Ep 4: You Should Pick Me

with Vineet 
Arora, M.D.

October 28, 2020


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Arora, M.D.
Professor and Associate Chief Medical Officer for Clinical Learning Environment, The University of Chicago Medicine

Vineet Arora, M.D., M.A.P.P., is an academic hospitalist and the Herbert T. Abelson tenured Professor of Medicine at the University of Chicago.  As Associate Chief Medical Officer for Clinical Learning Environment, she bridges educational and hospital leadership to engage frontline staff into the institutional quality, safety, and value mission.  An accomplished researcher who is an elected member of the National Academy of Medicine, she is PI of numerous NIH grants to evaluate novel interventions that combine systems change with learning theory to improve care in teaching hospitals.  As an advocate for women in medicine, she was featured in the New York Times for an editorial that called to end the gender pay gap in medicine. She is a founding member of the 501c3 Women of Impact dedicated to advancing women leaders in healthcare and of TIME’S UP Healthcare, which is dedicated to ending gender inequities and ensuring the creation of a safe, equitable, and dignified healthcare workforce.  She has authored numerous articles on gender gaps in academic medicine.



Whether you're at the front line of care or not, you always need to keep the patient heart in mind as a leader.



Vineet Arora  0:03  

The only intentional thing that I will say, that I’ve ever done is when I interviewed for Chief Residency, that first leadership job, my chair asked me, “Who should I pick to be Chief Resident?” And we all knew who was being interviewed. And I said, you should pick me. And I was apparently the only one that said that. 


Lan Nguyen  0:20  

That was Dr. Vineet—also known as Vinny—Arora, Professor of Medicine and Associate Chief Medical Officer for Clinical Learning Environment at the University of Chicago Medicine. As an academic hospitalist and medical educator, Dr. Arora shares her journey working her way up through the leadership ranks of academic medicine, from chief resident to the C-suite. 


Vineet Arora  0:44

I was alone making decisions around life and death for the patients. But I trained in a culture where, if you reached out, it was weak. I draw upon that ICU experience to think about, how am I going to think about being an ally, and learn from these women nurses who are going to help me? But I had to interact and figure out how to negotiate my interactions in a very different way than the men around me. 


Lan Nguyen  1:07  

In this conversation hosted by Ceci Connolly, President and CEO of the Alliance for Community Health Plans, we learn about Dr. Arora’s unique experiences as a woman physician leader, and how she bridges education and healthcare delivery. Let’s listen.


Vineet Arora 1:24  

I did have a major pivot. I started up the educational leadership track. And I realized—teaching quality and safety—and, lo and behold, I realized what I really liked was doing quality, safety and value work. And so I actually interviewed for a job in my health system for a Chief Quality Innovation Officer. I didn’t get that job, but I made it to the finals and was able to communicate a vision for the role that I currently have. 


Lan Nguyen  1:48  

We’re delighted to welcome Dr. Vinny Arra and Ceci Connolly to Her Story, a program that explores women, leadership, and healthcare.


Ceci Connolly  2:00  

Well, I’ve been having so much fun playing guest host of the Her Story podcast. But I have to say that this conversation is one I have really been looking forward to because it is a virtual reunion with a friend, and a fellow Women of Impact for healthcare founder, Dr. Vinny Arora. Hi, Vinny.


Vineet Arora  2:21  

Hi, Ceci, thanks so much for having me on Her Story. I’m super thrilled to be here and reconnect with you.


Ceci Connolly  2:28  

It is such a nice treat. We’re going to try to talk some here about your leadership journey, in particular, maybe some of the unique assets or challenges associated with moving up through academic medicine as a woman, and as a young woman. And I think we might want to touch on that, because I think that has also impacted your journey. But let’s start with a little bit of grounding, you started with an interest in being a physician, let’s kind of pick up Her Story there.


Vineet Arora  3:03  

Great. So I should say that—obviously, like many, many people who’ve been influenced to become physicians—I was influenced by my own family. I don’t actually have a doctor in my family. I do now, so it’s exciting to see some of the younger cousins go into medicine and help them out. 


But I actually have a brother who has a chronic illness. So he has spina bifida. So growing up in the 80s, with a brother in a wheelchair at a public school—these are challenging times. And I was exposed really early in my life to what the other side of healthcare is like being a patient. And my parents are immigrants. And the incredible complexities of healthcare, and trying to understand how to advocate for your child and your family member when you are not originally from this country—and don’t look like everyone else—is challenging. 


