Someone PLEASE Advise Me!!

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Doctor Dr

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Hi. I have never posted a request like this to a forum, and it's quite uncharacteristic of me. But I desperately need the help of my peers in deciding my best course of action. I am caught in a serious dilemma and I really need some advice about what I should be doing now to help my own cause.

MY STORY:
I graduated med school in 2006, and matched into a categorical university general surgery program. While serving in that role, I was literally a glutton for punishment... My work ethic was superior to my classmates. In terms of academic knowlege, during both years, I not only PASSED but also out-performed most of my fellow residents on the yearly exam (ABSITE).

MY PROBLEM: I suffer from a very mild benign resting tremor. Looking back, I'm sure this mild condition was worsened by stress, lack of sleep, caffeine, and fear (OF SHAKING, ironically enough!!)...

LONG STORY SHORT: Despite nothing but stellar resident performance reviews, I suddenly received word via written communication that the faculty felt that my tremor (or as they dubbed it--"performance anxiety") precluded any further training in surgery beyond the second year of residency.

MY RESPONSE: I responded with the worst possible recourse: I tried to FIGHT IT! I lowered my head and pummelled away, convinced that exerting myself 5x as much as usual, and religiously taking my beta-blocker, I believed I would change the faculty's decision. I would show them their own mistake in letting me go...

Now I know that my best action would have been to simply resign and find another program into which I could transfer. But instead, I fought tooth and nail, worked harder than ever, focused solely on my present duties all the way up to July 1st, 2008.

Of course I was wrong trying to change their minds. But no one can deny the sheer determination and self-confidence I demonstrated by committing to complete what I had begun. I also suffer from chronic loyalty to my superiors and I remained protective of their interests despite my belief of being "unfairly" treated--not once have I threatened or pursued legal recourse for the rampant sexism & bigotry shown by faculty, nor have I mentioned their blatant disregard for the 80-hour work week.

WHAT I DID AFTER JULY 1, 2008:
I had accumulated a decent monetary cushion from saving 20% of every paycheck for 2 years. So, I felt NO RUSH to transfer into a new field!
1. I rested. It must have taken 3 or 4 weeks before I was fully caught up on my sleep!
2. I began to explore my own interests, to ponder various futures, and to repair my marriage.

3. I read as many books as I could get my hands on. I found great interest in the history and teachings of philosophy.

4. I started and wrote on SEVERAL BOOK/WRITING PROJECTS. I have a dream of being a writer...
5. Just recently I started registering with ERAS so i can get access to the scramble.
6. Have been mass-emailing program directors for last 2 months with intro and copy of my CV...it seems no one is interested.


Why would I delay finding a replacement residency position? Several reasons: Having been recently disillusioned, I wanted a break from the grind--and more importantly, I wanted some breathing room to make an honest, intelligent, informed decision about what field I would pursue and I was determined to do so only after an honest, thorough self-appraisal. I was NOT going to make the same mistake twice.

As long as I can remember, I have wanted to be a writer, to create compelling and vivid landscapes using nothing but words, to author NON-fiction, while achieving the creative, inspirational, moving effects that are normally associated with fiction and novels. and in this pursuit of writing, in the time since July 2008, I have accomplished MUCH PROGRESS in several writing projects.


I have developed some extensive/detailed outlines for books I believe would be very profitable.

While I am certainly NOT giving up on my writing dream, I have essentially run out of resources to keep this dream alive right now. Likewise, after my initial attempt to find an employer, I have begun to feel pressured to do something (ANYTHING) NOW, and I have become anxious and depressed regarding my current employment-situation.
I know I would make a STELLAR resident in Internal Medicine, Emergency Medicine, or Radiology...I'm beginning to consider Pediatrics and Family Medicine as well. While I have a profound interest and appreciation for psychology, I have made the informed decision NOT to pursue psychiatry as a career. Basically, my reasons are in line with my "self-help"-oriented writing ambitions. My belief is that talk therapy is far superior to casting life-long judgements of patient's "problems" (diagnoses) and then throwing pills at the problem, avoiding interaction or intimacy at all costs.

I have a proven record of outstanding committment to excellence. My bedside manner is impeccable; genuinely interested in patient's and their family's concerns, while demonstrating warmth, compassion, companionship, and determination for accurate diagnosis and counseling for an informed, shared decision regarding potential treatment options.

