Dear Everyone in Pain

Dear Everyone in pain,
I am not the gait keeper of your opiate pain medication, and I am not the drug dealer either.  Chances are, if you are under 40, and you haven't been in some kind of serious accident or have an active major illness (cancer comes to mind), then the pain you are in really shouldn't require opiate analgesics (aka, Norco, Vicodin, Oxycontin, Percocets).  Chances are also, if you have a nickname for your medications like "my vic's" (pronounced Vikes) then you are not in so much pain that you would need an opiate analgesic.  Or your pain comes from someplace higher that needs other interventions that opiate analgesics cannot achieve.
The drug addiction epidemic in this country is vast and expanding.  Many news outlets have been blaming physicians for this problem.  It is true that we, as doctors, have the ability to put people on these medications, and if they have a tendency toward addiction, it may turn into one once they are given the opportunity.
It is amazing how many people come into my door at the office already saying that their home medications include Norco 5/325 three times daily for pain (or higher doses), and when I ask them why they are on these medications it seems an injury happened five maybe ten years ago, and technically speaking should be well healed by now.  But that patient assures me that they cannot function without those medications and that I would be a cruel hearted you-know-what if I were to take them off of that medication.  Part of the problem is that patient's lie.  I do it too sometimes, to my doctor.  We have this crazy tendency to want to please others so we leave out important details, like "oh yeah, I am a recovering alcoholic or BTW I often smoke crack but only like twice a week and its been like a whole week since the last time I did."  I as the physician don't get that information from the patient, I had to find out because when you come in my door asking for those medications I make it a point to always check your urine to see if you a)have been taking the medications b)are taking other things you didn't say you are and c)that you are not doing other illicit drugs.
This comes on the heels of the ACA which now links hospital reimbursements to patient satisfaction.  Believe me, I want my patient's to be satisfied with their care, but on the same note, often times patients do not know what they need and will fight you tooth and nail, or go somewhere where they will give them what they WANT, not what they NEED.  So am I going to be considered a bad doctor because I don't give my patients what they want all the time?  Maybe.
It is this "Have it your way" mentality that is crushing medical practitioners.  Everyone comes in having either already diagnosed themselves, or having been to the ER where they don't treat chronic pain, they just want those people to GOMER and so they give them their Vic's or their Norcos.  Then I am the one trying to clean up this mess.  Often times I will lose patients because I do not give them what they want.  There are plenty of doctors down the street who will give you whatever medicine you ask them, but I'm not that doctor.  I will work with you, try to treat your pain and find out the cause as best I know how.  But I will not be your drug dealer.  I will not be complacent in this epidemic.  I will not.  

Nine months, in or out

So, on the first of July JD turned 9 months old.  It has been a whirlwind, an exhausting, scary, exciting, amazing and awe-inspiring whirlwind.  I cannot believe that soon he will be older on the outside than when I was carrying him on the inside.  I have not had time to blog, nor do many of the things that I love to do.  And I don't blame him because really all I want to do when I go home is hang out with him, until he is cranky and doesn't believe me that sleep is what he wants...then I could hand him off and go write a blog or two.  But man, what an awesome adventure it has been so far.  He seems to be an introvert, as we described one day at a restaurant he literally was facing outward looking and smiling at other people.  He loves activity and people watching and now he is crawling!  He is so opinionated and so I guess he takes after me in that way.

So far the things that make him laugh the most:

He thought that me copying him while he banged on his high chair was a killer.  Literally he couldn't catch his breath and gave himself the hiccups. 

Oh and when I showed him how to blow up a pound it, that was pretty frickin' hilarious. 

He is starting to be ticklish, especially under his armpits, so that is cool.

Oh and did I mention how much he loves his grandma?  Sometimes he prefers her over me, which started with Moose (Moose prefers her over me hands down) so I was prepared to no longer be the favorite. 

