Dorothy: [00:00:00] Visiting with David Holmes was life changing for me, seriously. In spite of all the years that I’ve been in the breast cancer world. His story brought new levels of understanding about this disease, about what happens to the family, and quite frankly, when he finished, I was in awe. We’re gonna be featuring David in two episodes.
In episode one, you will hear how the love of his life, Heather, was diagnosed through tremendous battle she fought and the final tribute to Heather, A gift by David and their children. In episode two, David gives us a closeup and personal evaluation of the US healthcare system compared to the one in the UK. Is one better than the other? We’ll let you decide.
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Let’s Talk About Your Breast, a different kind of podcast presented to you by The Rose, a breast center of excellence, and a Texas treasure. You’re gonna hear frank discussions about tough topics, and you’re gonna learn why knowing about your breast could save your life.
David, thank you so much for being with us today. It’s just so good to see you again. It’s been a while.
David: It certainly has, and it’s a pleasure to be here.
Dorothy: Good. It’s so, David, your story has so many multiple levels to it. We’re gonna be talking a little bit about Heather, your wife. We’re gonna talk about her diagnosis. Your feelings as a caregiver, but also what always fascinated me listening to you talk was the differences that you felt were between the United States Healthcare System and the UK uh, system. And of course, being [00:02:00] from that part of the world, you certainly know that the other systems, so how did you and Heather get to the United States?
David: Well, it’s all my fault. Um, uh, Heather and I had been married for, uh, I think 16 years by complete coincidence. When we met, I was living in Edinburgh, Scotland. She was working as a nurse in Cambridge, in England. And, uh, I was actually working in banking at the time, uh, in it, but we decided we were gonna live together in Cambridge.
And I got a short contract working for a small little energy IT company in Cambridge just for three months. And it turned out that was the start of what became a 25 year career for me. Uh, and the energy industry is a global business, but it’s headquartered in Houston, Texas.
Dorothy: Mm-hmm.
David: And I found, I was spending numerous trips in 2016. I think I made. [00:03:00] Uh, 13 trips over to Houston alone. And so I said to my boss one day, I think maybe I should think about relocating. And three months later, our entire lives were in a 40 foot shipping container. And, uh, myself, Heather, and our two young children were on our way over to Texas.
Dorothy: Oh my goodness. So that had to be a bit of a shock for everybody coming to Texas and especially to Houston.
David: It, it definitely was because we arrived in August of 2017, 2 weeks before Hurricane Harvey.
Dorothy: Oh.
David: So our introduction to Texas was, uh, was one of the worst hurricanes to hit this town. So that was, that was certainly quite an experience for us.
Dorothy: Oh, I had forgotten that. Oh my gosh. That would’ve been terrible. God.
David: It was. It was, it was, it was difficult. We were, we were incredibly lucky. Our house was an island. We had water on all four sides, but it didn’t flood at all. So we were, we were very lucky in that regard.
Dorothy: So did Heather go to work here [00:04:00] also?
David: No, the intention was that, uh, when we moved over here, so Heather was a, uh, specialist, palliative and end of life care nurse and, uh, led a team in the, in the UK. Uh, the idea was when she came over to the us, um, she felt she could apply those, those skills. Here it’s actually quite a complicated process to have your credentials, uh, translated you have to have all of your certificates translated from English into American.
Dorothy: Mm-hmm.
David: Uh, you have to do, uh, additional exams. So, you know, Heather was working towards, um, being able to nurse, but she was never ultimately able to, to practice nursing.
Dorothy: So when did y’all first know that she had a problem going on?
David: So in June of 2019, Heather had, uh, an appointment with her PCP, and we talked about differences between [00:05:00] the UK and the US. One of the significant differences is that in the UK, routine well, woman checks and mammograms aren’t done till you are 50 years old. Heather was in her late forties and you know, had her regular checkup with her, her PCP, who thought she’d found a lump. So Heather scheduled an appointment to The Rose. Um, we’d met before Heather was, was diagnosed and came along for, uh, a diagnostic mammogram. And I was in London at the time and I got a phone call from Heather. I was about to give a, uh, uh, a big speech at a conference in London, and she phoned me up and said I think I have cancer.
Dorothy: Oh gosh.
David: And it was, uh, it was quite a shock.
Dorothy: Ah, that was her first mammogram.
