Turning Trauma Into Purpose: One PNP’s Journey to Private Practice, with Victoria McMullen

[00:00] Michelle: Sometimes the experiences that hurt us the most end up shaping the work we're called to do.

[00:07] My guest today knows that firsthand.

[00:10] Victoria McMullen has spent more than 14 years caring for children,

[00:14] from her early days as a NICU nurse to her work as a pediatric nurse practitioner specializing in mental, behavioral, and general health.

[00:24] But her decision to open her own pediatric practice is rooted in a deeply personal experience.

[00:32] During the birth of her first child, an emergency C-section and premature delivery were made even more traumatic by a lack of communication from the operating room staff.

[00:43] In one of the most vulnerable moments of her life,

[00:46] she experienced firsthand what happens when a patient is left frightened and uninformed.

[00:52] That moment stayed with her, and it helped her shape a promise: that families in her care would never have to feel the same fear and uncertainty from a breakdown in communication.

[01:03] Today,

[01:04] she's built a practice where individualized, family centered care is at the heart of everything she does.

[01:11] We talked about her journey, her love of pediatrics, and why communication,

[01:17] compassion, and truly seeing the child and family matter so much in healthcare.

[01:23] In the five minute snippet: she knows how to connect with kids!

[01:43] Well, good morning, Victoria. Welcome to the podcast.

[01:47] Victoria: Good morning, Michelle. Thanks for having me.

[01:50] Michelle: Thank you so much for reaching out. I really appreciate you reaching out and saying, hey, I do this and I would love to share it with your audience.

[02:00] So thanks so much for being here.

[02:02] Victoria: Thank you. I appreciate it.

[02:04] Michelle: All right, we're going to just jump in. That's what I like to do. We want to get to know Victoria McMullen. So take us back to the beginning. What drew you into NICU and then pediatrics?

[02:18] Victoria: Yeah. So pediatrics was my first straw. I wasn't sure I wanted to do NICU right away, but it was actually when I was in nursing school and I was kind of debating what field of nursing I wanted to go into.

[02:32] And then we did the pediatric abuse lecture.

[02:38] As difficult as it was to get through that and talk about that, those kinds of situations, I realized that I really wanted to be an advocate for kids because sometimes they don't have anybody standing up for them and they're such a vulnerable patient population.

[02:56] And I realized, okay, this is what I want to do, Pediatrics. Something in pediatrics is what I want to do.

[03:03] And then I was really lucky that while I was in school, I was able to do my capstone in the NICU.

[03:10] And I just absolutely fell in love with it.

[03:13] I loved that it was not only pediatrics, but it was ICU,

[03:17] and I was able to start working there pretty quickly out of nursing school. And that's where I was a registered nurse for five years.

[03:27] Michelle: Wow, What a cool story. I love hearing the stories of how people get into their professions and how they get into their specialties.

[03:36] Victoria: Yeah.

[03:37] Michelle: And pediatrics has a huge draw.

[03:38] Victoria: I mean, it was def,

[03:42] It's a little morbid when you think about it. But,

[03:45] I mean,

[03:47] since working in the NICU and being in pediatrics for as long as I have, it's,

[03:52] I wouldn't have chosen anything else. And I always joke with people because people in the adult world always say, I could never work with kids. And then people in the pediatrics world go, oh, I could never work with adults, so.

[04:03] Michelle: 100%. I've said that a million times. Yeah.

[04:10] And I don't know what it is that we can be those kind of people that just either love one thing or hate one thing. But,

[04:21] yeah, pediatrics, people either love it or hate it. That's what I've figured out.

[04:26] And I did 18 years right out of school in pediatrics before I went to the NICU.

[04:33] We had always floated to the NICU because traditionally, pediatrics units aren't super busy.

[04:39] At least ours wasn't.

[04:41] And so we had times where our census was low and we floated to the NICU, and I got a little taste of that. But then when I went there full time,

[04:49] I was like, wow, this is so cool.

[04:52] So different, really, from pediatrics. Yeah, love it.

[04:58] Awesome. Okay, so spent five years doing that. And then what did those early years in the NICU teach you about caring for both children and their families?

[05:11] Victoria: Well, yeah, that's a great question.

[05:15] So it taught me a lot. You know, it was interesting because when I first started,

[05:20] I didn't interact with a lot of parents. I was actually on the evening shift, and I didn't see a lot of parents come in initially.

[05:28] So it was really more, at that point, learning how to care for the babies in.

[05:33] They had. They had it split in, like, the feeder-grower area,

[05:38] and then the more acute care babies, like the 23 weekers and the kids who were intubated.

[05:45] So I learned. Actually,

[05:47] I guess one of my first experiences was learning that even something that seems simple to us or not a big deal, to a parent could be the end of the world.

[06:00] I was still in orientation and my preceptor goes, okay, you know, the baby pulled the feeding tube out, so we're going to replace the feeding tube.

[06:07] And, you know, after you become a seasoned NICU nurse, that's nothing.

[06:11] But I remember the parents walked in and they were standing right behind,

[06:17] right behind me, watching everything I did.

[06:20] And the mom was very upset when she came in and heard that, you know, baby had pulled the beating tube out and we had to replace it.

[06:29] I mean, she was on the edge of her seat the whole time that we were replacing it. You know, like I said to us,

[06:35] that's, you know, just another task we have to do. Not a big deal. Like, but when I saw the look on that mom's face and then talking with my preceptor about that, she was, you know,

[06:47] always be sensitive. You don't know what's going to upset a parent. You don't know where they're at right now with the NICU journey. And we always tell people this is a roller coaster.

[06:57] It doesn't matter if you have a 23 weeker or a term baby that's here.

[07:03] Anything can be devastating to a parent, and you have to be very aware of that.

[07:08] It was very much learning about communication with the parents,

[07:13] you know, being very cautious about, like, what you say, how you say it, and trying not to sound too,

[07:19] I don't want to say, like, casual,

[07:22] but not to seem like you're blowing something off to a parent that could be a big deal,

[07:27] you know, and just even little things like learning how to change a diaper on it, you know, on the 23 week or 24 week or. And saying, okay, you can't lift their feet above their head or you could cause a brain bleed.

[07:41] I mean,

[07:42] in other professions, where do you,

[07:44] That's not usually a concern,

[07:48] and it was just those little things.

[07:50] As I went on and learned more and more,

[07:54] it was just amazing how the tiniest thing could completely change the course of a baby's stay in you and parents experience with us. So that was a huge learning curve for me, because that's not what you,

[08:09] You don't really learn too much about that piece in nursing school. Like, you learn how to talk to patients and like, when you walk into a room. But I feel like you're not really taught how to talk to parents and, you know, talk to parents of a baby who is not doing well.