He currently has been jabbering away, he likes to hear himself talk.  Grandma always puts words to his jabbering and sometimes I think, yeah...maybe that is what he said. 

And did I mention he is a big kid?  He is in 12-18 months now, and can fit in some 24s.  So that happened.  Our nine month check up Dr. Hasaba said "OH he is now in the 75% for weight, for a 1 year old..."

Anyways, this past week Carl has been in Orlando for a church conference and I have been working long hours in the hospital.  Thank God for my mom because I would NEVER be able to do this on my own.  He is a great kid but he is not the best sleeper even still, we will see if that ever changes or he grows up to be like his dad who still has trouble sleeping.  Someday we will look back and remind him of the sleepless nights that he gave us...and we will hopefully be frustrated as to how hard it is to get him out of bed...instead of now where we are frustrated at him for waking up at 5:45am on my day off when the past three days I have had to wake him up at 6 to take him to daycare before work.  Alas, parenting is filled with twists and turns that no one can even describe or prepare you for.  As I am learning, day by day.  But man is he cute.  We sure do love him a lot.  #blessed.

Welcome to the +1

So it has been a whirlwind the past week, who knew!  But here we are on the other side of pregnancy with our little trophy to show for it!  May I say it is a sigh of relief every time I can look at him and know that part is done.  It all started Friday September 26th, after an appointment with Dr Marras where she mentioned the I word (induction) and I sobbed in the exam room because I just wanted to go into labor and have a natural, non-medicated birth.  

We went home and started to go back to our routine but then I started having some crampy contractions about every 45 min or so. I was able to tolerate them okay and so we continued on with our plans, talked to the doula, and began the early labor plan.  We went to the Tigers game with Jon and my mom, and had some contractions going on throughout but nothing to big or often.  The game was poorly played so nothing too exciting happened there.  Tigers lost, good one.

Overnight the contractions got worse to where I couldn't sleep through them.  And at one point they were every 20 min for over an hour.  And they worsened whenever I layed down so I stayed on the couch with lots of pillows to prop me up. Then in the early morning the contractions stopped, or just weakened and widely spaced out.  And not to shorten the next few days in this story (because it didn't feel short) but over the next day's Saturday to Monday every day the contractions would space out to about 40-50 min apart during the afternoon and then starting about 10-11pm would ramp up to about every 10 minutes.  Needless to say I spent the weekend not getting much sleep.

  Then finally Monday evening the contractions started to get really painful and I had to breath through them, throughout the night they were getting closer together and more intense until I was moaning through them every 5-7 minutes and my body started shaking uncontrollably.  We called the physician and she said to think about heading into the hospital.  We called the Alternative Birthing Center who said that they had just recieved 3 other calls so if we wanted one of their 3 rooms we should come in now.  So we called our doula, I put my leg on and we put Moose in the crate (to be taken later to canine to five) and headed out to the car. 

 When we got in the car it was warm without any signs of bad weather but by the time we were 2/3 the way to the hospital it started pouring.  So much so we had to significantly slow down!  All the nurses were saying the sudden drop in pressure put all the ladies into labor.

We got to the hospital and our childbirth class lady was right--stay together or else they will whisk the laboring mother away without waiting for dad to park and you will be laboring alone until he can catch up.  I was able to walk the short distance from the car to the ER doors so that we were not separated.

 We got up to the ABC in time to choose between two rooms so I had a nice built in jacuzzi tub in the room.  Emma, our doula came shortly after.  Dr Moore checked me and I was dilated to 5 cm, a great progression from the 1cm I was on the Friday before apt.  So we set into laboring with a rotation of showering, jacuzzing, yoga ball, etc.  Carl was there for every contraction offering his two fingers for me to squeeze as hard as I needed to.  It was a beautiful challenge but non of it centered on the pain or the time, just the task at hand and getting the hard work of labor done. 