David: Uh, well, it was, it was the first one that showed that there were, there were problems.
Dorothy: So, but she wouldn’t have had it if she, she’d had—
David: Yeah, she’d had a, she’d had a [00:06:00] regular scheduled mammogram just six months earlier, which was completely clear.
Dorothy: I remember that.
David: Um, and then this, this one showed up. So I booked on to the next flight back from London. Um, and you know, I spoke to the best piece of advice I got and there were many, but I spoke to my boss at the time whose wife had been through, uh, a similar diagnosis. And what he said to me, which is what I’d say to everyone is he said it’s different for everybody.
Uh, you think of breast cancer as being the single thing, and it’s lots of different things that present in lots of different ways, and you’ll find everybody you talk to will have some opinion based on their anecdotal experience. He said, be patient. Find out information, you’re gonna learn a huge amount, but other people’s experiences aren’t predictors or indicators of what [00:07:00] your experience might be.
Dorothy: That was excellent advice because breast cancer alone has 17 to 19 different kinds of cancers and then whatever stage they, you know, present at, or if it is spread or there’s so many factors that that can impact— outcome can impact treatment.
David: And I had no idea because you, you, you know, I’ve contributed to breast cancer charities in the, in the past.
Dorothy: Mm-hmm.
David: But breast cancer research seemed to be, to me as a very naive individual, seemed to be like one thing.
Dorothy: Right.
David: That we were working towards curing and, and now I have a completely different understanding.
Dorothy: What kind of cancer did she have?
David: She had triple negative breast cancer that, um, when she was first diagnosed with stage 2B.
Dorothy: So for our listeners, triple negative is, is one of the more tough cancers to have it, it is negative for estrogen, progesterone and HER2, [00:08:00] which means they really have to use a lot of different treatment, a lot of chemo, a lot of whatever they have to, to try and impact this cancer. So, uh, it’s, it’s a tough one and, and it is not often found, even though we’re seeing it more and more in Caucasian women, it, it is not, it’s just not the, the normal thing. So here she was, young woman with this, this cancer, and I think the, at least as we’ve been talking, I think one of the challenges was she was a nurse, so she knew stuff, you know.
David: She was, so, while I was flying back on the plane and both of our children were away, um, on various camps. One was in Washington, DC Um, my daughter’s in Washington, Dc. My son was at Space camp in Huntsville, Alabama. And so I [00:09:00] was flying back and as I flew back, I sent her the message and said, you know, I think we should go away for a couple of days. And it was the best thing we ever did. So I landed, she met me at the airport and we flew off to Mexico for two days and it was exactly what we needed. It gave, because Heather was a thousand miles, uh, ahead of me in terms of her understanding, you know, her practice as a specialist cancer nurse. Um, she knew far more than I did, but it was a great opportunity for us to ground ourselves in this new reality for her to prepare me for a lot of what was to come because the whole, well, what’s next?
You know, I didn’t understand about staging and grading and the different types of cancer. Uh, I certainly didn’t understand, you know, in my, in my head, if you have cancer, you get chemotherapy, then you get radiotherapy and some surgery and, [00:10:00] and maybe some more chemotherapy. And I had no clue as to the complexity of that.
So it gave us a chance to, to kind of, to connect on that level. But it also gave us a chance to kind of be together as a couple. I, you know, I certainly said to some of my friends at the time that, uh, if you think about the five stages of grief, that trip to Mexico was us embracing denial. It’s, you know what, for two days.
Dorothy: Right?
David: We are, we’re not gonna ignore it. We, we did talk about it, but we also took the opportunity before all the craziness starts. We’re just gonna be together for a couple of days away before the children come home.
Dorothy: What a gift though.
David: It really was. And I’d, I’d, I’d recommend it to everyone that, you know—
Dorothy: They just came to you. You should do that.
David: It would, you know, and, you know, cancer diagnosis is one of the most challenging things that any couple could possibly have to cope with. It will stress relationships in ways that [00:11:00] are you know, unimaginable and unpredictable, but that moment it was, it was definitely the right thing to do.
Dorothy: Are you comfortable sharing some of those ways that it impacts the relationship?
