germany, telling them about the movements of these US ships. And then next thing you know, the RMS Lusitania is torpedoed, killing American citizens and British citizens. Jyoti Asundi (08:03) There were a lot of Americans in there, but overall, more than 1,000 people died in that. Aarati Asundi (08:11) Yeah. And so it's very likely that these messages had a direct role in that because how else would the Germans know exactly where the Lusitania was going to be? Jyoti Asundi (08:20) Yeah! Aarati Asundi (08:21) And so happened in May 1915 and that dragged America into the war. Jyoti Asundi (08:26) Wow, yes. They... always they said, even in World War II also when Japan and Pearl Harbor happened, and even in World War I when the Lusitania was sunk, both times, history calls it that a sleeping giant had been woken up. They were this super power, was trying to stay out of the fray and then it's like okay you drag me in and now I'm going to stomp you down. Aarati Asundi (08:55) Yes, yeah. And so Charles Apgar had a direct role in kind of linking that, that this Sayville station was sending transmissions to the Germans about... Jyoti Asundi (09:08) The ships. Correct. Aarati Asundi (09:09) ...ship movements. And then when the RMS Lusitania is bombed, it's like, yeah, you knew about it. You had a direct role in it. And so Charles Apgar was crucial in cracking that code and you know, linking these activities. Jyoti Asundi (09:23) Wow, wow, you know, I've heard of a Chinese curse. They say, may you live in interesting times. Aarati Asundi (09:32) Yes, I've heard that one! Jyoti Asundi (09:35) Yeah. And this is exactly what this sounds like. It looks very interesting to sit in my armchair and listen to this, sounds absolutely fascinating, but I don't know if I have the guts to live through this. Aarati Asundi (09:48) I don't know. We are living in our very own interesting times, I feel like. I'm looking around and I'm don't think Gen Z has had a normal news cycle ever. Jyoti Asundi (10:00) Yes. that is very true. That is very true. Every time it's like, "Oh my God!" Yes, yes. Aarati Asundi (10:06) Yeah, millennials had a few good years in the 80s when things were kind of okay, but... Jyoti Asundi (10:12) Okay-ish, normal-ish. Aarati Asundi (10:13) Yeah but after that, millennials, Gen Z, Gen Alpha, like everyone that's come after, I'm just like, want to tell them, this is not normal. This is not normal what's happening. Jyoti Asundi (10:20) Yes, yes, but this has become the new normal. Yes. Aarati Asundi (10:26) Yeah, it has. So Virginia Apgar, the person we're actually, that the episode is actually about... Jyoti Asundi (10:32) Whose episode this is about. Aarati Asundi (10:33) Yeah, yes, is Charles's daughter. And she was born on June 7th, 1909. Jyoti Asundi (10:41) So she's just a little kid when all this happens. Aarati Asundi (10:45) Yep. Very young. And as I think we can already maybe tell about her family, Virginia said that her family, quote, never sat down. Always busy doing something. And it seems like the family had very high hopes for Virginia that she would really also do something great with her life and go far. Jyoti Asundi (11:05) Yes. Aarati Asundi (11:07) She had a number of hobbies, most notably playing the violin. Music was something that her whole family was into, and her older brother Lawrence actually became a music professor. Yeah. Jyoti Asundi (11:19) Oh wow, nice. That's a big gift actually. Music provides a connection to the soul. Yeah, very nice. Aarati Asundi (11:26) Yeah. And she was really into it throughout her life. She played violin throughout her life and she would always look for opportunities to play in duets or quartets other musicians wherever she was. So was a very big part of her life. Jyoti Asundi (11:39) What a gift. Aarati Asundi (11:40) But despite that, from a very young age, she was determined to go into medicine. I think this was likely in large part because brother, Charles Jr., died from tuberculosis before Virginia was even born. But obviously, she knew about it. Jyoti Asundi (11:57) Yes, so it impacted the family so much that they talked about him often. Aarati Asundi (12:01) Yeah. And then her older brother, Lawrence, the one who became a music professor, he suffered from a chronic childhood illness. So he was also sick all the time. And so she's witnessing their medical difficulties first hand. And then you pair that with the fact that she had such an amazing and curious father was into building radios and all this kind of stuff. And he also very much encouraged scientific curiosity. And so I think those two things together her towards medical science. Jyoti Asundi (12:33) And also she would have that innate feeling that I want to help my brother. I want to do something good. Aarati Asundi (12:38) Exactly. Jyoti Asundi (12:39) And I want to make a difference. And look at this, my brother's suffering. Let me do something so I can see why he was drawn to medicine and to become a healer. Aarati Asundi (12:49) She was an excellent student at high school in every subject except, ironically for home economics. She kind of failed at that. According to her friend, she never did learn how to cook. In 1925, she entered Mount Holyoke, which was a woman's college where she majored in zoology. And here again, she excelled academically while also holding down several part-time jobs to support herself, playing on sports teams, reporting for the college newspaper, and of course, playing the violin in the college orchestra. Jyoti Asundi (13:25) Lovely energy there. Aarati Asundi (13:26) She was known for that, for just having limitless energy and at the same time having a very deep understanding of the subjects that she was studying in science. So her professors were very impressed by her and her depth of knowledge. Jyoti Asundi (13:41) Yes. Aarati Asundi (13:42) So after getting her bachelor's degree, she enrolled in the College of Physicians and Surgeons, or P &S, at Columbia University in the hopes of becoming a surgeon. She was one of only nine women in her class of 90 students. Jyoti Asundi (13:58) peaks to the times. Aarati Asundi (14:00) Yes, yes. It was also the start