By morning I had moved to a 6-7cm, then at 11am I was "a good 7 cm dilated".  It felt like things were progressing really well.  But as the afternoon ticked away the contractions got further apart and each check of the afternoon was the same "7cm".  We tried walking, we tried knee chest position, we tried a stadol nap (medication to help me sleep/with pain), but the contractions still seemed too far apart to do any major change. 

 Finally at 7pm, still 7cm dilated Dr Marras suggested breaking my water.  I had resisted earlier in the day but she said to get things moving again it would probably help, I asked the nurse Heather and she said at that point in the labor she would go ahead with the breaking of water.  When my water was broken it came out with light meconium (baby stool in the amnion) which Dr Marras was concerned for, but Heather, the ABC nurse, was politically trying to say that it was very light and the baby was doing well.  Dr Marras concluded that we could have an hour to see if we make significant cervical change but otherwise would need to be transferred to labor and delivery for continuous monitoring of the baby due to the meconium. 

 It was the saddest and most stressful hour as no contractions were coming.  We tried all of our best efforts to get contractions going but it seemed like the stress of the situation actually made the contractions further and further apart.  She came back in what felt like the shortest and yet longest hour of my life, I was praying so hard that my cervix had opened and picturing it as much as I possible could and yet she frowned at me and said "still the same." I asked for one more hour but she resisted and said for the safety of the baby she couldn't do that.  So we were woefully packing up everything to get moved and of course that is when the contractions started coming more rapidly and intensely.  

We went over to L and D and got the last room there as well, popular night.  They strapped me up, took my blood, tried (multiple times) to start an IV and put the monitors on which, let me tell you add so much to the discomfort of contractions it felt like torture.  Then you lay in a bed that is more uncomfortable than the floor and wait.  (Hoa said it best "the bed breaks down, it's made for function not comfort).  And Carl was observing the difference between set up of the ABC and L and D. At the ABC every aspect of the room was there for the laboring mother.  Others can figure out where to sit/be.  L and D was a bed for a sick person with a bunch of chairs for others to watch the sick person in the bed not move around the room, stay stationary and be sick.  

I was laying in the bed contracting for what felt like hours but it may not have been.  Without my mobility and change every few contractions it made the clock go like molasses in January.  After a while I asked, so what are we doing?  Dr Marras came back and checked me again, still 7cm.  Lucky #7.  So she said to get things stronger and moving again we really needed to start pitocin.  Well I was contracting the whole while, my back muscles could not relax between contractions and I was so tired I didn't think I could handle even stronger contractions so I opted for an epidural at that point to help tolerate the pitocin.  I could see the progression in my head and other possible complications to come and so the decision made me and Carl both cry.  I felt like once we made this decision it would eventually lead to cesarean anyways but if I was to keep going the vaginal route I had to have some relief. 

They gave me fluids and paged the anesthesiologist. It felt like forever until he got there, still contracting away and when he did get there he was no helpful encourager.  Both Emma and I overheard the CRNA tell him I was a transfer from the ABC.  "Of course she is" he said to her in a judgemental and annoyed voice as if I'd been an idiot to ever attempt to try and labor naturally.  He came in and had me sign the consent form, bleeding, infection, headache side effects blah blah blah.  Then he made Carl and Emma leave the room because it was a "sterile procedure" and they weren't allowed to stay for it.  Carl was a little perturbed as they let his dirty two year old shoes stay in the room but not him.  So I was left to endure myself, they put the bed all the way up with my legs off the side, leaning over a table and a pillow to expose my back.  "Now hold still"...

You try and hold still in that position for 35 minutes while contracting and having constant back spasms and being poked with a spinal needle multiple times.  First attempt: "shoot" he says, pulls it out.  "Sorry we have to try again". Still contracting, baby's heart rate falls off the monitor, nurse gets it back.  He tries the space above.  Poke, ouch, "damn," he pulls it out again.  Third time is the charm, he goes back to the original site, "got it". They thread the epidural catheter in, give a dose of medicine which finally gives me some relief.  The anesthesiologist starts cleaning up and leaving when the CRNA says "um, doc? You need to look at this" So there was blood in the catheter he explained, that my epidural veins were engorged and he kept hitting a vein and not the epidural space.  It was my anatomy's fault that I couldn't get an epidural.  He told them to take out the catheter, he said there was little else we could do but he could do a spinal block which would give me three hours, max, then we would be back to square one.  I wanted to talk to Dr Marras.  This man wasn't poking me again until I knew where we were going.  