David: Um, I think, you know, marriage is hard on a good day. There are very few people who, you know, although Facebook might, uh, show a different picture of people living these absolutely perfect and delightful lives, but, but marriage is hard. Relationships are hard. You know, Heather and I were married for 23 and a half years, and from the point of of diagnosis, there are a lot of challenges. You know, there, there are days when. We, we didn’t get on where cancer made it. You know, incredibly difficult for me to understand what she was going through, for her to understand what I was going through.
Um, and certainly when the prognosis [00:12:00] was terminal. It became very difficult and that that phase, which was expected only to last for six to nine months, actually lasted for over two years. So living in this situation where, you know, somebody’s life could be very, very short and living in that way, it does make it difficult to, to maintain the type of relationship that you might you might aspire to. It’s, it is overwhelming. I’d say the other thing that nobody prepares you for is, and I, I had no idea that this was to come. Cancer diagnosis is an awful thing but what nobody tells you, told me as a caregiver is that I’d been condemned to five years of wrestling with insurance industry and billing departments, and certainly for the first year that was 20 or 30 hours a week, just dealing with all of the billing, the [00:13:00] prior approvals, the um, you know, uh, dealing with the insurance companies. It was absolutely overwhelming.
Dorothy: And it, it seems like the doctors are never in the same building and you’re always having to find another way to get to the next doctor’s appointment. And, and there’s, there, it just takes over.
David: It’s a, it’s a big toll. And obviously, you know, we had two teenage children to, to bring up. I had a, uh, full-time challenging career to balance. I mean, I’ve, I’ve been spectacularly lucky in that not only have I had really good health insurance, but uh, you know, my, my employers have been unwaveringly supportive. Um, and I’ve, I’ve been incredibly lucky in that regard.
Dorothy: And that doesn’t always happen. You know that. I mean, especially when it’s the caregiver, you know?
David: Yeah.
Dorothy: And that’s just, that’s very commendable. [00:14:00]
David: No, my, my, my boss just couldn’t possibly have done more, which is absolutely amazing. Um, yeah, that, that’s been—
Dorothy: How did you tell the children?
David: Oh, that was a difficult day. So, for a bit of context, um, my, um, my best friend’s wife had been diagnosed with cancer a few years earlier. Um. And, um, and so, um, and, and she was my, my daughter’s godmother, um, and her husband was my son’s godfather. And so the children were familiar and understood cancer and, and, and what it meant. And, and so when it came to telling the children, we knew that was gonna be difficult. Um. And I’d assumed [00:15:00] because Heather had this whole career in palliative and end of life care, and you know, I always, I always, I usually used to just say, she kept me grounded in my job. I’d come back from work, I’d had a really frustrating day, maybe we’d lost some big deal and everyone was really upset. And then Heather would say that she’d sat down with two teenage children to tell them that their mother was gonna pass away because the father couldn’t do it.
And I realized that my job just seemed incredibly unimportant in terms of these things. So I’d imagine that Heather, with all of her experience, would be the one who’d, who’d tell the children. Um, but when it came to it, she really found herself unable, you know? She said, look, I need you to, so the four of us sat down and, and what I realized is, is that all the years of listening to [00:16:00] Heather talking about how work had kind of trained me and prepared me for this moment, and so it was a really difficult conversation to have with the children, but it was also one where there was a huge amount of uncertainty and there was a huge amount of hope. You know, cancer is absolutely not a death sentence.
Dorothy: Mm-hmm.
David: Um, but it, but it, it’s very scary and for young children, you know, who just moved to a different country, it was certainly very difficult. So our plan with the children was, we always told them first, whenever there was any news, new diagnosis, new treatments, new updates, new surgery, we told the children first. We tried to focus on telling them things that we were certain about. Things that we did know, rather than speculating on things that could be. So the conversation with the children is, is that, [00:17:00] you know, these initial tests, and this is before the biopsy was done, um, showed that, you know, mum probably has cancer.
They’re going to do some more tests, they’re gonna understand where it is, whether it’s spread, uh, what type of cancer is, and you know how quickly it’s, it’s growing. Um, we said it’s likely that she’ll have chemotherapy, but we don’t know for sure and we committed to keeping them up to date. Um, it was hard, you know, over the five years as we, you know, there were numerous occasions where we’d be having dinner and say, okay, children, we have some news. And it was hard for the children because over the years the news was really good. There were some occasions where a particular chemotherapy, um, was, was doing [00:18:00] well and it was, you know, stopping a growth of the cancers. But, you know, the, the, the journey that Heather went on was the initial chemotherapy was not, didn’t fully, uh, eliminate the cancer, um, the pathology from her surgery showed that there were still active cancer cells. So after surgery she had more chemotherapy, uh, and then a number of scans and then had a recurrence. Um, and then, you know, through various different radiotherapy, chemotherapy, immunotherapy, all of those things held the cancer at bay. Um, but over time the prognosis became more and more advanced.