of the Great Depression, and Virginia was very low on funds. So she actually had to take out a loan from a family friend in order to get through her medical school. She completed her MD in 1933, graduating fourth in her class, again of 90 students. Jyoti Asundi (14:21) Oh goodness that's not easy. Aarati Asundi (14:23) No, but she was also $4,000 in debt, which in today's money is about $100,000. Jyoti Asundi (14:32) But it's her passion. She believes in it. Aarati Asundi (14:33) She's like, yeah, she's like, I want to become a surgeon. Jyoti Asundi (14:36) Absolutely. Aarati Asundi (14:38) So she went on to do her residency at the Columbia Presbyterian Medical Center under a surgeon named Dr. Alan Whipple. And when I was researching story, I was like, Allen Whipple, that name sounds familiar to me. And that's because, I've actually talked about him before on the podcast in the episode on Charles Drew. Jyoti Asundi (15:00) Blood guy? Aarati Asundi (15:02) Yes, blood guy. Jyoti Asundi (15:00) Yes! blood guy. Yes, the one showed that you don't really have to pull a person off the street, just as you need blood, you can actually collect blood ahead of time, check it a bit, store it carefully. And then when as needed... Aarati Asundi (15:16) we have it on hand. Yeah. Jyoti Asundi (15:18) Yeah, so how was Alan Whipple related to Charles Drew? I forget. Aarati Asundi (15:21) So Dr. Whipple was Charles Drew's mentor. And it's particularly noteworthy because Charles Drew was a black surgeon, again, like in the 1930s and 40s when, you know, black surgeons were pretty rare. Jyoti Asundi (15:38) Right. And now Dr. Alan Whipple is mentoring Virginia Apgar. Aarati Asundi (15:44) Yeah, so I think this is actually a little bit before that. Virginia comes just a little bit before Charles Drew in Alan Whipple's mentoring. Jyoti Asundi (15:50) Charles Drew, but he's mentoring, women and he's mentoring black students. So Alan Whipple progressive for those times. Aarati Asundi (15:59) Yeah, very open-minded, very willing to give people a chance and... Jyoti Asundi (16:05) Yeah, seeing the value in people past their external gender or race norms. Aarati Asundi (16:12) Yes, exactly. Very interesting character. So Virginia starts doing her residence with Dr. Whipple, who was the chair of the surgery department at the Columbia Presbyterian Medical Center. And again, she's aiming to be a surgeon. But Dr. Whipple very correctly tells her, "Actually being a surgeon is not the best path for you, because honestly, unfortunately, even though you are brilliant, opportunities for women surgeons are going to be difficult to come by." And he had actually mentored women who had wanted to become surgeons before, and none of them had been financially successful. Jyoti Asundi (16:56) Okay. he's giving her very practical advice... Aarati Asundi (16:59) Yes. Jyoti Asundi (16:59) ...and saying, this is how the world works. You can't fight the system. So, and you have this ton of student loan that you are... Aarati Asundi (17:08) Exactly. Jyoti Asundi (17:09) Yeah, the loans that you have to give back. Aarati Asundi (17:10) Yeah, you're you're 100 grand in debt. You're not going to get out of that by becoming a surgeon, no matter how amazing you are. It just is a fact that, you know, women surgeons... Jyoti Asundi (17:19) Because certain doors are just not going to open for you. Aarati Asundi (17:22) Yes, which is ironic because I actually just heard a stat that today the American Medical Association has showed that women surgeons are much better at their jobs than male surgeons. So I find it kind of funny. Jyoti Asundi (17:38) Yeah, because the pressure is immense, right? Aarati Asundi (17:42) Mm-hmm. Yeah. But I just found it kind of ironic. But yes, like she's really far in debt. This is during the Great Depression. She's not going to get a job easily. And so he said, instead of becoming a surgeon, you should go into anesthesiology. And this is a very interesting suggestion and a very smart and clever one, actually. Because up until this point, anesthesiology had been a nursing specialty. Nurses took care of giving patients anesthesia before surgery. Jyoti Asundi (18:17) Right. Okay. Aarati Asundi (17:19) It was really seen as this very menial task. It was basically just the nurse would place a gas mask or a gauze that had ether or chloroform over the patient's face and let them inhale it until they passed out. Jyoti Asundi (18:35) Got it. Aarati Asundi (18:35) So there was no like, you know.... Jyoti Asundi (18:39) Technique or ⁓ skill required... Aarati Asundi (18:42) Exactly. Jyoti Asundi (18:42) ...to be an anesthesiologist at that point. Aarati Asundi (18:45) And so it was very much the nurse's job. Just like nurses draw blood and they check your heart rate or whatever, it was relegated to one of those menial tasks that, OK, knock the patient out. And it wasn't very precise. And it wasn't very safe because the patient could very easily overdose or they could wake up halfway through the operation. Jyoti Asundi (19:05) Correct. Yes. And contraindications. You need to know anesthetic to administer and what the person could be allergic to and whatnot to mix and match, things like that. It's not just like, try and if it fails, you die. I'm so sorry, kind of. You can't do that. ⁓ Aarati Asundi (19:24) Yeah. And so in the 1930s, medical scientists are just starting to figure that out that, we need to you know, kind of... Jyoti Asundi (19:30) So it's an emerging field. Aarati Asundi (19:33) Exactly. Jyoti Asundi (19:34) And he tells her to get onto that emerging field of anesthesiology. Aarati Asundi (19:38) And especially because it was relegated to nurses who were mostly women at that time. So if she goes into anesthesiology as a woman... Jyoti Asundi (19:46) Right yes. Aarati Asundi (19:48) ....it's much more accepted. Jyoti Asundi (19:50) Yes correct. Aarati Asundi (19:52) But at the same time, anesthesiology is now becoming a medical practice rather than a nursing practice. So her medical degree will actually become very useful and very much needed. Jyoti Asundi (20:04) Absolutely. Yeah. Smart. Aarati Asundi (20:06) Yeah, so now they're