And so I would say that was a really formative experience for me in terms of wanting to figure out how to make the healthcare experience better for patients. And so I always use that as a grounding. Because no matter where we go, or what we do, or whether we’re at the front line of care or not, as a leader, you really do always need to keep the patient heart in mind. And so I always think about those experiences that grounded me and still led me to be what I’m doing today.


Ceci Connolly  4:28  

You were at the University of Chicago, and you’ve been there a good long while, correct?


Vineet Arora 4:33  

Yeah. It’s funny, I remember growing up, my mom used to say, at one point, she said, “I’ve lived here in the US longer than I’ve lived in India.” And I used to think about that. I’m like, “Hmm, that’s a pretty big moment in someone’s mind.” And so, I have now lived and worked at the University of Chicago, longer than I’ve lived anywhere else. I always think about that as well. 


I trained here. I came here for residency training. One of the reasons I came here for residency training was I was interested in health policy and how to make an impact beyond just the doctor-patient relationship, but also learning those systems skills. And so I was able to do that during residency and chief residency here—and so, really skill up and get that training that I felt was important to me. 


One challenge in remaining here where I trained is that, early on my first leadership position was as a chief resident in internal medicine. And so that was exciting because I was leading our residents and in between faculty and residents. And then I joined the faculty, but when you’re chief resident, or resident at a place that you train—no matter what your job role is—people are still going to be like, “I remember you when you started as an intern.” And that can be a little bit odd when you’re in a meeting with a dean or the chair. 


So you do have to sometimes gently steer the conversation away, or say, “Oh that was a long time ago. Great memory!” And just to put in a little bit of perspective, to highlight that you did not just finish training yesterday. But I do think that that’s an asset, but could also be something that you need to overcome as a barrier. I’ve thought about that a lot. And so I would say the same reason that I can be so effective is that I trained here, I know the culture really well, I know a lot of people. And so some of the things that I know other women leaders who move around talk about a lot is getting to know the culture and getting to know your allies. I know my allies, I know the culture. But I have to overcome different things if that helps.


Ceci Connolly  6:26  

Well, and I also, I’m just curious, because certainly much of my career was in the journalism world and then moving over into healthcare. And I have typically found that the path to advancement meant leaving one organization and going to another, maybe because you got a little bit put in a box at the one. “Oh, that’s the thing that she does. And that’s it. We don’t imagine her doing other bigger things.” And to be blunt, it’s also from a market perspective, often how you’re able to command better pay. How do you counteract some of those elements? 


Vineet Arora  7:05  

Absolutely. I’ll take the second question, Ceci, because it’s so important. The pay issue is hugely important. And I’ve done a lot of research on pay inequities and physicians. I’ve written about it, and I believe one challenge—there’s a lot of reasons for pay inequities for women physicians—but one in particular, I do think there’s this element of loyalty and difficulty to move. Many women physicians are married to male physicians, like me, and so it’s not like I can easily interview for a chairman position, and be credible as a candidate knowing that they know my husband, and he’s not interviewing, right? So that is the challenge. And just the way gender dynamics play, there’s usually a lead on a trail. 


And because of that, I will say I see a lot of women physicians who don’t look around, and they don’t take advantage of opportunities that come their way. And I fell into this category for some period of time. And I noticed that my salary was lagging behind my closest peers. I didn’t know what to do about it until I reviewed a paper. Somebody asked me—Rita Redberg asked me—to review a paper in JAMA Internal Medicine that had been written about this subject by three men, interestingly, and didn’t highlight this concern. The paper was well done—methodologically, rigorously, well done. But the discussion was lacking, because it just said women need to negotiate more. 


And obviously, you and I both know, there’s discussions of bias and discrimination, and even statistical discrimination, which is the idea that as a woman—I had my children very late in life. I have a six-month-old now, and a six-year-old. But I escalated up the path without children. Younger women even without children are seen as, “Well, you’re gonna be off on the mommy track, so I’m not going to invest in you.” 


So I think, even depending on where you are, you need to be careful, and really advocate for yourself. But it’s not just about advocacy, it’s about the system. It’s about leadership in this area, transparency. 