Dorothy: You didn’t expect that in the beginning though.
David: No, when I, when I sat down with, with Jess, Heather, and Alex to say that, um, Heather had, we thought Heather would had cancer, [00:19:00] um, we didn’t know she was triple negative. We didn’t know the extent, and we were in the best place in the world to be treated for cancer. And what I realized quickly is that, although we are in, in Houston blessed with the most incredible resources for treating cancer, you really hope you won’t need them.
Dorothy: Mm-hmm.
David: You really hope you’ll be, uh, one of those patients that could be treated anywhere and will respond well to the initial treatment. But yes, our initial conversation was definitely one of hope and optimism.
Dorothy: Mm-hmm. And when did you have to come to grips with Heather was not gonna make it?
David: I think the more I learned about triple negative breast cancer, we knew after the, after we got the pathology back from the initial surgery that one of [00:20:00] the characteristics of triple negative is if you have a complete response to the initial chemotherapy and surgery, your prognosis is actually better than many other cancers. But if you don’t have a complete response to the initial chemotherapy, then the prognosis is less good. Now, the hardest thing about any cancer is that oncologists are really, really good at predicting outcomes for a thousand patients. The problem is, I didn’t care about a thousand patients. I cared about one patient.
And oncologists are incredibly bad at predicting the outcome for one patient. And so that’s incredibly difficult. But I knew, we knew after the initial surgery that, um, that we could be on a difficult and challenging journey, and that the, the odds were not in our favor. [00:21:00]
Dorothy: You think Heather still maintained her sense of hope though, even knowing all that?
David: Yes. I think, you know, one of the most amazing things is that after, I think less than two years of treatment, every single drug that Heather had was not available at the point of her diagnosis. You know, people need to understand how incredibly rapidly the situation is changing with cancer. If Heather was diagnosed today, she’d have a completely different treatment regime than the one she had back in 2019. The development in different drugs and different techniques is, is incredibly, and especially in for triple negative, which has, you know, huge amount of of research going into it. So I think [00:22:00] it’s, I think a testament to Heather’s hope and her commitment to being around was the fact that she exceeded all expectations.
Now, part of that is the amazing work of the pharmaceutical industry in coming up with new treatments. But part of it was she had an absolute passionate desire to be around and to spend as much time with her children as she possibly could.
Dorothy: Mm-hmm. And she just had a positive personality anyway.
David: Yeah. Certainly when it came to battling cancer.
Dorothy: Mm-hmm.
David: That was very much her, um, her approach to it. She saw it as something to be defeated and overcome. And there are difficult decisions on the on the road because sometimes there are choices you have to make about whether you are gonna pursue a treatment, how aggressively you want to fight the cancer.
Um, and, and, and Heather had a lot of [00:23:00] experience. You know, it was in palliative and end of life care, that’s where she sat. Now in the UK it’s very different because palliative and end of life care is something that’s integrated into the entire cancer journey. In, in America, people tend to think of hospice or end of life care as something that happens right at the point at which curative treatment is no longer an option. And you know, people often describe it as comfort care. In the UK people think much more holistically about people’s cancer journey. ’cause palliative care ultimately is about treatments that improve quality of life, but aren’t necessarily curative. But having palliative care doesn’t necessarily mean you’re going to die. It just means you are thinking about patients holistically. So you know that that was kind of Heather’s experience of understanding. Like, when does it make sense to pursue curative treatments? When, you know, when when’s the right time to, to change the balance? But her [00:24:00] general opinion was that she will fight, she will, um, she will endure treatments as long as there, uh, uh, offering benefit. And you know, her, her focus was around maximizing, uh, the, a quality of li— you know, quality of life and the length of a life, and finding that right balance between the two.
Dorothy: But the kind of chemotherapy that she was having and the other treatments that it takes a terrible toll on the physical body.
David: It does.