[08:25] Like, that's a whole different animal in itself.

[08:28] So that was a very big learning curve that first year and a half was.

[08:33] tough.

[08:34] Michelle: Absolutely. And I think that the skills that you're talking about are like, soft skills. Right? Like how to read a room,

[08:43] how to read body language,

[08:45] and absolutely. Things that we do, you know, hundreds of times, we get very adept at it,

[08:52] and it's just so natural to us.

[08:55] And then when a layperson or a parent sees that for the first time,

[09:00] it's absolutely traumatizing to them,

[09:03] and we have to be sensitive to that. And that's a huge lesson to learn, for sure.

[09:08] What's great is you learned it, because I've worked with nurses that have been doing this 20, 30 years,

[09:15] and they never learned that. And that's really sad.

[09:19] Victoria: Yeah, that's tough. I mean, I will say it definitely helped me. So my oldest son ended up in the NICU for five days. 

[09:29] Michelle: Of course, Victoria, because you're a NICU nurse.

[09:30] Victoria: Of course.

[09:33] Of course. Of course this happened,

[09:35] and he ended up being okay. He just needed a little CPAP in the beginning, but it was nothing. 

[09:41] He was the survivor,

[09:44] My little fighter there. But it was interesting because just sitting there, it was not like that environment. Even though it wasn't the hospital where I worked, I was like. I was used to the monitors and the sounds and him being in an isolette that, you know, even though he was my baby,

[09:59] which is different,

[10:00] that part didn't, it wasn't as big of a shock to me. But then when my husband came in and my mom came in and, you know, alarms were going off because he was moving, and, you know, the O2 sat starts to come off,

[10:13] and they.

[10:15] What is that? What is that? What is that noise? And I go, okay, he's fine. I go, how do you know? Look at the monitor? I go, no, it's not a big.

[10:22] Michelle: Not a big deal. They're like, why aren't you freaking out?

[10:26] Victoria: Yes. You're like, oh, that's not anything to freak out about yet. Exactly.

[10:32] Michelle: Exactly, I got this. Oh, my gosh.

[10:34] Michelle: So much that we take for granted. Right. Okay, so when did you expand your role into becoming a pediatric nurse practitioner? How'd that work?

[10:44] Victoria: Yeah, so I actually kept working in the NICU while I was going to school,

[10:48] and I was, I got my bachelor's while I was still working, and then I transitioned into my master's just because.

[10:58] Especially that first year and a half, just seeing certain decisions that were made and the way certain providers communicated with the nurses. I just,

[11:09] You know, I don't. I think I want to keep going and do more so that I can be on provider in, like, still have that.

[11:16] The nurse piece,

[11:18] but then be able to make some of these decisions.

[11:21] And so. And I knew I didn't want to. Again, still didn't want to do adults. So I had some friends that wanted. They were like, no, you should do family practice.

[11:31] that broadens your scope and you'll be able to do more. And I said, no, I can't. I gotta stick with kids.

[11:40] So then 

[11:41] I stuck with becoming a pediatric nurse practitioner and then again, had a great clinical experience working in neurology and pediatric neurology at the same hospital and found out I could still take care of NICU babies and still go to the NICU and care for the babies who were considered,

[12:01] like, the neuro, NICU, ICU.

[12:05] I was able to get a job right when I graduated and just continued on with that for several years.

[12:11] Michelle: That's very cool. Did you ever consider the neonatal nurse practitioner role?

[12:18] Victoria: I had considered it,

[12:20] but I was, when I was talking to a couple of practitioners who worked there,

[12:26] there were PNPs and there were the neonatal nurse practitioners,

[12:32] they were saying, you know what,

[12:33] if you do neonatal, then you can only do neonatal. But if you decide maybe later on, like, when you have a family and things like that, that maybe you want to do more outpatient care, things like that, it would be helpful to have that Peds background.

[12:50] So that's why I ended up doing that instead of neonatal.

[12:54] Michelle: Got it. Yeah. Makes so much sense. Because ultimately you opened your own practice and you couldn't do that with being an NNP, right?

[13:05] Victoria: Yes.

[13:06] Michelle: Very cool. Well, you know, after working with kids for more than 14 years, has the way that you think about pediatric care changed over time?

[13:18] Victoria: It definitely has,

[13:19] for a couple reasons. I think becoming a mom has definitely changed the way I approach certain things.

[13:28] And I think also just, I think Covid changed a lot of things too. When there was the lockdown,

[13:37] I think that was part of the reason why I ended up transitioning to opening up my own practice because I was just seeing one. Like, when things opened up and we were starting to see people in person again,

[13:49] it was just so clear how devastated some of these kids were. We were seeing such a huge uptick in,

[13:58] obesity, anxiety, depression.

[14:01] I think the mental health piece, we didn't touch on that too much when I was going to school.

[14:08] And even though when I worked in neurology, I would see kids who would, for example, they'd have migraines, but they'd also have anxiety and depression.

[14:16] But it, I feel like it wasn't as widespread as it is now. So I always make sure to touch on that in every appointment that I'm in, whether it's a general visit or a sick visit.

[14:31] I'm always asking about mental health. And the other piece too, is that I'm always inquiring about the family dynamic as well.

[14:41] I think that's not something that's touched on as much because obviously when it comes to, when a child comes in, they're the center of the appointment.

[14:50] But, I'm only seeing them for 30 minutes, an hour max, if that.

[14:57] And the parent is the one that's going home with them.

[15:01] I think it's so important to make sure that, especially with little babies, that moms are okay.

[15:07] Usually the pediatrician, the pediatric provider is the first one to see the mom and after they have a baby,

[15:14] and which is wild to me.

[15:18] I came to find after working in primary care, which is what I went to after neurology,

[15:25] that we really need to focus on family-centered care and focusing on the family,

[15:34] not just the child, because that can affect a child's health more than I think people realize.

[15:40] And I think that's so important, especially to teach new nurses and new providers coming into the field.

[15:46] You need to make sure you understand what's going on with the dynamics, because that might give you more information than you realize.

[15:52] Michelle: Oh, my God. Like that's an understatement, right?

[15:57] I mean,

[15:58] yes, family is everything. And that dynamic is so complicated. And one of the things that I think is lacking after being a patient and filling out so many of those patient forms,

[16:15] they want to know your history. They want to know your surgical history, your hospitalizations, your medical history, all of that.

[16:22] I've never come across a questionnaire that addressed any kind of childhood trauma.

[16:31] Now, I myself am a victim of childhood sexual abuse.

[16:36] And being an adult,

[16:39] if someone was treating me,

[16:41] I would want them to know that information.