MY CURRENT PLANS / STRATEGIES / JOB-HUNTING:

Research Position: Despite my best attempts to find a 'one-year' position in post-doctoral research, I found this to be nearly impossible. The only 'offer' I have gotten was contingent on my acceptance of a PhD slot... unfortunately, I'm almost positive that I don't want to be an MD/PhD. Otherwise, it seems that this economy has severely affected the hiring potential for this kind of job.

The Scramble: I will have my FREIDA application completed and online early this week--but i'm not even sure that this is early enough to be included in the scramble. At this point, I don't mind being a PGY-1 again, nor would I mind a preliminary or transitional year.

"Finding" a Transfer Position: This is the largely-ineffective approach that I have been using for the last month... I have been emailing my CV and a brief statement of my intentions to every program director listed in FREIDA for IM, EM, & Rads. From this effort, I have gotten one SINGLE unexpected interview to fill a potential opening for a PGY-2 at a great EM program...That program director told me he would make his decision by march 1st, but I am very insecure and pessimistic about my chances with this job.

The Military. I had hoped to avoid this route but if they could have me working in a clinical setting essentially right now, then this might be my best/only option.

Moonlighting. Currently, I am not licensed, as Step 3 was not a requirement of my residency. However, I am scheduled to take Step 3 in 2 weeks. My state license has been 'in limbo' for the last 6 weeks, and I expect them to take their sweet time following my completion of Step 3. Therefore, I don't think that moonlighting is an option for me.

SOMEONE PLEASE GIVE ME SOME ADVISE, DIRECTION, CRITICISM, or INSIGHT INTO MY OWN SITUATION AND HOW I CAN FIND MYSELF A RESIDENCY OPPORTUNITY??--actually just ANY kind of job/career/employment advice would be GREATLY appreciated!!


  • How will I find a job?
  • Am I going about this search in the right way?? (blasting my CV to program directors all over the place?)
  • Perhaps there is a website where I can post my CV? ...even a "head-hunter" would be ok right now.
  • Does anyone have suggestions for me??

Thanks a lot for reading (ANY) of this...I know it's very long, but I feel that writing all this has been quite therapeutic to me and could lead me closer to an answer just by virtue of being more specific with my problem.

-Doctor Dr

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First, congrats on finishing up 2 years of surgery - that is a tough residency.

You sound like you are smart, but perhaps not very realistic. Your old program likely felt it was unsafe to have someone with a tremor operating on people. It sounds like your academics are strong so you should be able to find another residency position. Be careful that you don't come across as arrogant during your interviews, since your level of self confidence is coming across as a little overdone on this post (at least to me).

Try not to burn any bridges at your old program, as you will need them to at least not say anything blatantly bad about you if you hope to get another residency position.

It sounds like it might help you to narrow down the list of specialties you are interested in.

Definitely you should try to get your license ASAP. I'm surprised you didn't take Step 3 and try to get your license months ago.

There are sites like Findaresident and openspots.com that have open residency spots posted on them periodically.
 
I am sorry that you have had such a tough time over the last few years.
It seems like you are intelligent and hard working with great work ethic.
I am guessing that your disadvantage would be your year away from clinical medicine BUT.. you have two years of clinical experience behind you.

1.Firstly.. Decide on your plan..

Stay in Medicine/Write/Research?

If you want to continue to practice in Medicine then decide on what specialties you are considering and then...

2.Speak with your previous PD/Staff Surgeons that may be able to introduce you to contacts in other fields.

3. You could try looking for open spots in the hospital where you trained.
Since you were hard working that should be to your advantage.
People transfer all the time and an internal transfer could be a good place to start looking.

4. As Dragonfly99 mentioned, sign up for Findaresident , residentswap etc.

5. Meanwhile take and finish Step 3.

6. Take part in the Scramble as you have planned.

Good luck!
 
First off, I'd like to thank you both for responding to my 'urgent' pleas for assistance...

I first turned in my state license materials & step 3 application in june 2008.