Dorothy: I mean, it’s, it’s, I’m always amazed at the stamina that it takes just to do the regular things when you’re going through that things, if you’re not dealing with it, you don’t even think about. So knowing that, David, go back a minute. How old were your children when, when she was diagnosed?
David: Uh, they were 13 and 11. So my daughter was 13, uh, my son was 11.
Dorothy: [00:25:00] Which, which child do you think had the hardest time with it?
David: I think they, they both struggled equally. It’s incredibly hard on children. Let’s see, it would’ve been January of 2020. Our friend, Debbie, Jessica’s, uh, godmother passed away. That was a difficult moment for all of us. So I think, I think for both children, you know, it’s been, it’s been difficult and they’ve processed it in their own way. You know, this year, you know, Heather died on the 12th of March. 10th of March was Alex’s 16th birthday, and it was a huge milestone for, for Heather to be around for. And just a couple of months later, Jess graduated from high school.
And I know that was another milestone. You know, there were all these milestones, you know, um, you know, senior homecoming, senior prom.
Dorothy: Mm-hmm.
David: Graduation. You know, Alex’s 16th birthday and lots of other [00:26:00] things, and they very much kind of were the forefront of, of Heather’s mind.
Dorothy: Yeah. Well she actually delayed treatment to, during some part of that, to have Christmas, to have New Year’s. I mean, that’s pretty brave.
David: Heather used to, you know, we, we, we were incredibly lucky, um, to have two brilliant oncologists, Dr. Monica Desai, uh, and then Dr. Fred Anu and Heather would negotiate with them. She would, you know, you know, in the last couple of years she traveled around the world to see friends. She organized all kinds of different things and she’d. She’d negotiate a bonus week between cycles of chemo and constantly negotiate and, you know, and, and found a way to organize her life in a, in a way that enabled her to have the treatment that she needed, but at the same time to allow her [00:27:00] to live her life as well.
Dorothy: It’s so interesting. I’ve never heard that, uh, describe that when she negotiated her time—
David: Well and Heather would say, look, what’s gonna be the consequence? What if we delay the next cycle by one week, which will allow me to go off and see some friends in France for a couple of weeks? You know, what, what’s the, what’s the risk? What’s the consequence? And oftentimes the oncologist will say, I think it’s the right thing to do.
Dorothy: Wow.
David: You know? So.
Dorothy: You think her palliative care training kind of showed that to her? I mean, most people would never even think about how important that, that type of visiting and that type of keeping your life halfway normal would be.
David: So if you, again, you know, Heather was passionate about holistic care of patients.
Dorothy: Mm-hmm.
David: You know, and thinking, look, you, you can’t just think of patients as going [00:28:00] through this cycle of treatments. You’ve gotta think of their entire experience. You’ve gotta think about the, the impact of cancer on the, their faith, their family, their friends, their spirituality, how they’re achieving a quality of life, and making sure that there’s a balance between all those things. You know, Heather, Heather led a, a lot of work in the, in the UK on multidisciplinary teamwork, you know, bringing together um, all of the different stakeholders in a patient’s care to have this kind of holistic conversation about what’s best for them. She actually won an award from the International Journal for Palliative Medicine for some of the work that she’d done and the impact that it had on patients.
Dorothy: How ironic. ’cause that we talk about that here. Like we have multidisciplinary, but we really don’t at that level.
David: It’s, it’s not something that I’ve seen a [00:29:00] huge amount of evidence of, and the system here, um, it kind of mitigates against it, it does make it difficult. Um, one of the most shocking things I discovered early on in the process is it’s illegal in Texas for a hospital to employ a doctor. And that, that blew my mind. But it gave me some really useful insight into why it was that we had 74 different providers, billings individually.
Dorothy: Oh my.
David: And, and, and, and it’s the kind of thing that you don’t really expect.
Dorothy: Mm-hmm.
David: Um, so, uh, it was a, it was a big learning, but certainly I think how Heather made choices was very much informed by her experience of practicing nursing.
Dorothy: So, I don’t wanna forget this part as we’re talking, I thought one of the most precious things about Heather’s service was that her friends were reading from her [00:30:00] journal. And if ever you didn’t know someone and you’re hearing those words, it was like, oh my gosh, you really could hear her. You could, you could see her heart in that. And who in the world thought to do that?
