So how do we predict which patients are going to progress to need ECMO? versus just needing kind of conventional management?

So that's a very good question.

And I think that there's somewhere in that philosophy that might be answered by a look at all the patients who have ARDS of a certain level of acuity, be it by Murray criteria or any safe or Apache score amalgam that allows us to then say this patient is as sick as possible.

and give it any arbitrary number.

And if they are that sick on day seven, and we extrapolate back and see how sick they were on day five, and if that magnitude of clinical acuity is the same on day five and day seven, then maybe we can project that the outcome on day five would be exactly as it was on day seven.

And maybe we can start to dial back the EOLA criteria of saying, wait seven days before you make that decision.

And maybe it's five.

How do you mobilize your physical therapist? How do you get this done safely? Give us a little bit of an idea in West Virginia, what the protocols are and to do this safely.

And I think you've started doing this already, but if you were specifically speaking to a high school student, a medical student in Kenya who may not have as much control necessarily, or may not feel like they have that much control over their destiny and do not have any necessarily options, let's say, to go elsewhere, but they have an idea, they have a dream, how would you advise them to navigate that path?

Again, that's a very good question.

I'm going to tie it in also with the part of Dr. Pereira's question that I didn't completely answer, which is a preparation of what you will find when you leave home, because somehow we when I look back, we did not have a very good emotional preparation of what to expect when you're no longer living under the roof of your parents and the embrace and the community protections that exist when you live at home.

So if I were to go back, it would be to prepare the minds of the potential students or residents, trainees, or young people, young minds who are leaving to say, you are going to be faced with new challenges from a political standpoint, an emotional standpoint, a financial standpoint, and a strategic standpoint.

And understanding those categories will then allow you to categorize your response and to prepare yourself for those challenges.

Because right now, the biggest structural Hurdle is immigration.

That is the single biggest thing because there are There are sponsorship opportunities there there are ways to mitigate the financial burden of moving but it is not worth anything if you can't get the entry visa to get into the country that you're trying to go to and as there is a growing sense of country first nation-first politics, there is a reluctance to invest in the outside influx of people.

You know, we heard you say you formulated your path into medicine, but how did you formulate your plan into this well-respected academic surgeon scientist?