But my MEDICAL SCHOOL wouldn't send in the PAPERWORK UNTIL DECEMBER!!!
I hand-delivered 3 different copies of paperwork to secretary (hand delivery), plus there was at least 1 copy mailed to her that she denied receiving...
I have email conversations logged on my server where she promised me back in AUGUST that she was taking care of my medical school paperwork THAT DAY.
Before I realized what had happened, I had allowed my 3 month-eligibility for obtaining my state license (??) to lapse...and i had to start the application all over again, with higher fees.

So that's why i haven't taken step 3 until now...As a matter of fact, I think I PEAKED studying for this stupid test in August... the rest has been a downhill, forgetful, disinterested final stretch til step 3.

I know i shouldn't complain because most residents don't even get a chance to study unencumbered by work duties...but i guess it 'means more' to me right now, this time, this chance.

thanks again.
i really appreciate the advice.

regarding meeting with my PD & chairman, we've had handfuls of meetings but they don't actually OFFER ME ANYTHING SPECIFIC....like they're just too far-removed from anything non-surgical to even setup a meeting for someone who is struggling...

...and regarding contacting my original program's individual departments, I contacted the medicine PD. The weird thing is that his reply to my submission of a request to TRANSFER in as a resident (~mid-January) was "we don't have any room for transfers at this time.."---followed by last week's VERY CRYPTIC reply to my request to consider me for PGY-1 starting July 1, 2009: "we will not have any openings in our PGY1 class starting july 1, 2009."

How would he know that the medicine intern year will be filled?? a month before match-day?
btw, it's a mid-sized university hospital with TONS of medicine slots.

I am (possibly overreacting here) bothered by the itching notion that I must have some kind of "BAD REPUTATION" with my previous employer...(??)
 
You're having a hard time in the match because it's so late. And the scramble is often useless. So if nothing turns up soon, plan on going through the match in September along with everyone else.

You seem to be an AMG. Right? If so, some fields you mentioned, such as FP, aren't difficult to get into and won't mind your tremor.

As far as what to do during the coming year (assuming no spot turns up), there are jobs out there. Rather than blasting your CV, try calling or going in person. And hiring a headhunter who specializes in health care jobs is a very good idea.

Finally, why not reconsider Psychiatry? In my experience, they're not pill-pushers, and do place much importance on psychotherapy.
 
Had a brief chat with my advisor. Finding the cause of your tremor is important. It could be anxiety driven and beta blockers help. Dermatological surgeries might be something you could consider as a career. And, I think your ability to write will help you in the future.Good luck with your step 3!
 
haha.. actually atenolol 100mg was sufficient for treating the problem. That's probably one reason why I'm so mad and bitter still because I started the beta-blocker way back in september 07---the power of prejudice is great, i suppose...
 
first of all, i'm sorry, i feel for anyone with issues regarding careers in medicine. you dedicate so much of yourself and it becomes a part of your identity. that being said, you have a lot going on here... and there's a part of me that wonders if someone with the organizational and planning skills required to be a doc would be able to just kind of hang out and read/write/enjoy life (there's nothing wrong with this, i'm speaking from personal experience) without feeling some anxiety about planning for the future. so you have to figure out if you really want to be in medicine or if you are subconsciously 'allowing' yourself out...

secondly, your PD is your life line. maybe you were not the resident you thought you were, because i would think surgeons would really feel for someone who was in your situation and do all they could to get you help. regardless, how about other hospitals you rotated to? anybody there? advice from med school you went to?

finally, just a point, PDs put in their # for the match at the end of jan. so by that time, they can't offer anyone a position outside the match because then they'd match too many. i'd be skeptical of the ED program who said they'd let you know by march 1st, unless they have a pool and plan to accept a certain # which they've allocated for.

best of luck... you'll get through it!
 
First piece of advice...

read the description of the forums. This forum is for the posting of open positions ONLY. It is not for people looking for a position. I will move this to general residency forum.

FYI to the above poster ridiculopathy:

The EM position is a PGY-2 position, it does not have to be offered via the match. Secondly, since the poster says that the EM PD will let him know by March 1st, this is most likely because programs and applicants have to give each other 4 months notice of intent to offer or terminate contracts. Thus, it is likely that this PD either knows a resident who has said they will be leaving (but is waiting for formal declaration of such) or is planning on not offering the resident a contract for next year). What seems odd to me is that you can't generally start as a PGY-2 in EM with just surgical training. Surely the OP will get some credit, but what I suspect is that it may be a second year position, but he will be treated as a first year.