[16:43] I think that's very important information in terms of trauma, in terms of the sequelae that that kind of leaves in its wake.

[16:55] I've never seen this on a pediatric form.

[17:00] What are we missing by not talking about childhood trauma?

[17:06] Victoria: Yeah, and that's actually, first, I'm so sorry that you went through that. That's horrible. I don't wish that on anybody.

[17:15] And no child should ever have to go through that.

[17:18] Well, the thing is,

[17:19] I think unless something is flagged, or someone gets a feeling that maybe we need to dive deeper and they need, there's additional screening forms that you can give,

[17:32] I think, unless you ask the right questions, you know, and a lot of the times there's time constraints, you know, you're just kind of going through the checklist on your computer.

[17:42] Those things can be missed so easily.

[17:45] And I always joke with people that I don't know if it's something about my face or something like that, but I feel like a lot of the time patients don't really bring that up.

[17:54] Like, I'll go through their notes and there's nothing in their notes about any type of abuse or anxiety to anything like that. And then I go into the appointment and that's when it's brought to our attention.

[18:08] Yeah, I think that we really need to change how we are approaching healthcare. And obviously there's always the argument that healthcare is a business and you need to see X amount of patients and you need to be limiting your time with people so that you can have more patient.

[18:25] Like, whether you're in the hospital or you're in an outpatient office, they're always wanting you to see more and more and more.

[18:32] And again, one of the reasons I opened my own practice, because you'd be surprised if you really just take your time, sit down and look someone in the eye,

[18:42] they realize,

[18:43] oh, maybe this person actually cares. And I'm comfortable enough telling them that this is a fear of mine.

[18:50] This happened to me. This happened to my child.

[18:53] And can we address it?

[18:55] Because I think a lot of the times people just feel dismissed. They feel like there's not enough time,

[19:02] so kind of why bother bringing it up? Or,

[19:04] well, someone's probably just going to prescribe medication to me and I don't want that, or they're going to just medicate my child. I don't want that. I want someone to just listen and give me other options.

[19:16] And so I really think we need to address that and stop kind of making this assembly line of people in and out of hospitals and clinics because kids and adults too, are falling through the cracks and things like that.

[19:32] Then, I mean,

[19:34] you could have someone be completely fine. And then you go to do, for example, like even just something simple like Tanner staging and have the patient completely have a meltdown or panic attack, and you have no idea why, because you're just kind of being rushed through your appointments.

[19:55] So I really do think we need to be big.

[19:58] Management needs to be more aware of that quality care.

[20:04] Sometimes that means more than quantity.

[20:07] Michelle: Yeah,

[20:08] we need a complete overhaul of the system and how it's run because it's,

[20:14] it's definitely not patient-centered. I just spoke with a physician,

[20:18] OB GYN, Dr. Christian Borberg, about this, and, you know, that was his number one complaint is the time factor of, he's allowed 15 minutes with maybe a pregnant mom or a postpartum mom.

[20:33] And in that time,

[20:35] the checklist is huge of what needs to take place.

[20:40] And there's very little time to actually sit down and hear what a patient's saying and to read between the lines and to hear what they're not saying. It's causing, I hear this from every single provider that I've spoken with, and it's causing a bit of moral distress.

[20:58] You know, that the system and how it operates and then the person and how they operate and that disconnect,

[21:11] not being able.

[21:13] Are there days when you go home and you're just like,

[21:16] I don't know if I,

[21:19] if I was able to get through to anybody today. I don't know if I missed things.

[21:24] You know, does that happen Victoria?

[21:26] Victoria: Oh, a hundred percent. And that was my previous job. And pretty much why I left, because it was,

[21:34] And I talk about this with my husband some days where he goes, the difference in how you feel about treating people is he's like, I can't even.

[21:44] Like, every day you came home from that other job, you were like,

[21:48] like, did I actually make a difference today?

[21:50] Like, did I get through to that patient?

[21:53] And yes, there was the big piece of that was there was a lot of abuse and assault victims that I was seeing pretty much daily,

[22:02] which was horrible in itself. And then I felt like I was trying to go above and beyond with the little time I had with the nurses that I was working with.

[22:12] And I remember there were times that I had two nurses that I was very close with that would come to my office and we would just sit and cry during our lunch hour because we go, what did we just spent all this time trying to help this person,

[22:26] help this child.

[22:27] And did it actually make a difference? Like, that is probably the most disheartening thing.

[22:34] And you do feel,

[22:35] then you do start to feel like a huge disconnect, and almost say to yourself, which is horrible, but go like, do I bother?

[22:44] Do I bother?

[22:46] Because I don't have the time.

[22:48] And is what I'm gonna do actually going to help this person other than just burn me out and exhaust me. And you go home at the end of the day wondering what you're doing every day.

[23:03] Yeah, that is very real.

[23:06] That is very real. And I hear that from people that work in the hospitals and other,

[23:12] you know, kind of bigger practices where they're seeing, like, 20 to 24 patients a day, and they come home at the end of the day absolutely miserable.

[23:20] And I feel a complete disconnect and lack of love for the profession now.

[23:26] And that's why people are leaving.

[23:29] You're losing good people because of that.

[23:32] Michelle: Yeah, it's a crime. We gotta do something about it. What was the motivation behind wanting to open your own practice?

[23:42] Victoria: So it was a couple things.

[23:45] I guess it kind of started after everything that happened after I had my first child.

[23:50] And it was a combination of that and also the job that I was at that was physically and emotionally draining me.

[23:58] I ended up having an emergency C-section. It was very traumatic. I actually felt them cut me open because the meds didn't kick in in time.

[24:09] And then my son didn't cry.

[24:13] We didn't hear him or see him until I went to the NICU.

[24:17] And of course, being a NICU nurse,

[24:20] my mind went into nurse mode when I didn't hear that.

[24:25] And of course, there's a huge drape blocking me. And I keep asking,

[24:29] is he okay? Is he okay?

[24:31] No one's answering. No one answered me to the point that my midwife actually,

[24:36] looked up and goes, can someone give us some info? Like,

[24:39] can someone say something?

[24:41] And so for me, I ended up pretty much thinking he was gone and that just no one was telling me because I'd been in situations where I'd been on the other side of the drape.

[24:52] And I was the nurse, not the provider. And no one was telling the mom what was going on because they didn't want to upset her.

[25:01] But after that, and,

[25:04] you know, I had pretty severe postpartum depression.

[25:08] My husband said to me, he's like, you can't go back to that job. Everything you just went through.

[25:13] And we talked about everything that happened, the lack of communication, just thankfully, you know, I ended up being okay after, like, a year, but my son was okay.

[25:25] That was the priority.

[25:27] We talked things through. And he goes, I would rather you quit now. And he's like, do something else.