So they called her in.  Waiting for her I couldn't help but think of how crappy it was, my peripheral veins were too small to hit so they bruised me trying to find one and then my epidural veins have the opposite problem.  Alanis Morrisette's definition of ironic, but really just a piece of shit that fate handed me.

Dr Marras came in and talked with anesthesia and said we could try the block but three hours might not be enough and then could he still do the spinal if we needed to go to cesarean.  He said he could but I had already been poked so many times I told Dr Marras I didn't think it would make the difference and that I couldn't do it.  

She suggested a check right then because I did get a little relief from the med they tried to give me before realizing they couldn't use the epidural, so maybe my pelvis had relaxed.  Carl and Emma were back at this point.  Carl with his shaky shoulders looking at me crying and wishing there was something he could do to help me not have to suffer anymore.  So Dr Marras checked me "Anna!  You're complete!"  Wait, what???  I was complete?  I couldn't understand or comprehend but as it sunk in Carl and I cried with relief and were so excited that we were ready to push!  Emma was congratulating me, the problem with the epidural didn't matter anymore. Complete/100/+2. 

So Dr Marras went to get ready, the nurse began setting up the delivery cart which wasn't even ready yet.  Once the cart was ready the nurse lifted my leg and helped me to ready myself for my first push.  I pushed twice while Dr Marras was out and the nurse said she could already see the head.  Then Dr Marras came, put on some gloves and checked me with the next push.  She told me to stop, wait. She continued to check me then removed her hand and with a sad face said "Anna I am so sorry, I didn't feel any cervix before but when you pushed I could feel it, you aren't complete you are basically still the same exam."  7cm.  The air was punched right out of me.  We went from tumult to glory back to tumult in a matter of five minutes or so.  The emotional roller coaster was unbearable. "I'm so sorry Anna, I haven't made that mistake since residency. But since that is the case I think we need to start pitocin." 

So we did, we started pitocin at the lowest it possibly could be and immediately the contractions were very intense but not only that I had the strongest urge to push ever in my life!  It hurt not to push, I had to contract every muscle in my body and I was shaking and moaning to not push.  I told the nurse the pressure and need to push was so great, she said "no no, don't push."  I do not know how many contractions I endured like that but I don't think it was many.  Crossing my legs, tightening every muscle I knew of, moaning so loudly I knew the desk staff outside was wondering what was going on with me.  At this point I had also developed a headache from being tapped in the spine multiple times.  Emma asked about it but anesthesia was too busy in the ER to come check in with me.

  I asked for Dr Marras to come back, I told her I couldn't handle it anymore.  I couldn't handle not pushing without an epidural, I couldn't handle listening to the baby's heart tones fall off the monitor every contraction, I couldn't handle thinking I could be doing this for another two or three hours and still not change, I couldn't do it.  "Uncle Dr Marras, uncle."  So with that we were prepped for the OR.  Carl was given his scrubs so he could come back while I was ready, I signed another consent form and before you could say supercalifragilisticexpialidocious they were rolling me away to the OR.  One of the residents I knew well would be assisting Dr Marras.  Luckily I knew she was one of the good ones.  They took me back and sat me up for my spinal block.  