But more importantly, one other thing that I found very important—which I now advise women—is to know your worth. Look for the job, even if you’re not ready to move. I’ve interviewed for jobs that I thought were way out of my league recently, and I didn’t get the job. But I learned a ton, and it helped me perfect my pitch. I met some great people, and I’m gonna be ready for that next job interview. 


And then I’ve also come close to leaving our institution. And unfortunately, that counteroffer is what actually helps improve your pay. I’m not a big fan of this prospect, because I think we waste a lot of time being recruited, etc. So one of the things I proposed to institutions is a loyalty bonus. Like, you could save a lot of money and help women and men who don’t interview and don’t look around, but actually escalate up the path. 


And so thinking about system fixes—just thinking differently, and rewarding people who are those loyal citizens, as opposed to the people that move all around. That’s really important in academic medicine, because in order to be blunt, in academia especially, you need to put all your effort into your scholarly work. And if every interview that you do, every job talk that you’re giving, is just taking away from your mentoring and work and impacting your research. So in some ways, I kind of think there’s ways to get around this and we have to push our leaders to think differently. So that’s one thing. 


And then I know that the other question was about reflecting on the pivot, if you will, in leadership. And I did have a major pivot. I started up the educational leadership track. And I realized—teaching quality and safety—and, lo and behold, I realized what I really liked was doing quality, safety, and value work. And so, after writing and teaching—writing a book about it—I then switched gears and thought, okay, I really want to be doing this, actually, in our health system. And so I actually interviewed for a job in my health system for a Chief Quality Innovation Officer. I didn’t get that job, but I made it to the finals and was able to communicate a vision for the role that I currently have, highlighting the importance of connecting and bridging the two spaces—the health system space and the education space—so that trainees weren’t left behind, and somebody was thinking about learning in the C-Suite. 


And it’s been really exciting, especially during the pandemic, which is not necessarily exciting, but definitely a sea change. But having somebody in your organization in the C-Suite thinking about learning during that pandemic is key, right? I mean, because the whole world has changed in terms of how we learn, what we need to learn. The fact that we’re even on Zoom—but everyone’s on Zoom, even at the same organization. And so, I think that bridging leader model, and articulating it, was helpful. But my main point is, don’t be afraid to interview for the job, whether it’s outside of your place or inside of your place, because that’s going to be what lets people know that you’re ready for a new way to lead. And it was through that interview process that I was able to convince others that this is the right thing for me. So even though I did not get the job that I had interviewed for, I was able to articulate the vision for the job I have now.


Ceci Connolly  11:53  

I hear some interesting themes and threads coming out of your stories and your experience. I mean, one to me sounds to be practice. You do more of these interviews, and you get better at it.


Vineet Arora  12:06  

Absolutely! I will tell you an interesting story. And I think you’ll know this story. For any physicians watching this, this is going to sound a little scary. But interviewing for physician leadership is quite different than interviewing for being a physician; those are very different roles. And so with my current boss, my CMO, I remember interviewing with him. And I know him—like, I’m interviewing with people I know, who have known me for years, who are friends, and so this is an important time. And he assumed like, “Okay, I’m going to treat you as any interviewee.” 


And so it was not like, “Oh, we’re palling around. This is an actual job interview. I’m going to go through your mind and how it’s going to work as a leader.” And he’s like, “Okay, so let’s say you take this job, and you have about 15 direct reports, who are at this mid-level physician—lead direct reports—in a year. How many are you going to turn over?” Immediately, I’m like, thrust into a leadership position and have to answer this question. And I know those people. I know those 15 people, like the back of my hand, and you have to answer that question. 


And I say that because that’s the type of expertise that you gain through those processes. If you really want to lead, you’ve got to be in the room and be able to answer those questions. So, I basically gave a number and defended the number and he was like, “Okay, that’s about right. You’ll probably recycle a third and then see how they do.” 


And so I didn’t know the answer to that question. I don’t know what he was thinking. But I’m highlighting this because as a physician who trained as a physician, and not necessarily coming out of business school or something like that, this was more of an HR question. And I was not ready for that question, and that was coming at a different angle. And so I start thinking now about leadership questions in a very different way.