[25:34] And then start opening, start planning and opening up your own practice.

[25:39] He kind of goes,

[25:41] you've been kind of talking about it, hinting at it.

[25:43] And I think this is the push you needed.

[25:47] That kind of jump started everything.

[25:49] And I just knew that after being the patient and,

[25:54] you know, even with the knowledge I had,

[25:56] sometimes people weren't communicating well with me. And I just go, I never want to have a patient of mine feel that way.

[26:04] No one deserves to feel that way, mom or child, otherwise.

[26:09] And so I decided,

[26:11] okay, I'm going to,

[26:13] And I think other people feel the same way I do.

[26:16] So I'm going to open a practice and let people know that there are providers that do care,

[26:23] there's nurses that care,

[26:26] and hopefully they come to me and want me to take care of them.

[26:31] So, as hard as all of that was,

[26:35] I think that, I mean, it's opened up so many doors for me. It's. I've been meeting some incredible families who come to me with similar experiences that I had. Basically saying, you know,

[26:47] we just keep being, being told,

[26:49] no, you're fine, everything's fine, and just kind of getting dismissed and shown the door and no, that's unacceptable.

[26:58] Michelle: You essentially went through birth trauma.

[27:06] Victoria: Yes.

[27:06] Michelle: Yeah, absolutely. And man, bravo to your tenacity. Just talking about it because it takes time,

[27:17] Victoria: it's been over three years.

[27:20] Michelle: Look at the time that it's taken to heal. And thankfully that you went the healing route.

[27:29] You're coming out on the other side,

[27:31] but man,

[27:33] so sad that the interaction in that room is really essentially what caused a lot of that trauma.

[27:43] Victoria: Yes.

[27:44] Michelle: And it was done by healthcare providers.

[27:47] Victoria: Yes.

[27:47] Michelle: We gotta be better, we gotta be better than that.

[27:51] And that's motivation enough for wanting to start your own practice and say,

[27:57] I can't tolerate this, I'm gonna be different.

[28:00] I'm going to do something different. I'm going to look at the patient, the family differently. I'm going to communicate better.

[28:10] Man, bravo to you.

[28:12] Sorry you went through that.

[28:14] Victoria: And it's just interesting because, you know, people kind of joke like, oh, you're a nurse practitioner, you must get five star treatment when you go to the hospital.

[28:23] And I go, I wish,  that doesn't happen.

[28:27] But it was,

[28:29] I guess it was more like a shock after I started to heal more and being able to go back to that day without completely breaking down.

[28:41] My husband even said, he goes, why weren't you more angry,

[28:44] you know, about that? And,

[28:46] I think it was just because, and I was like, I don't know. Because if anyone else told me that story, I'd be angry for them. I'd be like, I'm gonna go and I'm gonna,

[28:56] I'll say something.

[28:58] Michelle: Exactly.

[28:59] Victoria: But I think I just so you know, I was.

[29:03] There was just so many different things, but ultimately I just wanted my son to be okay.

[29:09] So I think I go, okay. I can't get angry because then really no one's going to communicate with me.

[29:16] So we just have to approach this a different way.

[29:20] So usually,

[29:22] I've got stubbornness, and I'll say something and, like, my husband will be the calm one. And we switched when I had him, so that was

[29:34] was interesting because he would always,

[29:38] There was one time on rounds, I remember, and the nurses who I had in the NICU were phenomenal. They were so nice and they loved my son,

[29:46] which made everything better.

[29:49] But they knew that I was a nurse, a NICU nurse, and that I was an NP.

[29:55] I actually yelled at my husband. If you're telling them that, like, don't tell people. 

[29:59] Get in trouble.

[30:01] But on rounds, they were talking about the labs, and you know how usually they do rounds, they usually talk amongst themselves and then.

[30:08] They talk to the parent.

[30:10] So I'm sitting there listening, and 

[30:12] They said, oh, do you have any questions?

[30:14] And I said, oh, I'm sorry. You mentioned his platelets were low. What were they?

[30:19] And the attending, like, put his hands on his knees, got real, like, kind of in my face, and goes, platelets are things that clot.

[30:27] Michelle: Wow.

[30:28] Victoria: And my, I could feel the, like, the anger waves coming off my husband. And he just looks at him and goes,

[30:35] she knows what that is. She's an NP, and she's in pain, like, trying to calm himself down. And then when they left, he goes,

[30:43] that was so rude. He, like, he knows you're a provider. And I go, 

[30:48] It's fine. It is what it is. But I remember the nurse looking at me, too. She goes,

[30:55] Michelle: I wish, this is one of the times that I wish I was recording in video because I wish people could see your

[31:03] Face. Yeah, that's exactly the look that we would have given. Right.

[31:09] Victoria: Just the closing of the eyes and deep inhale, like, oh, my gosh.

[31:17] Victoria: And I go, oh, I make that face all the time.

[31:21] Michelle: So. Wow. The fact that you can laugh about it now shows that some significant healing has taken place.

[31:31] Victoria: will say I have an amazing midwife.

[31:34] And I did some mental health coaching before the birth of my second child, which was actually an unmedicated VBAC.

[31:44] So I will say,

[31:45] because people ask me why I was crazy and did that, and I said, you'd be surprised how healing pushing a baby out can be after you have an experience.

[31:56] So that helped.

[31:59] And like I said, I have an amazing midwife. She actually, she has her own practice and she is all about the communication and,

[32:09] you know, treating the whole patient. And I think it meant a lot to her too.

[32:15] Everything that, like, it was.

[32:17] It was obvious how devastated she was,

[32:20] not only for me, but as a provider that,

[32:23] you know, it wasn't the experience that we were beyond, the experience we weren't anticipating. Because it's nerve wracking to just have a baby and then to have all that. And I know 

[32:36] She was upset for me. So then when all of that happened, we joked we were gonna pop champagne in the hospital.

[32:44] But that's why I always appreciate having her as a provider, because she practices like that. And I know that she was always on my side and having my back, so I trust her.

[32:57] She saved my life that day and she saved my son. So I will never be able to pay her back for that.

[33:04] Michelle: Wow, that is just such a great story, Victoria. Thank you so much for sharing it.

[33:09] You know, it definitely wasn't on our radar, but I definitely appreciate you,

[33:15] sharing that because for one, you know, hearing that, I'm sad for you and for what you and your family went through,

[33:23] and I'm embarrassed. I'm embarrassed and I'm angry at the colleagues that we call healthcare providers that they could be so callous and unprofessional.

[33:39] That's not what we want to be known for, for sure.

[33:43] And I love that you're changing that.

[33:46] Let's talk about pediatric, mental and behavioral health, because the need is enormous.