trying to develop more precise ways to control anesthesia. And so, they need to understand more about the circulatory system, the respiration system, metabolism, and things like that, which all require medical training. Jyoti Asundi (20:22) Correct. Aarati Asundi (20:22) Which is not given to nurses. Jyoti Asundi (20:24) Yes, and even the basic stuff like, hey, don't eat before you come and all those little things. Who knows if they knew that, that otherwise you're going to choke. ⁓ Aarati Asundi (20:32) I think they're starting to because they realize metabolism has something to do with how anesthesiology or anesthetics are affecting you. Yeah. So Dr. Whipple is seeing that there's going to be a need for medically trained anesthesiologists very soon. And so it's very shrewd, this move of suggesting that she goes into this very female-dominated field, which is going to become... Jyoti Asundi (20:59) Yes, but now needs a medical degree and here's your intersection to rise. Very, very good mentor. Aarati Asundi (21:08) Yes, very smart. And so Virginia agreed. And so after completing her residency with Dr. Whipple, she then went to the University of Wisconsin Medical School where there was an anesthesiologist named Ralph Waters, who was also at the very forefront of this, you know, switching anesthesiology over into a medical profession and he had set up an anesthesiology program that was meant to start quote unquote professionalizing this as a field. Jyoti Asundi (21:39) Yes, got it. Formalizing this as a true medical program rather than this slapdash, just throw some chloroform on them and hope it sticks kind of field. Aarati Asundi (21:51) Yeah, exactly. And hope you don't overdose them also. Jyoti Asundi (21:54) Yeah, you overdosed or underdosed, we'll figure that out as we go along. No, not like that. More of a formal field requiring actual skills, actual knowledge, actual training, ⁓ thinking through the whole process more clearly beforehand. Aarati Asundi (22:10) Yeah. So Virginia was the only woman in this program with 15 other men. Jyoti Asundi (22:16) Wow. Now the percentage has gone even lower. She was within the 10 % and now what.... Aarati Asundi (22:22) One out of 15. Jyoti Asundi (22:24) It's seven percent. Wow. Aarati Asundi (22:26) ⁓ I thought this was cute. They dubbed themselves the "Aqualumni" playing on Dr. Waters name. Jyoti Asundi (22:32) Got it, got it. Ha ha, good fun. Aarati Asundi (22:35) I think she was in the first class, but anyone who went into his program from then on were the Aqua alumni. Jyoti Asundi (22:39) Became an "Aquaumni" Okay, aqua for the waters. Cute, very cute. Aarati Asundi (22:46) She finished up her training with Dr. Emery Rovenstein at the Bellevue Hospital in New York. And when she graduated in 1937, she became the 50th American doctor to become a board certified anesthesiologist. Jyoti Asundi (23:01) Ooh wow, wow! 50th anesthesiologist in the USA. ⁓ wow, Aarati Asundi (23:07) In America, yeah. Jyoti Asundi (23:09) ⁓ wow, Aarati Asundi (23:10) We have one per state now. Yes. ⁓ Jyoti Asundi (23:13) Amazing! That's truly amazing! Aarati Asundi (23:17) She then returned to the Columbia Presbyterian Medical Center where Dr. Whipple supported her in setting up a new division of anesthesia where she served as the director within this department of surgery. So within his own department. Jyoti Asundi (23:29) Nice! Got it. She's so young. Aarati Asundi (23:33) Yeah, and she's the first woman to head a division at this medical center. Jyoti Asundi (23:38) Wow! She just rose like cream to the top. Amazing! Aarati Asundi (23:44) So the plan was that slowly over time, they would replace the current nurse anesthesiologist with medical doctors as the nurses naturally relocated or left the hospital to get married. Jyoti Asundi (23:57) Yes. Aarati Asundi (23:58) They also plan to start out focusing on clinical anesthesia and then slowly set up a teaching and research program. Virginia did most of the teaching herself and became a much loved clinical instructor, even writing textbooks on anesthesiology for students to study. Jyoti Asundi (24:14) Wow, that limitless energy coming back to serve her. Need to figure out what she ate and how she managed to have that unlimited energy like that. Aarati Asundi (24:24) And very outgoing. A lot of her teaching happened outside of the classroom during clinical rounds. She was completely unembarrassed or unashamed about talking about any part of the human body, didn't matter. She often had students feel her own tailbone, which was apparently at a weird angle when they learned about spinal anesthesia. Jyoti Asundi (24:46) Oh! So she was willing to use herself as a guinea pig basically. Like, look, this is the kind of weirdness you can have. Aarati Asundi (24:54) Like, do you see how my spine angles at this weird way? You may have patients like that. So... Jyoti Asundi (24:58) And then you need to do XYZ in order to circumvent that when you give them the spinal anesthesia. Oh wow. Aarati Asundi (25:05) She also carried around a pen knife for and an endotracheal tube and a laryngoscope, advising her students to always be ready for emergency resuscitations. Jyoti Asundi (25:18) Oh my gosh! Aarati Asundi (25:19) She said, quote, nobody but nobody is going to stop breathing on me, end quote. Jyoti Asundi (25:24) Yeah, you never know when you're... so this is not even CPR level. This is the next level up. Aarati Asundi (25:31) Yes. But all that said, the going was very tough. Since anesthesiology had just become elevated into a medical practice, there weren't many trained doctors in the field or even willing to enter the field because it was still very largely looked at as nurses' work. Jyoti Asundi (25:49) That's right, that's right, it has a stigma. Aarati Asundi (25:52) And surgeons also were not used to having another medically trained doctor in the room with them. In the operating room. They were used to being the ultimate authority in the operating room. And now if you introduce a medically trained anesthesiologist into the room, They now have to share power. Jyoti Asundi (26:14) That's right. And they have to be a little bit more