Ceci Connolly  13:44  

That brings to my mind a question that I think so many women leaders, maybe, have to confront themselves throughout their careers. I think of it as the toughness, the angle. Is there some sort of a double standard? And I know you’re talking in that instance about probably having to fire or get some number of people to move on. That’s a tough thing to do. And so often, when women execute on these sorts of decisions, you can be labeled a certain way. Have you, over the years, felt torn between the nice gene and the tough gene, and what your image is going to be? 


Vineet Arora  14:27  

I do think a lot about, and I’ve written a little bit about, the likeability penalty that Sheryl Sandberg has written about and others even before her. And the reason I think about it a lot is, that’s where being a physician also comes into play. And so, being a physician leader is also about being a physician. 

Early in my career, I remember a situation where I was in the intensive care unit. And I had to call the shots, I had to make the big decisions. I mean, I was alone making decisions around life and death for the patients, I had people on the phone able to help reach out, like attendings and fellows. But I trained in a culture where if you reached out, it was weak. That’s less so now, but that was the culture I trained in at the time. 


And I was the only woman on that rotation in the senior role. And all the nurses around me were all women. And so I realized quickly that I needed to be an ally. I couldn’t interact with the nurses the same way my colleagues were. There was a very different dynamic there. And I couldn’t put my finger on it, but it was more of a collegial, “Yeah, whatever you say, doctor.” It was a little bit more accepted. And part of it is an age issue. It’s also managing as a woman—junior woman. It’s not always age that accelerates people’s path. You could be managing women or men underneath you that are older than you. And these are important things to think about if you’re a younger leader.


And so I draw upon that ICU experience to think about, how am I going to think about being an ally, and learn from these women nurses who are going to help me? But I had to interact and figure out how to negotiate my interactions in a very different way than the men around me—that’s just the most blunt way I can say it—which is that it wasn’t a given that they were going to help me. It was going to be, I had to work for that help. And I did, and so I feel like that is something that I lean on. 


And I think, to this day, it’s still an important thing that I think about is that, when you’re the only woman in the room, you have to—that’s the likeability issue, right? Which is, I wasn’t automatically liked. If I was too well-liked, then I wouldn’t be taken seriously. Right? And so I had to conform, which is, “How am I going to run a code and demand that everybody exits the room?” I had to raise my voice and do that. And people had to listen. And I know that there were other women who were going into cardiology, and people would be like, “Oh,” they would joke like, “Oh, she’s Doctor Code.” Because what they meant is she was going to come in and be a code leader for everything, you know? And so I didn’t want to be Doctor Code. I didn’t want to overtake everything, but I wanted to exert myself as a leader and highlight that I’m doing the best that I can for the team and the patient. 


This is something that I think is one of the hardest things for women right now, is that you can’t just overnight, say, “Let’s get rid of implicit bias. Let’s get rid of the likeability penalty and toss it out the window.” I wish we could. I hope we can for a lot of the junior women that are out there. But we can’t and so, Ceci, I would say you, me, all the other women of impact we know have had to deal with this. And we’ve each come to it in our own way. And figuring out how to lead with grace. How to put your best foot forward and still not lead like a man, but lead like a woman and highlight that you can lead. I don’t know that every person in the country is ready for that, unfortunately, as national politics have played out, but it is incumbent upon us to really show that we can do this as role models.


Ceci Connolly  17:58  

You mentioned your children. And I certainly want to ask you about work-life balance, although I also want to mention the caution that I think sometimes it’s almost, “Well if you don’t have children, you don’t have to worry about that. You can just work like a dog around the clock.” 


Vineet Arora  18:13  

That’s what I did do. I will say, you can ask too much about children, to the point where you dump on the person who doesn’t have kids. So I think a lot about that in terms of equity and well-being issues. I would say that nothing is easy; certainly, having a six-month-old is not easy. Having a six-year-old is not easy. And in the pandemic, everyone is facing something different, right? Whether it’s a sick grandparent or parent or being alone. There is some data coming out that the people that are doing the worst right now in the pandemic are those that are alone. And I am not alone. I have a house full of people. And so I’m just like, “Don’t come in through that door right now.” So, to me, being alone is a luxury. 


So I would say it’s about taking advantage of, what’s your comparative advantage? And leading from that. And so, I am often struck by the fact that having children allows me to think about things that I’m not normally thinking about, like the plight of parents in our organization, or how to handle evening meetings and things like that. So I can be a better leader in that space. 