[33:54] What are you seeing right now in children and families that concern you the most?

[34:00] Victoria: Oh, that's a great question. Concerns me the most?

[34:05] I would say one of the big things that I'm seeing is the anxiety that's coming from just doing basic daily things that I think sometimes people take for granted and they think it should be no big deal.

[34:23] But I would say just even talking to people,

[34:29] going to school,

[34:31] it's not even things like, oh, getting up and doing like a speech at school, like public speak, like a public speaking class.

[34:38] It's just basic communication skills,

[34:42] following instructions,

[34:44] and some very real fears of just people in general.

[34:50] I think there's a lot of contributing factors to that, I think.

[34:55] And I think a lot of it stems from fear, I think,

[34:59] on the parents end and the children are picking up on that.

[35:03] I think a lot of it is also social media related.

[35:07] It sometimes it's just,

[35:09] it's not even, oh, we need like, it's something like a severe diagnosis,

[35:15] like a severe psychiatric diagnosis. It's just teaching kids basic living skills and just surviving in this world kind of thing.

[35:26] And I'm seeing it at every age level.

[35:30] And I shouldn't say that it's so widespread right now. I have like a great patient population, some really great parents that are,

[35:37] you know, trying their best with their kids.

[35:40] But especially if there's a parent that has,

[35:45] you know, they already have anxiety,

[35:48] depression that was now exaggerated after Covid. Because we're still seeing those effects for sure.

[35:56] Yes, I think that we were seeing it immediately after things opened up, but we're still, we're still seeing it now, like no four or five years later that people are so afraid of just the world in general.

[36:15] And I get that need to want to protect your children, but some people are real. It's sometimes it's doing a disservice to the child and it's making them so afraid that we're.

[36:27] Sometimes, if you catch it at a young enough age, there's just some parenting tweaks, behavior tweaks that you can do. But yeah, there's a lot of,

[36:37] I would say a lot of fear and anxiety right now that we're trying to undo.

[36:44] Michelle: Do you think it's kind of like the chicken and the egg, is the anxiety and the fear coming from the parent and then the kids are like absorbing that and also becoming fearful and anxious?

[36:57] Or is it this parent has a fearful and anxious child and that's making them fearful and anxious? You know, what do you think?

[37:08] Victoria: I would say I'm seeing both.

[37:11] I'm definitely seeing both.

[37:14] Yeah, I would say it's,

[37:16] I'd say it's about 50, 50 when I'm dealing with a situation like that,

[37:21] you know, then it's still education and teaching, teaching, teaching.

[37:27] A lot of the time, it's just teaching the parents and not even saying, oh, they're being a bad parent. Because that's not majority of the time that's not the case.

[37:39] it's just trying to talk them through things, giving them time to kind of go over their concerns. 

[37:48] what's giving them, what's making them scared and like, okay, let's,

[37:54] let's stay off of Google and let's talk this through.

[37:58] Michelle: Right?

[37:59] Victoria: Stay off of social media. That will not help you.

[38:03] Michelle: Yeah.

[38:03] Victoria: Wow. I can't even tell you how many times I have people come in, they're like, well, I saw this on TikTok. I go, nope, nope.

[38:10] Michelle: So many providers are telling me that. Yeah, again, Dr. Christian Borberg said that so many of his pregnant moms are coming in saying that they get their education,

[38:22] their prenatal education from TikTok.

[38:26] Victoria: Yes.

[38:27] Michelle: And I talked to a nurse practitioner, and her name is totally escaping me right now. It was a couple months ago,

[38:36] and she's got her own practice in Texas,

[38:39] and her big concern was social media.

[38:43] Like,

[38:46] it's just huge how pervasive it is and how much destruction it's causing, especially for teens and,

[38:55] young adults. And they're seeing these kids being admitted.

[39:00] The figure that she gave me was astonishing. I know it was over 70% of kids admitted to psychiatric institutions, it had to do with social media.

[39:12] Either something they saw on social media,

[39:14] something someone said,

[39:16] being bullied,

[39:18] you know, inappropriate behavior, whether that's sexual, violence,

[39:24] being really just addicted to their phones.

[39:28] If an adult tries to take their phone away, they just completely have a breakdown.

[39:34] Are you seeing that as well?

[39:37] Victoria: So I will say in the last office I worked in, that was 

[39:42] A huge issue.

[39:44] I will say one of the big things that I was seeing was if I was seeing it was, let's say almost 90% of it was elementary school age,

[39:54] that there was these TikTok challenges going around where it was doing, like, a lewd or sexual gesture or behavior,

[40:05] and it was like a challenge.

[40:07] And while it wasn't necess, it was doing it against a teacher or another student.

[40:15] And these kids were seeing it, and then they were having these kids come home and tell their parent. You know,

[40:24] so and so did this to me.

[40:25] And it was,

[40:28] I just go, where are they? You know, I asked because I'd had multiple kids from several schools around the area who were telling me similar things. And they go, where?

[40:39] What's going on?

[40:40] Michelle: Yeah.

[40:42] Victoria: And they were saying that there was this TikTok challenge going around, and it was aimed at elementary school age children.

[40:51] First of all, what are kids in elementary school doing on Tik Tok? They should not be looking at it. It is not a _______social media.

[40:58] You could see a video of a puppy, and then the next video could be something R-rated.

[41:03] Michelle: Yeah.

[41:04] Victoria: The other problem that was coming with that was schools were sweeping it under the rug and not addressing it and kind of saying, well, you know,

[41:14] almost saying, well, kids will be kids. Well, no, that's unacceptable.

[41:20] They switched classrooms from your child to do it. You also probably need to invest in what would be performed because what's going on in that home and where are they seeing this behavior and why do they have access to seeing challenges like that?

[41:36] You know, kids talk and they mimic behaviors as well and other children may not understand what they're doing is completely inappropriate.

[41:46] And just think it's something off of social media. What's the big deal?

[41:51] That it was something I was seeing quite a bit where it was, well, it's on social media. What's the problem? Like an influencer said this or a celebrity said this,

[42:00] what, so it must be okay?

[42:03] It's having to teach these kids. It's more so with the teenagers getting into more of

[42:09] that nitty gritty piece saying, okay, that's a snapshot of somebody's life or something they're showing you.

[42:17] You can't take their word as gold. You can't do that. Like, this is not something that you should be facing. Like this should not be a role model for you.

[42:28] But yeah, that was probably one of the more disturbing things I was seeing from social media was the sexual assault in very young children.

[42:37] I was very shocked by that.

[42:39] Michelle: Yeah, we gotta overhaul that too. That's very distressing. How do you balance the needs of the child with the concerns and the expectations of the parent?