careful. They can't just be like, yeah, that's what happened. And because there will be another doctor watching them, it's like there's a check and balance system inadvertently being introduced into the system now. Aarati Asundi (26:29) Yes, and this was another point that I found a little bit ironic because today I've heard that actually it's like whatever the anesthesiologist says goes. It doesn't matter. They actually the ultimate boss in the operating room. If the anesthesiologist says stop the operation, we're stopping the operation. Jyoti Asundi (26:47) Oh wow, because they are more intimately connected to the metabolic system of the patient who is under the anesthetic. Aarati Asundi (26:53) Yep, they're monitoring the health and if you know anything is going wrong... Jyoti Asundi (26:56) Yeah, and if they're the, the breathing has gone off, stop, yeah. Aarati Asundi (26:59) Yep, yep. Jyoti Asundi (27:00) They're not, the patient is not able to sustain this stop. Aarati Asundi (27:03) Yeah, so it's completely flipped now. Anesthesiology is one of the toughest medical fields, I think, to get into nowadays because it's just so much responsibility. It's so much pressure. Jyoti Asundi (27:15) Yes, you're the ultimate authority in the operating room. It's so funny, right? To go back in time to see a place where they're like, nah, we don't want to be an anesthesiologist. Aarati Asundi (27:25) Yeah. Jyoti Asundi (27:25) Oh my gosh. Aarati Asundi (27:27) So then you add to this now, so we have all these problems with like doctors not wanting to go into anesthesiology, surgeons not wanting to power, and then you add to this in the 1940s, the US is preparing to enter World War II. Jyoti Asundi (27:41) Correct. Aarati Asundi (27:41) And so a lot of physicians are enlisting in the military, which is leading to staff shortages in all the hospitals. Jyoti Asundi (27:48) That's right. Aarati Asundi (27:50) But, during and after the war, there's a huge boom in more complex medical practices because physicians are faced with these big traumatic injuries. And so the interest in anesthesiology as a medical profession really took off. So during the 1940s after the war, the anesthesiology division under Virginia's direction was finally able to develop into a very solid teaching and clinical program. So much so that by 1949, there was talk of converting the anesthesiology division, which was, remember, in the Department of Surgery... Jyoti Asundi (28:27) Yeah. Correct. Aarati Asundi (28:28) Yeah. So they were talking about converting it into its own full-fledged department. Jyoti Asundi (28:33) Yeah, okay, this is getting bigger and bigger. Aarati Asundi (28:37) However, despite Virginia having spent 11 years building up the anesthesiology division, there were doubts that she would be able to lead a full department because she had spent so much time focusing on teaching and clinical practice that she had not really done anything in the way of research. And a department needed all of these things. Jyoti Asundi (28:55) Oh my God. You know, they'll find the one thing, you know, "You did this, you did this, you did this, but you didn't stand on your head when you're doing it and that is truly required." I don't know. I feel that that's like nitpicking to kind of squeeze her out of the... Aarati Asundi (29:13) Maybe a little bit. So they did form the new department and one of her colleagues, Dr. Emmanuel Papper, who was a man, who had a research background, he became head of the department. However, Virginia was appointed a professor of anesthesiology, which made her the first full woman professor at Columbia's College of Physicians and Surgeons. So she wasn't completely shoved aside, you know, it wasn't like a complete dismissal of her... Jyoti Asundi (29:43) Yeah, complete dismissal of her skills. Okay. Aarati Asundi (29:47) Yes. And actually it worked really well in her favor because it removed the burden of her having to do administrative work. And so she was finally able to focus all of her attention on teaching and clinical work. Jyoti Asundi (30:00) Okay, which was probably more rewarding in the long run. Okay. Aarati Asundi (30:03) Yes, which is what she wanted to do. So it worked out for her. __________________________________________________________________________________________________________________ Aarati Asundi (30:13) Hi everyone, Aarati here. I hope you're enjoying the podcast. If so, and you wish someone would tell your science story, I founded a science communications company called Sykom, that's S-Y-K-O-M, that can help. Sykom blends creativity with scientific accuracy to create all types of science, communications, content, including explainer videos, slide presentations, science, writing, and more. We work with academic researchers, tech companies, nonprofits, or really any scientists. To help simplify your science, check us out at sykommer.com. That's S-Y-K-O-M-M-E r.com. Back to the story. ________________________________________________________________________________________________________________ Aarati Asundi (30:59) So during the war, Virginia had developed a strong interest in obstetric anesthesiology, which is anesthesia that is given to a mother during childbirth to help ease labor pain. Jyoti Asundi (31:11) Yes. Aarati Asundi (31:12) And that's because a lot of the work at the hospital during the war was focused obstetric anesthesiology. Jyoti Asundi (31:18) Obstetrics. Yes, yes. Aarati Asundi (31:20) Yeah. At this time now, more babies are being born in hospitals than they were at home. Jyoti Asundi (31:26) Slowly that shift is happening, okay. Aarati Asundi (31:29) And of course, you know, with all the men away at the war, most of the people needing anesthesiology are women giving birth. That's the bulk of the population. Jyoti Asundi (31:38) That's true. Correct, correct. Aarati Asundi (31:40) However, Virginia noticed that in a delivery room, most of the doctors and nurses were completely focused on the mother. Even after the baby was born, no one was focusing at all on the newborn baby. And so no one was really checking to make sure, it okay? Is it breathing properly? Things like