Having said that, I also have to draw a line, and I’m fortunate that I am part of an organization and a leadership team that’s able to draw that line. Having said that, I will disclose that on the senior leadership team, I am the only woman with children in my smaller group. The men have children and the other two women don’t. And so it’s something I think about, in the sense that I also escalated up the leadership path with no children. I now happen to have young children and I’m still a leader. So I find that I see myself on both sides of that coin. I remember what it was like to be in my late 30s, and not have kids and be dumped on with work. And I also now know that it’s extremely difficult right now as well. And so you have to be thoughtful on both sides. 


I will say, when I disclosed to my boss I was pregnant, I was super nervous. You know, I was in a leadership position, I had been in it for a year, and he was so happy and gracious. And he was like, “We’re gonna make it work. And you’re going to show people how it’s done.” And so that gave me incredible pride to work for him and for the University of Chicago, in a way that I needed. 


And nobody plans to have a baby during a pandemic, either. And so I would say my team has been incredibly gracious, and this is why I would say, “Choose wisely,” right? Like, you have to find a place that’s going to accept the fact that you have a personal life. And for me, that has been finding this pod of people and senior leadership that do that. And I think the culture of our organization is like that. But I have to say, we all have little silos. And so I’m not going to be ignorant. I know that this is probably different for other people. But I’m proud of the fact that my clinical senior leadership team in the CMO office is very supportive. And I would say every woman out there needs to find that pod of people who are going to support them like I am supported.


Ceci Connolly  21:14  

At Her Story, a couple of questions we like to ask our guests. One, would you say that you are an accidental or an intentional leader?


Vineet Arora  21:24  

That’s a great question. I would say that I am an accidental leader. And certainly, I’m also an accidental advocate in the gender equity space, in the sense that it was really that paper that I spoke about—that Rita Redberg from JAMA Internal Medicine emailed me—that kind of got my blood curdling, to be like, “This is a gender gap, and it’s written by men, and it’s not framed well.” And so I’m going to go out there and start talking about this. And I wrote an editorial and it ended up being featured in the New York Times. And so that’s really what led me on this path. And so I would definitely say I’m accidental. 


The only intentional thing that I will say I’ve ever done is when I interviewed for Chief Residency, that first leadership job, my chair asked me, “Who should I pick to be Chief Resident?” And we all knew who was being interviewed. And I said, “You should pick me.” And I was, apparently, the only one that said that. And so perhaps that was an accident. But also it was really an upbringing of my parents to be like, “Put yourself out there.” I do think the intentional part about it is don’t not see yourself as a leader, because that was an important key point. He said he picked me because I said that. So that’s interesting.


Ceci Connolly  22:33  

Well, there is this sense of almost a self-limiting factor for so many women. I mean, one of the greatest joys I had as a leader and supervisor was in having a conversation with a young woman on the team. And it was kind of a, “I’m just sort of checking in, how’s everything going,” conversation. And almost the first thing out of her mouth was, “I really would like a promotion and a raise.” And at first, I was sort of so startled because I had no idea that was the agenda for the conversation. And then I immediately said, “Well, I gotta congratulate you very few women do that. So you’ve just scored points for just saying it.” 


Vineet Arora  23:12  

Let’s talk about that. That’s the agenda for the meeting. I think about that all the time. We go into meetings, we see people in the elevator. “How are you doing?” And a lot of women will launch into their, “I’m great. Kids are great.” You know? And I’m like, “Yes, but how are you doing?” Meaning, if I was in an elevator with you, as a man, you would be telling me about the grant that you just got or some success. So really put yourself out there and let people know what’s happening to you, that’s good. I think that’s important.


Ceci Connolly  23:38  

Would you say that there is a particular characteristic you have that has been, I might say, kind of like your secret weapon or given you that edge?


Vineet Arora  23:50  

Well, one possibility is that I have not been afraid. I mean, I have fear; don’t get me wrong. I have fear. I always have fear. But I have said some really bold things in my lifetime at a younger age. And I’ve gotten into some rooms with some very powerful people at a younger age, like Women of Impact. I remember being the youngest person in the room being like, “How did I get here?” But when we were all starting, I’m like, “Okay, I’m on the boat, we’re going forward, and I’m going to participate. And so I think that getting into the room where it happens is part of the battle. Staying in the room is the second piece, especially when you’re junior. And so, I think that what I have been able to do is get in the room and stay in the room, because I wasn’t afraid to speak up. 