[42:57] Victoria: So again, I try and take a family-centered approach with that where I will,

[43:05] I will definitely talk to. It depends on the age of the child too.

[43:09] You know, if it's a teenager and 

[43:11] Able to have like a one-on-one conversation with them and treat them like an adult in that way, let them know that they're in control with the plan that we come up with.

[43:20] That can be very helpful. But you know, with the younger kids,

[43:25] I guess it's definitely addressing their concerns one-by-one and saying, you know,

[43:33] if like I'm concerned about this, here's why, or I'm not concerned about this, here's why,

[43:38] and then saying, you know, based on what you're telling me, but then what I'm seeing with your child,

[43:44] let's come up with a plan.

[43:46] And then I also kind of put it back to the parents. Sometimes I say, okay, here are my recommendations.

[43:53] How do you feel about that?

[43:55] And I say this is the least invasive,

[44:00] not invasive, but like,

[44:02] like the minimal approach. And then here's the maximum there's we can do. Like, what are your thoughts? I mean, one of the things I'll always say to people, if they come in and they say,

[44:12] I'm concerned about,

[44:13] like, my child, I think they're anxious, I think they're depressed.

[44:16] And I always ask them, I go, okay, how do you feel about medication?

[44:20] I always ask.

[44:21] And a lot of the time people go, I definitely don't want medication. I go, okay, perfect. And that's included in our plan.

[44:29] Again, always putting it back to the parents. How do you feel about that?

[44:32] How do you feel about the recommendations I gave you and kind of approaching it that way.

[44:38] I feel like majority of the time the parents feel like I'm listening to them, I've addressed their concerns and I'm putting their child's health first and that I'm not just kind of brushing them aside and making them feel like they're a part of the plan while still moving forward with what I think is best at the time.

[45:03] And I feel like that's generally a good approach to kind of address everything with the parent and with the child.

[45:11] And again, not everybody necessarily follows every step of the plan that we come up with, but I do at least feel then we address all the concerns and we're still making sure the child is safe and healthy and going home to a safe environment at the very least.

[45:29] Yeah, if that answers your answer.

[45:30] Michelle: Yeah, absolutely. No, I love the family-centered approach.

[45:33] And mind you, you have to do all of that in a very short period of time.

[45:39] Right? With the constraints that you have.

[45:43] Yeah, that's a lot. What do you wish more providers,

[45:47] understood about families?

[45:53] Victoria: I would say that again,

[45:56] majority of the time that,

[45:58] you know, obviously there are very sad cases where there's abuse going on, things like that. So this is not addressing that piece of it.

[46:07] But majority of the time,

[46:10] parents just want the best for their child and they're just looking for someone to listen and guide them in the right direction.

[46:20] And I think that's where it all comes from. They just love their kids and they just want to make sure that they're protecting them the best way that they can.

[46:28] So whether they're coming to you scared or angry,

[46:34] upset, whatever it is,

[46:36] it's stemming from a place of love for their kids and they're just trying to keep their family together and make sure that they're prioritizing their kids and families.

[46:50] It's hard to say something like, it depends on, I also see sometimes it depends on, like, the size of the family. Like, if it's an only child versus, 

[46:59] five or six, for example. I'm one of eight kids.

[47:03] Michelle: Me, too.

[47:04] Victoria:  Oh, my gosh. Really?

[47:06] Michelle: Yeah, we don't meet other people that have big families like that. Wow.

[47:12] Victoria: Oh, my gosh. And my husband's one of seven.

[47:14] Michelle: Wow.

[47:16] Victoria: Yeah. Five brothers, one sister he has. And there's four and four in my family.

[47:20] Michelle: Five and three in mine. Five boys, three girls.

[47:24] Victoria: Oh, my gosh. Wow. Oh, that's really cool that we both have that. I love that.

[47:32] Victoria: Yeah, we went off topic, but I love that.

[47:34] Michelle: But that does matter. That does matter because that was our family in,

[47:41] you know, in seeing the pediatrician,

[47:44] and our pediatrician had to be really on point because all those kids, it's different. And I,

[47:54] you know, I have one daughter, and so the way my pediatrician approached me was different than the way our pediatrician approached my parents.

[48:06] Victoria: That's true.

[48:07] Yeah.

[48:08] And I would say sometimes you can get a lot of your,

[48:12] Like,

[48:13] right now, one of the practices that I'm hoping to take over, actually,

[48:20] we will oftentimes see a lot of the kids. Like, we'll do, like, family appointments or we're seeing like three, four, five kids all together. That's cool.

[48:30] Yes. Which I love.

[48:32] And a lot of the times you can actually get a lot of information before you even sit down and ask a question.

[48:39] You can walk in the room and go, okay,

[48:42] you know, and I'll think about.

[48:47] Michelle: So true.

[48:49] Victoria: Every family is different.

[48:51] So I think knowing what's going on at home, what's going on with,

[48:56] you know, I always ask, too, like, who's primarily taking care of the kids?

[49:01] Sometimes it's the grandparents,

[49:03] sometimes it's dad.

[49:05] You know, never just assume you know what the family dynamic is. That would be another thing, too.

[49:12] I think a lot of times people are afraid to offend people right now. They think if they ask a question about,

[49:19] oh, is this so and so, or,

[49:22] oh, who's taken care of your daughter,

[49:26] that people are going to get offended. I mean, well, it depends how you ask it,

[49:31] I guess.

[49:32] But I think because people are, they don't want to offend anybody, they hesitate asking those questions. That could actually give you a lot of information.

[49:42] And quicker than you think.

[49:46] You know, for example, like, I had a child,

[49:50] the mom said the school was concerned about ADHD.

[49:53] Well, come to find out at home. Like, he's getting bullied at school. Apparently, he was getting bullied by cousins that had moved in with him a month prior.

[50:02] Mom didn't know that until the appointment. And we found out what the home environment was like.

[50:08] And he said, well, so and so isn't very nice to me. Like, when I get home, so I'm not able to do my homework, and I usually just hide out in my room.

[50:16] And that was not known to anybody and was,

[50:21] someone had just asked the question.

[50:25] So I would say never be afraid to do a deeper dive into what the family dynamic and what's going on at home, because you're not at home with them,

[50:34] Michelle: No, absolutely.

[50:37] Yeah. Those are great messages.

[50:39] I want to talk about your own practice because that always just amazes me.

[50:44] The number of nurses now that have become,

[50:49] I guess you could say entrepreneurs or business owners is just something that,

[50:55] When I was, you know, growing up in nursing,

[50:59] we didn't see that. We didn't see nurses, owning their practices.

[51:03] After all these years in pediatrics,

[51:06] what was it that said,

[51:08] I want to build this myself? And you did touch on some of those things.