Back again was the oh so loving and kind Dr. Globerson.  He pricked me only once this time and layed me down.  "Why is she in trendelenberg?" He exclaimed, a position where your head is lower than your feet.  Someone corrected the bed.   They began draping me, went to get Carl, but in the meantime my finders started to feel numb, then heavy, then I couldn't move my arms, then my chest felt tight, like I couldn't take a breath deep enough.  When I tried to express this to the CRNA he just said "your Sats are fine, you are breathing fine."  But I again pressed him as my ability to talk also began to wane.  I whispered/mouthed the word "I can't talk and I feel like I can't breathe..."  Again he reassured me my Sats were fine.  Finally the third time I pressed him, although I couldn't talk at all then he called the anesthesiologist back and told him "uh, she can't talk."  So he came back and started bagging me (using a manual bag to ventilate me).  

During this time they were bringing Carl back, he had said goodbye to our doula who had to teach 5th grade the next morning and as he turned the corner to come into the OR all he could see was one of the nurses waving her hands frantically no! No!  And she came out and said to Carl "everything's okay but your wife just feels like she can't breathe" so you'll have to wait for her in the room.  There it was, farthest from our birth vision. Separated and both very alone.

  It was what is called a "high spinal" and can be dangerous because it can cause lack of sympathetic drive to the heart, hypotension and if it bathes the brainstem, a lack of respiratory drive.  Carl was crying and pacing in the room and the nice lady at the desk asked if she could make him some coffee but otherwise he was alone.  I was in the OR aware but not awake.  Then... I heard him scream when they first brought him out "Anna you have a boy," Dr Marras said over the curtain.  I was so groggy but was so thankful for the loud cries I heard, our baby was okay.  Healthy.  9 lbs 5 ounces.  21 inches, a boy.  They quickly showed him to me but then whisked him away for some skin to skin time with Carl.  

As Carl was pacing and crying it was non-other than Dr Globerson, the anesthesiologist at the desk who was complaining about what a day he had with all these complications, then saw Carl and said "oh hey, you have a Son".   Thanks for everything and nothing Dr G.   Soon after came the nurse with our baby "take off your shirt" and handed him quickly to Carl.  There they waited for me, skin to skin, while I was sewn up and while the effects of the high spinal wore off.  Carl and JD together for the first time.  Carl told him a tall tale.  Checked him out up and down and was patiently waiting for me with our baby.  

Once they wheeled me out to recovery we could all finally be together.  I had to lay flat and my arms were still numb so I couldn't hold JD but Carl was there and I knew we were all safe.  There we were on the other end of insanity.  It all felt so surreal and it was crazy looking at this little being.  Are they sure?  This is definitely mine?  It would take some getting used to but was all so hard to wrap our heads around because of all that had happened.  But there we were, what once was two, three.  

(This is how JD feels about our anesthesiologist and how he handled things)

Knock on the door

As Carl and I were settling down to bed in our still new to us home in this new neighborhood around 9:40pm last night there was a knock at the door.  Moose bounded out of the bedroom and bellowed at the door.  I was immediately nervous and scared.  We sat there for a moment not sure what to do.  Looking out the window it was a man we have gotten to know this past year who is functionally homeless.  It was a personal dilemma whether or not to open the door.  Carl went out and spoke with him and found out he had just gotten back from being on the road with some guy but had to buy a bus ticket back and had very limited cash in order to find a short term motel to stay the night in.  We gave him what cash we had in the house (not much) and asked politely if he would kindly not call so late in the evenings.  He expressed his thanks and said he'd pay us back the next day.

This whole experience was quite jarring and also gave us a strong sense of guilt.  We have made it a point to reach out to this guy in particular because we realize we cannot help or save every person who is homeless in Detroit.  But now by inviting him into relationship, we have found ourselves in a position that made us feel uncomfortable...and then we were feeling guilty for feeling uncomfortable.  In the end we are no worse for the wear but we have begun to think about where this relationship may go in the future.  How to set boundaries but also tear some down in order to help his place in life.