that. Jyoti Asundi (31:57) That's right. You do need two teams. You do need two teams to be there. Absolutely. There's two patients right soon as the baby comes out... Aarati Asundi (32:05) it went from one to two. Yeah. Jyoti Asundi (32:08) Yes, you went from one to two right there. Yes. Aarati Asundi (32:10) Yeah. So normally what happened is when the baby was born, it was given a quick look to see if it looked normal. But what constituted as quote unquote normal was not well defined. And so it was really up to the interpretation of the doctor if they deemed it to be normal or not. Jyoti Asundi (32:28) Which is very subjective. Aarati Asundi (32:30) Very much. If the baby looked blue or wasn't crying properly or was gasping for air or had a very slow heartbeat, the doctor could rate it as abnormal. And then if the baby died shortly after birth, it could be chalked up to that abnormal condition that the baby was born abnormally and nature just took its course. And it was like no fault of the Jyoti Asundi (32:52) My goodness. Aarati Asundi (32:54) It's not the doctor's fault. It's just how nature intended. Jyoti Asundi (32:55) Nobody's fault. This is what it is. Aarati Asundi (32:57) Yeah. Nothing to do. Jyoti Asundi (32:59) Oh sad. Aarati Asundi (33:01) But Virginia was like, all of these symptoms, like the baby turning blue, gasping for air, not crying, slow heartbeat, that's all indicative of the baby not having enough oxygen. So if you notice these symptoms, and instead of saying just "Abnormal birth" and then going back to the mother, Someone... Jyoti Asundi (33:25) Give them oxygen! Aarati Asundi (33:25) should take the time to, yeah, make sure the baby's airways are clear and provide it with oxygen and get it breathing properly, either by giving an oxygen mask or doing mouth-to-mouth resuscitation. Like, try to get it breathing properly. Jyoti Asundi (33:40) Yeah. Aarati Asundi (33:41) The other thing that she noticed importantly was that there was a link between the type of anesthesia the mother got during labor and whether the baby was breathing normally when it was born. Jyoti Asundi (33:51) Oh wow! That's a good one to catch. Aarati Asundi (33:54) Yeah, so she noticed that if the mother was given really high doses of anesthesia, it was more common for the baby to exhibit breathing problems immediately upon birth. Jyoti Asundi (34:04) Yes. Aarati Asundi (34:05) So soon she started making it mandatory for all of her anesthesiology residents that she was mentoring to start doing rotations in obstetrics. So according to legend, one day, one of her students approached her at breakfast and they asked her exactly what signs should they be looking for when a new baby was born to tell if it was okay or not. Virginia grabbed a napkin and she wrote down five things to check. In the early 1960s, medical students turned these five things into an acronym based on Virginia Apgar's name to help them remember. Jyoti Asundi (34:42) Okay. Aarati Asundi (34:42) So we have A for appearance, which is what is the color of the baby? Is it pink, a healthy pink color, which means lots of oxygen, breathing properly, or is it turning blue? Then P is the next letter for pulse or heart rate. G is for grimace, which means reflexive response. The next A in Apgar is for activity or muscle tone. And then R is for respiration. Is the baby gasping or breathing normally? Jyoti Asundi (35:16) Yes, yes. So Apgar became not just the score, reflects not just the name, but it's actually an acronym for actual tests to be conducted. Aarati Asundi (35:29) Yes. So Virginia didn't make up the acronym, but she heard about it because students are learning, like, these are the five things you need to check. They're like, "Oh Apgar has five letters. We'll just correlate and help remember that for the Apgar score, you have to check these five things." Jyoti Asundi (35:43) Correct. Nice. Aarati Asundi (35:47) And actually, I read that a lot of people didn't realize that Apgar was a person's name. They just thought it was called the Apgar score because of that mnemonic device. Jyoti Asundi (35:55) Because of those symptoms that they correlated to. Aarati Asundi (35:58) Yeah, and then they would meet her and she's like, "I'm Virginia Apgar." And they're like, "You're a person? Wait..." Jyoti Asundi (36:05) Amazing! Aarati Asundi (35:06) Yeah. she was thrilled by this. She was like, this is so cool. They came up with a mnemonic device. Jyoti Asundi (36:10) This is so cute. Yes. But it also shows you, how much she was loved by her students. don't do these kind of things. They don't take the trouble to make your name into a mnemonic device unless they really respect the heck out of you. Yes, nice. Aarati Asundi (36:25) Yeah. So I thought that was very cool. Jyoti Asundi (36:28) Very nice, very cool. I like it a lot. Aarati Asundi (36:31) Yeah, and the other important thing to note though is that she didn't just like choose these five things randomly. These five things are what anesthesiologists check when they are monitoring patients who are under surgery. Jyoti Asundi (36:42) Yes. Aarati Asundi (36:43) Over time, she developed this into a scoring system where doctors would rate the baby in each of the five categories as either 0, 1, or 2. And then you would add them up to get an APGAR score. So a 2 in each of the five categories would give you an APGAR score of 10, meaning the baby was in the best possible health. An APGAR score of 7 or higher means the baby's in good health. And a score of six or below means maybe further evaluation or medical intervention may be needed. She presented the scoring system in 1952 at an International Congress of Anesthetists and she published the Apgar score in 1953. Jyoti Asundi (37:26) Nice. Aarati Asundi (37:27) Over the next few years, as doctors started using the score, it became clear that it was a vital tool in the delivery room as low scores correlated very strongly with infant mortality and that immediate medical treatment was needed to try and help these babies survive. Jyoti Asundi (37:44) Yes, you need to intervene right away. Absolutely. Aarati Asundi (37:46) Yes, you can't just call it abnormal and