[51:13] Victoria: Yeah, I think it was the time.

[51:17] The time given to patients.

[51:20] And,

[51:21] you know, I definitely would get a little flack for sometimes going over my time with a patient or if I needed to, like, move things around with my schedule.

[51:32] But in my head, I go, I don't think, you know, if I had someone that was, there was a concern that they might hurt themselves or they were gonna hurt somebody else.

[51:41] I go,

[51:42] yeah, I'm gonna have to rearrange my afternoon to spend more time with this patient. And I would get in trouble for it a lot of times, get spoken to, and they are spending more time with my patient, which I always found was funny.

[51:57] And so to me, I go, you know what I don't want.

[51:59] I don't know if I can work for another institution or another practice with someone telling me how to take care of my patients.

[52:09] Michelle: Yeah.

[52:10] Victoria: And that I shouldn't give them more time, even though there's an urgent concern that I should just pass it off to somebody else.

[52:17] So I,

[52:19] I really thought, you know what? I want to build something where I can make those decisions, and I can say, you know what you want?

[52:27] If you only need 15 minutes of my time, you can have 15 minutes of my time. If you want to sit down and have a full discussion for an hour, I will give you that.

[52:35] And whether it's Telehealth or an in-person.

[52:37] I just knew that I wanted to build something where I could arrange my schedule based on who I was seeing and what they needed from me, rather than someone telling me,

[52:50] hey, look at your watch.

[52:52] Get in there and see 10 more people,

[52:54] rather than giving someone the time of day that they really deserve and need.

[52:59] So that was a huge motivating factor and kind of 

[53:03] How I market myself and my business and how I practice as a provider. And while not that may not be the standard way, I will say I do think more and more, not necessarily New York, but I will say nationally, I'm seeing more and more and connecting with more and more people who are see who realizes that even though it's going to be a lot of hard work and a lot of behind the scenes,

[53:30] that it's worth it to give patients the kind of care they need,

[53:34] which is really nice.

[53:36] Michelle: Yeah, I love that. I love that you're thinking that way and I love that,

[53:40] you know, there seems to be a trend to go that way. That gives me so much hope that you guys have figured out this other way is not working and we got to do something different.

[53:54] Was becoming a practice owner scary, Victoria? Like, how did you just,

[53:58] Victoria: Oh, yes.

[53:58] Michelle: Yeah. How'd you do it?

[54:00] Victoria: I think I remember the night before my website went live, I was,

[54:06] I go, what am I doing?

[54:10] And it was so funny because the marketing team I was using and the owner, she was messaging me. She goes, I'm so excited. I love what we created. I cannot wait to, you know,

[54:20] share this on social media. Like, this is going to be great. I'm so excited for you.

[54:24] And I'm responding. Oh yeah, me too. And like,

[54:27] could not sleep the night before. I go, oh my gosh,

[54:31] you know, what is, what do I do?

[54:35] And there's definitely a lot of behind the scenes. There were a lot. Still are a lot of late night staying up till 2:00am, you know, after the kids go to bed and doing things that I guess I never pictured myself doing.

[54:49] But I will say it's been so worth it. And it's just a different kind of,

[54:55] you know, I'm able to prioritize my family, arrange my schedule so that I can be home with my kids and say, you know what if I need to put off work till, like doing some things till after they go to bed, then I can do that.

[55:07] But I'm still here,

[55:09] I'm still home with them and that's,

[55:11] I mean, that's all worth it.

[55:13] So I would say, as scary as it is, and there's a lot of things I'm learning about business that I didn't know before,

[55:22] it has been,

[55:24] I wouldn't. I wouldn't change the decision.

[55:27] Michelle: That's so great. I love it.

[55:30] I mean, there's so many nurses who have ideas about healthcare and how it could be better, like yourself,

[55:37] but they never act on them. What would you say to those nurses?

[55:42] Victoria: I would say, just don't, fear can be either a great motivator or it could be debilitating.

[55:49] And I think just everything I went through, I go, you know what? I need to change the course of my career.

[55:59] I think, you know, my kids have been a huge motivator behind that. So that definitely was a huge piece of it. But I would say,

[56:07] if you want to see change, be that change, and you can do it.

[56:11] And that there is a group of people,

[56:14] you know, they may not be necessarily on the news or in social media like other people, but you'd be surprised once you start that journey to creating your own business.

[56:26] I've connected with people I never in a million years I would connect with. And I'm sitting here with you on a podcast. Never thought I would do a podcast in my life.

[56:35] And,

[56:36] you know, I've done a couple now, and you'd be surprised how many doors it opens and how many, like,

[56:42] how many opportunities and ways you can be a positive change. So I would say, as scary as it can seem is very much worth it and take the risk. There are people that will definitely support you, and there is a group of us who we continue to grow every day and join us.

[57:05] It's fun.

[57:07] Michelle: You just make it sound so fun. I mean, I'm sure there are times that it's very daunting.

[57:14] Victoria: Yes.

[57:15] Michelle: But to have the autonomy and the freedom and the agency that you have now, that. That has to be so worth all the tough times.

[57:26] Victoria: Oh, yes.

[57:27] Michelle: Yeah.

[57:27] Victoria: It has made a huge difference.

[57:29] Michelle: Yeah. And to,

[57:31] you know, to escape that moral distress of, like, I know how things should be done, I know how I want to do them, but it's not happening.

[57:40] And that frustration with that and the anger that that causes and the burnout, and then to be able to turn it around and say, no, you know what? I'm going to do it.

[57:49] I know how to do it.

[57:51] And, yeah, that's admirable.

[57:55] Well, Victoria, thank you so much for sharing everything that you have today for patients.

[58:03] For families, for nurses,

[58:06] for potential entrepreneurs.

[58:11] It's been very enlightening, thank you so much.

[58:14] Victoria: Well, thank you so much for having me and this was a great conversation. It was so nice talking with you.

[58:21] Michelle: Me too. Well, where can we find you if people want to reach out?

[58:26] Victoria: Yeah. So I have a social media account. It's actually called @Boots BooksandPeds.

[58:32] You can find me under Victoria McMullen on social media and there's a link to my website on there and you can send a message,

[58:43] through Instagram or you can shoot me an email which is also on my website. But it's info@mcmullenhealthcare.com and I am always here to chat with people and connect.

[58:56] I loved and I love connecting with fellow business owners as well. It's great.

[59:01] Michelle: Awesome. I will put those in the show notes. Again, thank you so much.

[59:06] Victoria: Thank you so much.

[59:08] Michelle: So this is the last five minutes of our show, Victoria. And the last five minutes I do this thing called the five minute snippet.

[59:17] And it's just five minutes of fun.