David: When Heather was first diagnosed, one of the things we had to think about was how we were going to communicate with everybody and, it’s something I recommend everybody in my situation thinks about because it’s exhausting, especially having to phone up different people and have the same conversation with them. It’s, it can be overwhelming. So we decided very early on, we created a Facebook group called Heather on the other side, and the idea of it was very much like.
Heather spent all this time nursing. Now she’s on the other side understanding the patient experience. And uh, her thought was that, you know, she would use that experience and document a lot of it as a way of, of helping other people. And we talked about [00:31:00] a variety of different ways we could do that.
Heather certainly found it incredibly helpful and insightful to be on the other side as she went through it. She’s like, there is so much I’ve learned, that I wish you know that, uh, that the nurses all knew. Um, and, and certainly her thought was, you know, you know, if she came outta the other side of it, she was like, I’m gonna be such a good nurse because I have this, this real deep understanding.
Everything that I’ve learned and practiced over the years, combined with kind of personal experience of the things that, that would be unknowable to somebody who’s, uh, who’s, who’s experienced it. So, when it came to putting together Heather’s memorial service, it was a difficult process. You know, I remember one of the strange moments is Heather maybe only had a few hours to live, and, uh, uh, somebody came in from the hospital and said, oh, [00:32:00] we, we don’t have a record of your chosen funeral home.
I said, well, I haven’t chosen a funeral home ’cause I didn’t know we’d be here at this point. And they said, well, um, if you could find one and, and let us know, that’d be really helpful. And so I’m sat at Heather’s bedside holding a hand Googling funeral homes.
Dorothy: Oh David…
David: And uh, and, and it was a laughable, laughably funny situation, but the reason for sharing it is the day after she passed the, we, we’d not signed any contracts with the funeral home. So we went the day after she died, I went with, with Jess and Alex, this funeral home, and they sat us in this meeting room and they gave us this PowerPoint presentation of the bronze plus premium package with this, that, and the other. And nothing about it was in any way what I thought Heather would’ve wanted. And so, you know, I sat down with the children, we, and we walked out and I was, [00:33:00] and, and we looked at each other and we said, whatever we’re gonna do, it’s not gonna be that. Um, and, and, and this is like, you know, a $25,000 deal that they were trying to persuade us to do.
And so we decided that we’d take a pause, not rush into anything. Heather’s body was cremated and then we decided to have a memorial service. And as I was pulling everything together for the memorial service, I remembered this, this diary that she’d written, and I found these excerpts from them and I thought we have to have a way of incorporating them.
And then I had this idea of, well, I could get some of Heather’s closest friends each to read a little vignette and then we can put those throughout the memorial service. And honestly, like a couple of people I asked, thought I was crazy. But the great thing is when you’re a grieving widower, people will say yes to pretty much anything. So. Yeah, we had these, uh, six [00:34:00] little vignettes from, uh, from Heather’s diary that, that really tell her story in her own words. Um, and, uh, I, I, I think it worked brilliantly.
Dorothy: Oh, it was beautiful. What do you miss most now that she’s gone?
David: I think the thing that’s most shocking is that I think I had this crazy delusion that when Heather passed that somehow normal life would be resumed and, and certainly there are certain things that they go away. I’m no longer on first name terms with the pharmacist at CVS and I don’t have a gigantic supply of class A drugs in the house anymore, which I’m very happy about. And so there’s lots of, there’s lots of things that that do go back to normal, but it takes a while and [00:35:00] and the strange thing is it’s the oddest things that, that, that catch you out. Strange moments that you, you wouldn’t expect some things like the first day back at school. That was really hard. Uh, especially ’cause um, you know, my daughter went off to university in Scotland. That was pretty tricky. It was our wedding anniversary on, uh, on Monday. And each of these things are, are, are difficult. But it’s, I can’t say that there’s any one particular thing that, that makes me think, oh, that’s, that’s the thing I miss, or that’s the thing that I’m without, I think, but at some point I hope to get back to some sort of normality and, and, uh, and start leading life again. I know it’s, I know it’s what Heather very much wanted. Um, and something that I’ll, I’ll do.
Dorothy: You will. [00:36:00] Thank you so much for sharing this. You’ve told us some different aspects I’ve not heard before and such good advice. Really appreciate you being here, david.
David: Thank you. It is been, uh, good to talk.
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