be like, "Okay." Yeah. Jyoti Asundi (37:50) Yeah, yeah, whatever. Yeah. Actually, you know, I have to be grateful for this score and the fact that she brought attention to the fact that if the baby is not doing well, do something about it right away and rescue the baby because your brother was born like that. Aarati Asundi (38:09) Oh really? Jyoti Asundi (38:10) Yeah he was born with the umbilical cord around his neck. Aarati Asundi (38:14) Oh! That's scary. Jyoti Asundi (38:15) Yeah when he came out, they took him and they immediately put him into a vent-like situation. Aarati Asundi (38:22) Mm-hmm. Jyoti Asundi (38:23) And I kept looking. It's like, hey, when I gave birth to my daughter, she was brought to me right away. But this little child is being kept over there on the side. What is going on? Aarati Asundi (38:34) Yeah. Jyoti Asundi (38:35) And then after about 20 to 30 minutes, they brought him in. And nobody really said anything, but I get it. I get it that that's what had happened. And that is why they were making sure that he was... Aarati Asundi (38:45) Yeah, they must have realized that, you know... Jyoti Asundi (38:48) He has to be fully oxygenated. Aarati Asundi (38:48) ...that that's a potentially...yeah, potentially dangerous situation. And that vent was probably giving him oxygen. Jyoti Asundi (38:54) Yeah, just giving him oxygen. Make sure he's fully oxygenated. And then his color is good, he looks good by the Apgar score, then take him out of there. Aarati Asundi (39:04) Yeah. my gosh, that's so scary. Can you imagine if they were just like, "Oh well, we'll see what happens." Jyoti Asundi (39:08) Oh yeah, yeah, he's a brown baby anyway. He's never gonna look pink, no problem, bye. Yeah. Aarati Asundi (39:14) That would be so, so terrible. Oh my gosh. Yeah. I can't imagine the number of stories like that that are out there that, you know. Jyoti Asundi (39:24) And he was perfectly healthy. Just needed five minutes of care at the right point. That's it. And that is such a "Duh, obvious" at this point. Like, hello, you just came from one world into another world and through a very weird portal. So maybe you should be.... Aarati Asundi (39:43) And it's not even like, know, maybe he wouldn't have even died, but it's like, who knows what happens to your brain. Jyoti Asundi (39:50) No, but the brain function would have been reduced maybe. Aarati Asundi (39:52) Yeah. And so he could have had, you know, disabilities or difficulties throughout his life just because of that. Jyoti Asundi (39:58) Absolutely. Throughout his life, he would have struggled. Aarati Asundi (40:00) Yeah. And that all was avoided. Yeah. Jyoti Asundi (40:01) Yeah. And now he's like... everything. And he's like this fantastic fellow running around conquering the world because, you know, because of those five minutes of accurately timed intervention. Thanks to Apgar. Aarati Asundi (40:17) Yes, exactly. Jyoti Asundi (40:18) Amazing. Aarati Asundi (40:19) Really amazing. The impact she had is incalculable. Jyoti Asundi (40:24) Absolutely you cannot calculate the... yeah, incalculable. Aarati Asundi (40:29) Virginia kept doing studies on thousands of newborns using her score. And she found that the Apgar scores also showed correlations with the type of delivery. So whether the delivery was spontaneous or whether forceps were needed to pull the baby out or whether it was a cesarean section and whether the cesarean section had been planned versus if it was an emergency. Jyoti Asundi (40:53) Yes. Aarati Asundi (40:54) This all correlated with, like, if it was an emergency C-section, the Apgar score tended to be a bit lower. So things like that, she's starting to notice patterns. Apgar scores also correlated with the type of anesthesia used on the mother, with general anesthesia correlating to asphyxia in newborns as opposed to local anesthesia. Jyoti Asundi (41:16) Yes, so that is why women are now given epidurals, I think. Aarati Asundi (41:20) Yes, it's safer. These studies really shown a spotlight on how important it was, like we were saying, for physicians to understand how to take care of newborn babies. And it kicked off the field of neonatal care. Jyoti Asundi (41:33) But also I think it shows a deep respect for the birthing process itself as to how complicated the whole birthing process is, how many different factors can make a huge impact. And actually if you if you give that kind of respect to the birthing process, then health of the mother is also taken more seriously during this process. And very often today, it's actually going in the opposite direction where women's health is not being given as much importance. The woman is going through an extremely crucial and complicated and sometimes life-threatening situation when she gives birth. And you need to respect that. Aarati Asundi (42:22) And especially when there's like really basic things that you can do to make sure that everyone is okay, you know? Jyoti Asundi (42:28) Yeah. Common sense. Aarati Asundi (42:29) Just, yeah very common sense. Jyoti Asundi (42:30) Some of this is just... so it looks like common sense right now. is shocking that this actually to be stated out loud that, "Hey, don't just take care of the mother in the birthing room. Have a second doctor in the room who is focused on the other patient in the room, which is the baby that just came out." Aarati Asundi (42:50) Yes, yes, So her work really kicked off this field of neonatal care and it became an essential tool today with many obstetricians saying that every baby born in a hospital anywhere in the world is first seen through the eyes of Dr. Virginia Apgar. Jyoti Asundi (43:08) Amazing! Every newborn, first look at it the way Dr. Apgar taught doctors to do. What a contribution to society. What a contribution to humankind. Aarati Asundi (43:19) Yes. Virginia was virtually swimming in newborn health data from hospitals all over the country. But soon she realized that she didn't know enough about statistics to be able to properly analyze all this data. She also didn't know much about congenital defects and how they were formed and maybe how that correlated with pre-existing conditions that were