At any rate...on to Gen Res Forum....
 
I confess to skimming the original post. I found it too hard to read. But the military option caught my eye. If you are a US trained and licensed physician (which is possible in many states after PGY1), you could join the military. You would then serve in a general medical officer billet for at least a couple of years before you could apply to military residencies (surgical or otherwise).

I would only advise this route if you want to join and you should spent a minute perusing the milmed forum here on SDN.
 
sorry about the confusion, i also confess that i didn't notice that position was pgy2. regardless it, does explain the 'cryptic' comment that the PD made regarding pgy1 positions in early feb...
 
If I may make a suggestion...You will probably not get too far without your Step 3. The experience I've had is that other specialities tend to think surgery residents don't know enough general medicine to pass Step 3,or score poorly on it. Mass emailing your CV without a Step 3 score will not help either. A solid score will definitely get you noticed. It is not a difficult test. If your surgical knowledge and test taking skills are as good as you say they are, you'll find it a cakewalk.
 
Hi. I have never posted a request like this to a forum, and it's quite uncharacteristic of me.......


First of all, your post reads like a business resume. "I have a proven record of outstanding committment to excellence. My bedside manner is impeccable!!" If your CV reads anything like that, I'm sure it is a large part of your problem finding positions, since it's over the top and weird. It would be an immediate red flag to most program directors.

Secondly, I think there's more than just a little bit of denial vs. lack of self-awareness regarding your work. There are probably hundreds of surgical residents across the country who have a "mild resting tremor," many of which are on beta-blockers, and most of which didn't lose their jobs as interns. Resting tremors are common, and I find it hard to believe that this is the true reason you got fired.....especially since you supposedly had excellent evaluations, and your tremor resolved 4-5 months into residency with a simple prescription.

I think the first step is finding out what really got you canned. It's obvious to me, without any more information, that you were not outworking and outperforming your peers. Find out where your weaknesses are, and concentrate on those instead of your current focus on what a great job you did.

Thirdly, your heart is not in medicine, and it seems like you're looking for cash flow to support your writing career. I also think it's weird to list off potential careers in FM and Radiology in the same breath (side note: your comment on the goal of psychiatry was really rudimentary and off-the-mark). What makes you think the same thing won't just happen again?



I'm sorry, but are you really in a position right now to author a self-help book?
 
I do not mean to be condescending whatsoever, but it seems a bit contradictory to me to me that someone would cast a negative light on pyschiatry while using beta blockers to help curb the physical manifestations of fear/anxiety... :confused: Just a quick observation.

I do feel you are in an unfortunate situation, and I truly wish you all the best in figuring out your future. Good luck!
 
I think the OP lacks insight and seems a little disorganized in her thought process. She thinks she is working harder than everyone else, but she is just more disorganized than everyone else.
Ther's more here than meets the eye.
 
I think the OP lacks insight and seems a little disorganized in her thought process. She thinks she is working harder than everyone else, but she is just more disorganized than everyone else.
Ther's more here than meets the eye.


I have a benign essential tremor. I've had it since I was 14 years old. I've been told many, many times that I could not be a surgeon. It is often the first thing on people's minds when they either notice or are told about it.

I want this poster to know that I agree with some of what he/she says. However, the way the post was written makes me agree with the above quote also. There may be something else going on here. However, I will write this as if the post at the beginning made sense throughout.


I agree that what happened to you was horse-sht. I think that any reputable place would have made an extreme effort to work with you before canning you for something beyond your control. I do feel a great deal of prejudice from other students and some physicians. It becomes somewhat of a sing-song "don't go into surgery" line that I hear over and over. People have no right to tell you what you can and cannot do.

Having said that, after getting many dirty looks during my surgery rotation, I decided to go into internal medicine. I actually just submitted a rank list.

Now, if you tried and failed at a residency in surgery, you simply need to tell other programs in other fields why you were canned and go into a field that doesn't need great dexterity. Radiology is an obvious choice.

It is very clear that a tremor COULD affect your ability to perform surgery. It is definitely unfair and obviously prejudice, but it is hard to say that the prejudice is unfounded. However, I have seen people with tremors do amazing work in surgeries. My father has a tic disorder and performs OBGYN surgeries routinely with ZERO problems.