I wish there were a manual on this kind of stuff.  I know we are not the first ones to have these thoughts and conversations.  Reba House and the Simple Way probably have a better way of going about this, maybe a manual of what to do in these situations.  But maybe it's different when you live alone vs in an intentional community.  I'd feel much more comfortable inviting him in with a house full of folks to help out if something were to go wrong.  Most likely nothing would have gone wrong but these thoughts are hard to quell.

So in all we learned a lot about ourselves, our comfort zone and how to push past that comfort zone in order to make it a better world.  I hope next time we can be more prepared.  And I hope he was able to find a warm place to sleep with the little money we were able to provide.

Sun in the City

So today I am in between night shifts at the hospital and could only sleep through half the day, woke up and found it to be the most beautiful day outside in Detroit.  I just had to be a part of it, as Maria from Sound of Music would say.  Unfortunately for me I had a flat tire on my bike, so like the industrious person I am I decided to fix it myself.  I have the kit, went to a presentation once on how to do it and have successfully done it before.  So I went about my marry way fixing my flat, and I found the hole and everything.  Once that was done off I went, down through Corktown toward the Joe, past Cobo and onto the Riverwalk with Detroiters of all shapes and sizes and colors.  It was not until I arrived about 4 miles from my house at the north end of the Riverwalk, on my way to Belle Isle that I realized my tire was loosing air, slowly, but losing air.
Luckily I was near a gas station with an air pump, but wait it was 50cents in quarters and I only had one quarter, but the nice young man pumping gas was willing to trade--actually he just gave me a quarter and said don't worry about it.  Thanks young sir!  So I put in my 50 cents and then realized--road bike attachments don't work with car air pump attachments.  So I was really in a bind.
I was sitting there thinking of a conversation I had with one of my attending physicians about a patient who had no coping mechanisms to get herself out of a bind.  She had asked the patient if she knew how to get a bus schedule, and the patient didn't and couldn't come up with a hypothetical solution for if she were to be stranded somewhere.  So here I was, my chance to prove myself and my coping mechanisms and of course it is on a day when Carl is out of town and I have to work in four hours.  So.  I laid out my options.
I could call a cab, but as I was looking at yelp reviews that were not so flattering I thought to myself, I have friends, I know people...surely I can find someone to come pick me up.  As I was sitting there figuring out my situation another nice Detroiter lady asked if I needed change for the air machine, "I'm set, thanks" I said.
Phone a friend.  I called my good friend Ang who has been sick in bed all week but was willing to come out for a poor stranded soul.  The first person I called and they agreed to come pick me up!  And while I was waiting another man on his bike (with the appropriate tire attachments) came to fill up with air.  He offered me the rest of the time on the air but I told him my attachment dilema.  Thanks anyway, though.
So all in all I made it home.  Thanks to Ang.  But I think I have learned a lesson in pride, don't be to proud of your work that you go testing it to the limit before doing a trial run.  And also, don't be to proud not to ask for help when you need it because more often than not if you give good people the opportunity they will take care of you and do the right thing.  Thanks to all the nice folks here in the City of Detroit.  That is why I love this City.

God opening up your life.

For Palm Sunday Carl and I spent our worship Sunday at the Core at Rochester UMC.  Jon Reynolds inspired me to think a bit about life and living faithfully.

I'm a pretty competitive person, I don't know if you know that but I .  Put my brother and I in a room with a stack of board games and you will figure it out before long just how competitive I am.  So when I was sick and I had a subpar doctor I thought to myself, man...I could do better than this guy!  Seriously.  That's how I decided as a late sophomore early junior year student that I was being called into medicine.   It was my competitive streak that told me I could do it but it was God that told me how I would do it.

It is interesting how God works in our lives because as much as I'd love it to be all happy and fuzzy it turns out God has a different idea of what my life should look like than I do.  I'll be the first to admit, I'm pretty selfish.  And I like nice things.  I like vacations to far of lands, I like Patagonia fleeces, I like Zingermans deli, I like shoes.  I like expensive things sometimes and so I have had to rethink those desires and selfish wants.  And sometimes I give in, but sometimes God strengthens me enough to overcome those desires.  One of those moments was when I decided to go into family medicine.  I have been told by multiple rich physicians that I won't make any money in family but I think that money that I won't be making is all relative.  I won't be making what they are used to but I am sure I won't ever go hungry or be out on the cold.  