seen during pregnancy and then how that all affected her Apgar score. So she's starting to see these holes in her knowledge. So in 1958, she decided to take a sabbatical from Columbia to go to the John Hopkins School of Public Health to earn her master's degree. Jyoti Asundi (43:59) No way! Aarati Asundi (44:00) Yeah, she's 49 years old by this point, by the way. Jyoti Asundi (44:05) Wow! get her masters in statistics and all that? Aarati Asundi (44:08) Yeah, in public health, but to learn more about statistics and congenital defects and things like that. Jyoti Asundi (44:13) ⁓ my God, you know, my brain did not even go there with her. I thought... I was just impressed by the fact that she had enough wisdom to recognize what she did not know. I was anticipating that you were going to tell me that she brought in these other people to her team. Aarati Asundi (44:33) She collaborated, yeah. Jyoti Asundi (44:35) Collaborated with mathematicians and statisticians who had some kind of interdisciplinary knowledge of medicine or something like that. No, she does it herself. Aarati Asundi (44:46) Yeah. Jyoti Asundi (44:47) She's like, stop this, go get this other piece of knowledge that I need, how to break down all this information into bins and try to make sense out of all this data that currently looks random. Aarati Asundi (45:00) She's like, know there's a pattern, but I can't put my finger on it because I don't have the... Jyoti Asundi (45:04) I can't put my finger on it because I can't see it because I don't have the skills. Aarati Asundi (45:10) Correct. Jyoti Asundi (45:11) And she herself goes to get the skills. Aarati Asundi (45:13) Yeah she doesn't just hand it off. Jyoti Asundi (45:13) Because, and now I get it. I get it. Because she has the medical knowledge to how to break the data into correct statistical bins. So she has to do it herself. You need that person who has both skills in one brain. And she decides to be that person. What an amazing lady. Aarati Asundi (45:34) Yeah so she's off to earn her master's degree. And around this time while she's doing her master's degree, there was and still is, there still exists a nonprofit national foundation called March of Dimes. Jyoti Asundi (45:50) Oh yes! March of Dimes, I've heard of that. Yes. Aarati Asundi (45:52) Oh yeah? Jyoti Asundi (45:53) Yeah. Aarati Asundi (45:54) So it was originally set up in 1938 by President Roosevelt to help fund research for a polio vaccine, but today, it focuses on just generally improving the health of mothers and babies by funding research into the cause and prevention of birth defects, premature birth complications, infant mortality, and advocating for better policies to care for mothers and their newborns. So in 1959, when Virginia is studying for her master's degree, March of Dimes was starting a new division called the Division of Congenital Malformations. And they approached Virginia asking if she would be interested in becoming director of the new division. And she thought, hey, that could be a really interesting opportunity. And it's a really good time for a career change anyway, right when you're doing your sabbatical learning these new skills. Jyoti Asundi (46:45) Yeah. Aarati Asundi (46:45) So immediately after graduating, she started her new job there. By the way, this is also right around the time when Frances Oldham Kelsey, remember her from your very first episode? Jyoti Asundi (46:57) I do remember her. Yeah the lady who was the FDA soldier. Aarati Asundi (47:03) Yes. Jyoti Asundi (47:04) Yes. Prevented thalidomide from coming in. Aarati Asundi (47:06) Yeah, she right now is making her grandstand. Jyoti Asundi (47:10) Aha, against thalidomide. Aarati Asundi (47:12) Yes, she is refusing to let the thalidomide become approved by the FDA. And so because of this, like this whole question of newborn babies and congenital birth defects and like, you know, how to take care of newborns and are they okay? Are they healthy? What can we do? This is receiving a lot of attention at this time. Jyoti Asundi (47:34) Yes, yes. Aarati Asundi (47:36) So Virginia, joining March of Dimes is really just like the perfect fit. It's the perfect firestorm for her. She has this outgoing nature. She has years of teaching experience. She's perfect for the job. She's traveling the country giving lectures to medical students, physicians, and the public congenital birth defects. And because of the thalidomide scandal that is now coming to light, she has this captive audience. Everyone wants to know more about this. Jyoti Asundi (48:05) Yes. Yes, absolutely. Yes. This is a topic that touches every home. Aarati Asundi (48:13) Yes. Jyoti Asundi (48:14) Personal interest. Everybody has either a baby or a grandbaby on the way or a niece or a nephew on the way. Like, we want our family to be healthy. How do we make that happen? Aarati Asundi (48:25) Yes, and she's just like the most brilliant teacher and she's very enthusiastic and so she's.... Jyoti Asundi (48:29) Yes, very well equipped to pass on the correct knowledge. Yes. Aarati Asundi (48:36) Between 1960 and 1974, she helped double the annual income of March of Dimes. Jyoti Asundi (48:42) I can imagine this. Aarati Asundi (48:45) In 1972, she teamed up with a medical journalist named Joan Beck and contributed to her book called "Is My Baby Alright?", which was an educational book about birth defects. Jyoti Asundi (48:57) Educating in every possible way, beautiful. That's such a fantastic force of the universe. Everything that you do, you're doing it to make the world a better place. You're aligned so well to something for the greater good. That is beautiful. Aarati Asundi (49:15) Yes. Really amazing. She also continued to lecture at medical schools. At Cornell, she was a lecturer and clinical professor in pediatrics with a specialty in teratology, which is the study of birth defects. She was the first of her kind in that regard at Cornell. She was also a lecturer at John Hopkins School of Public Health. So she went, turned right back around after she did her master's, started lecturing there. Virginia never got married or had any kids of her own, which really allowed her to pursue