Forgive the length of this post, but I have a vested interest in this subject. I am sick to death of people with the wondrous gift of steady hands (wondrously wondrous) thinking that they can ride roughshod over people with such a benign problem.

So to people on this site noticing something like this in a colleague, maybe try to not say the first thing on your mind, if possible. Just know that I probably hate your tie, but I don't tell you about it. Shut up and let me do my job. ;)
 
First of all, your post reads like a business resume. "I have a proven record of outstanding committment to excellence. My bedside manner is impeccable!!" If your CV reads anything like that, I'm sure it is a large part of your problem finding positions, since it's over the top and weird. It would be an immediate red flag to most program directors.

Secondly, I think there's more than just a little bit of denial vs. lack of self-awareness regarding your work. There are probably hundreds of surgical residents across the country who have a "mild resting tremor," many of which are on beta-blockers, and most of which didn't lose their jobs as interns. Resting tremors are common, and I find it hard to believe that this is the true reason you got fired.....especially since you supposedly had excellent evaluations, and your tremor resolved 4-5 months into residency with a simple prescription.

I think the first step is finding out what really got you canned. It's obvious to me, without any more information, that you were not outworking and outperforming your peers. Find out where your weaknesses are, and concentrate on those instead of your current focus on what a great job you did.

Thirdly, your heart is not in medicine, and it seems like you're looking for cash flow to support your writing career. I also think it's weird to list off potential careers in FM and Radiology in the same breath (side note: your comment on the goal of psychiatry was really rudimentary and off-the-mark). What makes you think the same thing won't just happen again?



I'm sorry, but are you really in a position right now to author a self-help book?


Agree.. if the OP was such an absolute rockstar and was doing everything so much better (surgical skills included??), they wouldn't let them go. Plus, being that awesome I can't see how they would have any problems finding another job.
 
Hi. I have never posted a request like this to a forum, and it's quite uncharacteristic of me. But I desperately need the help of my peers in deciding my best course of action. I am caught in a serious dilemma and I really need some advice about what I should be doing now to help my own cause.

MY STORY:
I graduated med school in 2006, and matched into a categorical university general surgery program. While serving in that role, I was literally a glutton for punishment... My work ethic was superior to my classmates. In terms of academic knowlege, during both years, I not only PASSED but also out-performed most of my fellow residents on the yearly exam (ABSITE).

MY PROBLEM: I suffer from a very mild benign resting tremor. Looking back, I'm sure this mild condition was worsened by stress, lack of sleep, caffeine, and fear (OF SHAKING, ironically enough!!)...

LONG STORY SHORT: Despite nothing but stellar resident performance reviews, I suddenly received word via written communication that the faculty felt that my tremor (or as they dubbed it--"performance anxiety") precluded any further training in surgery beyond the second year of residency.

MY RESPONSE: I responded with the worst possible recourse: I tried to FIGHT IT! I lowered my head and pummelled away, convinced that exerting myself 5x as much as usual, and religiously taking my beta-blocker, I believed I would change the faculty's decision. I would show them their own mistake in letting me go...

Now I know that my best action would have been to simply resign and find another program into which I could transfer. But instead, I fought tooth and nail, worked harder than ever, focused solely on my present duties all the way up to July 1st, 2008.

Of course I was wrong trying to change their minds. But no one can deny the sheer determination and self-confidence I demonstrated by committing to complete what I had begun. I also suffer from chronic loyalty to my superiors and I remained protective of their interests despite my belief of being "unfairly" treated--not once have I threatened or pursued legal recourse for the rampant sexism & bigotry shown by faculty, nor have I mentioned their blatant disregard for the 80-hour work week.

WHAT I DID AFTER JULY 1, 2008:
I had accumulated a decent monetary cushion from saving 20% of every paycheck for 2 years. So, I felt NO RUSH to transfer into a new field!
1. I rested. It must have taken 3 or 4 weeks before I was fully caught up on my sleep!
2. I began to explore my own interests, to ponder various futures, and to repair my marriage.

3. I read as many books as I could get my hands on. I found great interest in the history and teachings of philosophy.

4. I started and wrote on SEVERAL BOOK/WRITING PROJECTS. I have a dream of being a writer...
5. Just recently I started registering with ERAS so i can get access to the scramble.
6. Have been mass-emailing program directors for last 2 months with intro and copy of my CV...it seems no one is interested.