I’ll give you an example. I’m on the Joint Commission board. And that’s a pretty powerful board, as you know. I was excited to have that opportunity—a Woman of Impact actually nominated me—so part of why we like our networks. I’m definitely one of the younger ones on the board, probably the youngest. And being the young one on the board and the new member on the board, I have taken my opportunity to speak up. And I take note when some of the senior men around the table say, “You know, that was a great point.” Because I know I have scored some points on the chalkboard for the future when I need to go back and say something and make an appeal. But I had to overcome my fear of speaking up as a junior woman, younger leader. And so, that’s just a great example of, you know, you’re kind of frozen in time, and you’re like, “Do I click the microphone to say something? Or is somebody else gonna say it?” Just press it. Just press it and get in there. And that is how you start being invited back into the room.


Ceci Connolly  25:34  

Did you ever find yourself a little bit conflicted around, I’m here in an immediate circumstance, somebody said or did something that is not really respecting me or my experience or my contributions? Maybe I should call them out right now. Or, I’m thinking about a longer game that I’m playing. And so I’m just gonna be quiet for now and smile. I mean, do you ever find yourself torn between those?


Vineet Arora  26:06 

All the time. Academia is not an easy path. So actually, even, I would say that this is lending myself on years of research experience in academia. It can be pretty cutthroat, and the quality of your ideas—people are competitive at that junior level, and thinking about what are you getting, versus what am I getting? And so I’ve had that experience, I’ve also had the experience that people like to have carved out their little domain. And if you’re a transformative leader and trying to change things and trying to innovate, that can be very difficult. And so you can run into issues there. 


My two strategies around these two areas are, one, see what common ground you have with the person you’re trying to engage with, whatever it is. And maybe that is, you have kids, you live in the same neighborhood. Start the conversation there. You know, “How was this weekend? Oh, I do that too.” You know, and just try to keep, humanizing your relationship so that it’s understood that you’re both human and you’re coming from good intentions. 


And the second is, you can agree to disagree. There are people that know that I disagree with them. And we still work together. And that’s important because you have to have that psychological safety to have a good team. And so I learned a ton from seeing Amy Edmondson and others speak about teamwork. I, myself, have gotten team training. And so I don’t want a Pollyanna team that’s always telling me, “Yay, yay, yay!” I want my team members. And I want the people who are in the meetings—my co-leaders, people that I work with collaborate with, my partners—to tell me that an idea is not good. Or, “Let’s do the following. Let’s change it up.” Because if you blow up the idea, then you can be like, “Okay, yeah, let’s take a little bit of the best, we’ll come up with something that works.” 


And so, try to not make it personal, and then make it about the work. And then, invite people to actually figure out how to make the work better in a collaborative way, where they can speak their mind safely. When you can get to that point, that’s when the sweet part of innovation hits, and you’re on your stride. And so to me, I welcome the dissent, but I welcome it in a way that’s safe and friendly, that we can all take it together. 


Ceci Connolly  28:13  

I know, maybe, that you and I could just catch up here and trade stories, and I could listen to your insights and experiences forever. But I am going to see if we might close on a potential title for the book of your story.


Vineet Arora  28:32  

I’m going to tell you two things. One is that if you ask the people that work for me what the title of my book would be, they would tell you it’s Perfect is the Enemy of the Good. So that’s my mantra to them, which is, “Just get it done. And let’s see how it goes.” And in the pandemic, I would say good enough is the enemy of anything, you know. But my own personal thought around this is that, especially around leadership—I did a Curbsiders podcast, which is a popular physician podcast on women in medicine—tried to launch it for them. And when you do a podcast, they excerpt little things from you, and you forgot what you said, like this. And they excerpt a quote, and then that thing actually is the one that people remember. And so the thing that I said that people remember was, “Be bold.” And I didn’t think about it at the time. I was just chatting. And it kind of got picked up on social media. Be bold. And I was like, “Okay, I think that’s my theme: Be Bold.”


Ceci Connolly  29:28 

I like it. I think that is the perfect note to conclude Her Story. Vinny, thank you for this delightful conversation. 


Vineet Arora  29:28

Thank you, Ceci. It’s always a pleasure.


Lan Nguyen  29:41  

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