her career and also her other interests. I already mentioned that she played the violin, but later on in life, she got into actually making the instruments herself. Jyoti Asundi (50:02) That's a completely different skill set! Aarati Asundi (50:05) Yeah, so apparently she had a friend who's like, I will teach you how to make a violin on how to make these string instruments. Jyoti Asundi (50:13) And because she loved the violin, she could then make the sounds that she wanted. That, this wood produces these tones and these strings produce these tones. Oh wow. When she likes it, it's like an obsession. She goes deep, deep to the very roots of it. Aarati Asundi (50:33) So she made a violin, a viola, and a cello. So all these different string instruments. Jyoti Asundi (50:37) Wow, nice. Aarati Asundi (50:40) She also started taking flying lessons just for fun. Jyoti Asundi (50:44) Whoo, yes. Aarati Asundi (50:45) She loved fly fishing, golfing, stamp collecting, and gardening. Jyoti Asundi (50:50) You know, she reminds me of Frances Oldham Kelsey also, who was also having all these various interests. Aarati Asundi (50:57) Yes, very well-rounded, just, you know, into everything. Jyoti Asundi (51:00) Full of energy, living life to the fullest. Aarati Asundi (51:04) Yeah. Very interestingly though, although she was sometimes frustrated with the lack of opportunities for women in science, and especially at the salary inequalities that she noticed... Jyoti Asundi (51:15) Oh yes Aarati Asundi (51:15) ...she never really joined a woman's organization or particularly tried to advocate for women in science. She had felt being a woman herself had not held her back from achieving what she wanted in her own career because she had been able to kind of adapt and work in spaces where there were opportunities for her to explore new frontiers and expend her energy. Even though she was kind of like withheld from being a surgeon, the fact that was she able to get into anesthesiology and put her full efforts there and still make full use of her medical training, she never felt that she was held back in any way. Jyoti Asundi (51:57) So she felt that, where there is a will, there is a way. If you want to make it happen, you'll make it happen, that kind of thing. Aarati Asundi (52:04) Yeah. I just thought it was interesting that she never really became a strong advocate or outspoken advocate for women's rights in medicine in general. She was just like, yeah, just do it. You know? Jyoti Asundi (52:16) Yeah, just do it. It'll happen. Yeah. Yeah. Aarati Asundi (52:18) Yeah. In 1973, Virginia was diagnosed with cirrhosis, which is a progressive liver disease. Jyoti Asundi (52:26) Why? Was there a cause for it that they could... Aarati Asundi (52:29) Not that I saw. I don't know what happened. Jyoti Asundi (52:33) Okay all right. Aarati Asundi (52:34) Yeah. Despite this though, she continued to work as hard as possible, keeping a completely full schedule. On August 7th, 1974, Virginia passed away at the Columbia Presbyterian Medical Center, where she had spent so much of her life learning and teaching others. Jyoti Asundi (52:52) Yeah, that's like her second home. Aarati Asundi (52:55) Yeah basically. After her death, she continued to receive honors. In November 1995, she was inducted into the National Women's Hall of Fame. In 1999, the National Women's History Project designated her an honoree. Jyoti Asundi (53:12) Nice. ⁓ Aarati Asundi (53:13) And of course, my favorite, the Google Doodle honored her on June 7th in 2018 on her 109th birthday and it's a very cute graphic. It has a little baby on there as one of the O's, I think, and her checking out the baby. Jyoti Asundi (53:27) Wow. my goodness. Aarati Asundi (53:30) So it was very cute little graphic. Jyoti Asundi (53:32) Oh my God. What a fantastic woman. What a beautiful life she led. And she didn't let anything stop her. She's like water, you know, like, there's an obstacle. I'll flow around it and do something else. But a force of nature, you cannot stop me. Fantastic. Aarati Asundi (53:52) Yes. And she had some good mentors, good role models, and then she became one herself. Really an amazing woman. Jyoti Asundi (54:00) Amazing. I love the story. I did not know that Apgar was the name of the score and the name of the woman and how they had modified her five criteria to kind of mneumonically fit to make it into her score so that permanently now, forever and ever, her contribution in making sure that the limelight is on the newborn as soon as birthing happens, not just on the mother. That was her contribution to society. Use very objective terms to decide whether the baby is good or not. And do something about it right away. Very small minor interventions at that moment when it's born will actually make the baby healthy, happy, and alive and good again. Aarati Asundi (54:48) Yeah. Jyoti Asundi (54:49) And don't just ignore it saying something abnormal came out of the mother, make the mother better again and throw the baby away. No, that's not how it's supposed to do. And that is now permanently associated with her. That is fantastic. Aarati Asundi (55:02) Yes. Amazing, amazing lady. Just touched countless lives, I can't even imagine. WE have a lot to be thankful for for her... Jyoti Asundi (55:08) Absolutely. Our family has a lot to be thankful for. Your brother would not have been the amazing young man that he is today. Aarati Asundi (55:17) Yes. So for this Thanksgiving, we are giving thanks to... Jyoti Asundi (55:22) Dr. Apgar, fantastic. Aarati Asundi (55:23) Yes, Dr. Virginia Apgar. Yep. Jyoti Asundi (55:26) Yes, thank you. Thank you, Aarti, for sharing the story with me. I loved it. Aarati Asundi (55:29) Yes, I'm glad you enjoyed it. Thanks for listening. If you have a suggestion for a story we should cover or thoughts you want to share about an episode, reach out to us at smartteapodcast.com. You can follow us on Instagram, TikTok, and Blue Sky @smartteapodcast and listen to us on Spotify, Apple Podcasts, YouTube, or wherever you get your podcasts. And leave us a rating or comment. It helps us grow. New episodes are released every other Wednesday. See you next time.