[59:19] We do a lot of laughing and a lot of giggling.

[59:23] It's just a chance for our audience to see the off duty side of Victoria McMullen when she's not a pediatric nurse practitioner, when she's not a business owner. So it's a lot of fun.

[59:37] And it's just five minutes.

[59:39] Are you ready to play?

[59:40] Victoria: I am.

[01:00:20] Okay.

[01:00:21] Describe a perfect day where you live.

[01:00:25] Victoria: Oh,

[01:00:26] that would be a cup of coffee on the porch with my kids.

[01:00:31] And then I guess now since it's fall, like I'm a summer girl, but we'll talk about fall since it's going on.

[01:00:41] Michelle: It's still summer here.

[01:00:44] Victoria: You know what? Okay, so let's pretend it's summer here too.

[01:00:47] Then it would be packing a bag to go swimming or go to a lake or a beach and just spending the day outside and letting my boys run their energy out.

[01:01:02] And then honestly finishing with either soft serve ice cream or like a Peanut butter cup sundae. That's always a good way to end the day.

[01:01:13] And I guess for my son it's a vanilla milkshake. That's all he wants.

[01:01:19] Michelle: Sounds idyllic for me,

[01:01:22] Victoria: yes, that is a classic summer day and it's always my favorite.

[01:01:28] Michelle: Okay. Your best purchase under $100.

[01:01:34] Victoria: Let's see. That is tough. I'm trying to think, best purchase under a hundred dollars. See, I'm thinking of things for my kids, not me.

[01:01:49] Michelle: Yeah, right?

[01:01:51] Victoria: Actually, you know what, it'll work for me too. I got those blow-up tents, like the pop-up tents that you can crawl into and I loved those as a kid.

[01:02:04] So I'm like reliving my childhood and got that for my son. And we'll like go in the tent and like have nap time or we'll just play and look at the stars and constellations on the top.

[01:02:17] I would say that is probably one of my best purchases. And that's all I can think of right now because I'm only thinking of my kids recently.

[01:02:25] Michelle: That's awesome.

[01:02:26] Victoria: That or a pair of like, on-sale cowboy boots. That would also be always a good purchase.

[01:02:33] Michelle: So if the kids and dad are in the house and they're like,

[01:02:38] where's mom? We haven't seen her in a while.

[01:02:41] Just check in one of those tents?

[01:02:46] Victoria: Hiding. Hiding out.

[01:02:49] Michelle: Okay. First thing you do when you reach your travel destination.

[01:02:54] Victoria: Stretch.

[01:02:58] Yeah, right after I usually do the full body stretch. Yeah, um, yeah, that's always, yeah, that's always nice. After, especially a long car ride or a plane ride, I always stretch.

[01:03:10] Michelle: That's good advice. Okay, what's your secret weapon for getting a nervous child to trust you?

[01:03:19] Victoria: Oh, I always make everything into a toy or a game,

[01:03:25] Or make things silly, like make silly faces. So if I like, if I have my otoscope and I know they're probably going to get upset with me trying to look in their ears and their mouth.

[01:03:38] I always like make it into a flashlight, like make my finger glow or I like light up their mom's arm and you know, I make silly faces like with my tongue and things.

[01:03:48] And that usually gets them to laugh and then I can do a quick little exam.

[01:03:53] Those are great strategies.

[01:03:55] Michelle: Yeah. Yeah. I worked with a nurse on night shift when I first started in nursing. I was 21 and she couldn't have been much older.

[01:04:03] And you know, we had the whole Peds unit at night and what she would do was, when we had a kid that needed an IV,

[01:04:11] she would give the child $1 for each stick.

[01:04:17] So she got really, really good at starting IVs,

[01:04:22] because she would bring this whole wad of $1 bills,

[01:04:26] like, every night when she worked. Yeah.

[01:04:28] And I remember when we first started,

[01:04:31] you know, she was giving away five, six, $10 a night. And then after a few months, it was like, $1.

[01:04:40] Victoria: That's hysterical, I have never heard anyone do that. But, I mean, that's good. I like that.

[01:04:46] Michelle: So good.

[01:04:47] Victoria: Yeah.

[01:04:48] Michelle: Okay. What did you do as a child that made the hours pass like minutes?

[01:04:54] Victoria: Did a lot of reading.

[01:04:56] Which. I know these answers aren't necessarily, like,

[01:05:00] unique, but,

[01:05:03] I remember I read one of the Chronicles of Narnia books,

[01:05:07] and I read it in less than a day. And my dad didn't believe that. Because that's how fast I can read.

[01:05:15] I can read books in, like, a day.

[01:05:17] And he didn't believe me, so

[01:05:19] He made me do a book report because he's like, there's no way you read that whole thing. And I go, I did. And he goes,

[01:05:25] there's no way that you actually read it. So then we did a book report, and I got all this.

[01:05:30] Michelle: I love that.

[01:05:31] Victoria: It serves him right so he believed me.

[01:05:34] Michelle: Girl, that's awesome work.

[01:05:36] Victoria: Wow.

[01:05:38] Michelle: All right, last question. There's a billboard by the side of a major highway with your picture on it, Victoria. What is the message?

[01:05:50] Victoria: Oh, my goodness. Is this as a provider or just in general?

[01:05:55] Michelle: Yeah, just whatever you want it to be.

[01:05:57] Victoria: You know what?

[01:05:58] One of my favorites, and my friend and I came up with this.

[01:06:02] We would say, in the grand scheme of things,

[01:06:05] it doesn't matter. Now, there was an expletive before that, but,

[01:06:10] you know, just when people are nasty or not being nice, we would just say to each other, in the grand scheme of things, it doesn't matter.

[01:06:19] Michelle: I love it. Yeah, we curse on this program. It's fine.

[01:06:24] Victoria: So I would say, in the grand scheme of things, it doesn't effing matter. Yes, I love it.

[01:06:30] If I ever get merch. If I ever do that, if I ever get to that point, I go, that's gonna be my soul.

[01:06:36] Michelle: I love it.

[01:06:37] Victoria: Hey, that's perfect for mental health, right?

[01:06:40] Michelle: Yes, exactly. We need that. Well, see, it was so much fun. We did a lot of giggling. Thank you for playing.

[01:06:48] Victoria: Yes.

[01:06:48] Michelle: And thank you for everything that you've brought today, Victoria, I've absolutely loved seeing your beautiful smile and just learning so much from you about pediatric care. Just when you think you know everything,

[01:07:02] you meet somebody who always knows more, and that's wonderful.

[01:07:08] Victoria: Well, thank you so much. Thank you for everything. This was great.

[01:07:11] Michelle: Yeah. You have a great rest of your day there.

[01:07:14] Victoria: Thank you.