Why would I delay finding a replacement residency position? Several reasons: Having been recently disillusioned, I wanted a break from the grind--and more importantly, I wanted some breathing room to make an honest, intelligent, informed decision about what field I would pursue and I was determined to do so only after an honest, thorough self-appraisal. I was NOT going to make the same mistake twice.

As long as I can remember, I have wanted to be a writer, to create compelling and vivid landscapes using nothing but words, to author NON-fiction, while achieving the creative, inspirational, moving effects that are normally associated with fiction and novels. and in this pursuit of writing, in the time since July 2008, I have accomplished MUCH PROGRESS in several writing projects.


I have developed some extensive/detailed outlines for books I believe would be very profitable.

While I am certainly NOT giving up on my writing dream, I have essentially run out of resources to keep this dream alive right now. Likewise, after my initial attempt to find an employer, I have begun to feel pressured to do something (ANYTHING) NOW, and I have become anxious and depressed regarding my current employment-situation.
I know I would make a STELLAR resident in Internal Medicine, Emergency Medicine, or Radiology...I'm beginning to consider Pediatrics and Family Medicine as well. While I have a profound interest and appreciation for psychology, I have made the informed decision NOT to pursue psychiatry as a career. Basically, my reasons are in line with my "self-help"-oriented writing ambitions. My belief is that talk therapy is far superior to casting life-long judgements of patient's "problems" (diagnoses) and then throwing pills at the problem, avoiding interaction or intimacy at all costs.

I have a proven record of outstanding committment to excellence. My bedside manner is impeccable; genuinely interested in patient's and their family's concerns, while demonstrating warmth, compassion, companionship, and determination for accurate diagnosis and counseling for an informed, shared decision regarding potential treatment options.

MY CURRENT PLANS / STRATEGIES / JOB-HUNTING:

Research Position: Despite my best attempts to find a 'one-year' position in post-doctoral research, I found this to be nearly impossible. The only 'offer' I have gotten was contingent on my acceptance of a PhD slot... unfortunately, I'm almost positive that I don't want to be an MD/PhD. Otherwise, it seems that this economy has severely affected the hiring potential for this kind of job.

The Scramble: I will have my FREIDA application completed and online early this week--but i'm not even sure that this is early enough to be included in the scramble. At this point, I don't mind being a PGY-1 again, nor would I mind a preliminary or transitional year.

"Finding" a Transfer Position: This is the largely-ineffective approach that I have been using for the last month... I have been emailing my CV and a brief statement of my intentions to every program director listed in FREIDA for IM, EM, & Rads. From this effort, I have gotten one SINGLE unexpected interview to fill a potential opening for a PGY-2 at a great EM program...That program director told me he would make his decision by march 1st, but I am very insecure and pessimistic about my chances with this job.

The Military. I had hoped to avoid this route but if they could have me working in a clinical setting essentially right now, then this might be my best/only option.

Moonlighting. Currently, I am not licensed, as Step 3 was not a requirement of my residency. However, I am scheduled to take Step 3 in 2 weeks. My state license has been 'in limbo' for the last 6 weeks, and I expect them to take their sweet time following my completion of Step 3. Therefore, I don't think that moonlighting is an option for me.

SOMEONE PLEASE GIVE ME SOME ADVISE, DIRECTION, CRITICISM, or INSIGHT INTO MY OWN SITUATION AND HOW I CAN FIND MYSELF A RESIDENCY OPPORTUNITY??--actually just ANY kind of job/career/employment advice would be GREATLY appreciated!!


  • How will I find a job?
  • Am I going about this search in the right way?? (blasting my CV to program directors all over the place?)
  • Perhaps there is a website where I can post my CV? ...even a "head-hunter" would be ok right now.
  • Does anyone have suggestions for me??

Thanks a lot for reading (ANY) of this...I know it's very long, but I feel that writing all this has been quite therapeutic to me and could lead me closer to an answer just by virtue of being more specific with my problem.

-Doctor Dr
hi doc, i know a very nice consultancy that might be able to help out..can you send them your up-to-date CV as soon as possible please. perhaps they might be able to get you something. Wish you all the best.
 
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