This lent I have been practicing a certain type of self deprivation which is tough in this day and age.  We get plenty of free lunches And as I see it there on the table I think instead of how I could eat it and enjoy it, I think who else could benefit from it.  As I go hungry by choice, others don't have one.  So I take my serving to the guy begging on the corner by my street.

And I live in a place where intentionally that is near to me so I can continue to be reminded and not isolate myself too much that I forget that others are hungry and I can help them by giving them one meal of mine, I will live without that meal,  but others may live too.  

So in all, God calls me to live uncomfortably.  Because if you get too comfortable it leads you to forget too much of what others  need or don't have.  God calls us to live in harms way.  So that we may be the armour of the homeless and the bed of the weary.  Don't forget to give yourself up so that others may live.  

Rant

So I need to go on a rant here for a while.  We were discussing political views due to some unfriendly comments on Facebook and made earlier this week by a parishioner of a church we visited and it has been making me somewhat frustrated (*understatement).  The comment about a free store needing to have assurances that people weren't "abusing" the store or "going from store to store" for personal gain was one thing.  Then the Facebook comment about how due to her tax increases in her paycheck she was going to have to put a picture of the "ghetto family she was supporting" on her fridge; now that was just sh*tty.

Do people not realize that the largest group of those benefiting from you taxes is grandma and grandpa, not "ghetto families."  Or the defense budget and how war budgeting isn't even calculated into the federal pie chart because the damn pie chart would look too ridiculous because we spend so much money on war?  But the thing that this person likes to focus on is that she is supporting some "ghetto family" somewhere.

Well, I'm appalled at her language but also WHAT IS WRONG WITH SUPPORTING PEOPLE THAT NEED HELP?  And yes, there will always be those who abuse the system, BUT THAT IS NOT THE MAJORITY.  And DON'T BLAME/PUNISH THE VICTIMS. And also in case you were wondering, Medicaid spending is decreasing for the most part, not increasing...so most of that money you see coming out of your paycheck is going due to our mismanagement of the federal budget for years and our continued military presence in multiple countries.  Do we forget how people cut corners and recycled every last little piece of metal during the world wars due to rationing and other programs to help save money?

And do people forget that they benefit from their OWN taxes?  Like public schools, or ROADS to drive on, or social security, or that if they lost everything including their job and didn't have anyone in the family to lean on THEY COULD APPLY FOR THESE PROGRAMS TOO?  Honestly.  There is no dignity in having to ask for help, even beg for help....but without programs like these, returning from the brink of poverty and starvation would be even more impossible.

I just want to say I appreciate the woman I met who was thankful for medicaid because she had been a middle class housewife all her life until suddenly her husband left her and her two kids for another woman and she had not been working for over 20 years and so obtaining a job was difficult for her?  But this would never happen to you right?  You are immune to the perils of poverty and so therefore you can continue to judge the poor people who have no where else to turn than the governmental programs that were put in place to support them.  Since you can just move back in with mom and dad and continue playing your Xbox360 or ipad while others struggle to try and get a job in a volatile job market that doesn't hire people based on 1. not having a permanent address 2. based on being named a name that sounds "too black" or "too ghetto" or 3. you've been out of the business for too long or 4. you don't have any experience (but how can I get experience if no one will hire me?)  

I am sorry for this awful rant but I get frustrated especially when folks think they are somehow better or different than the poor, because you are not.  You are just the same, you were just born into a privilege that they were not.  So shut your mouth.

Toronto 1

Oh, man. It has taken until Christmas for us to post about our fun vacation to Toronto. But here goes! 

 and I decided that trains are cool and so is Canada, so we'd ride the rails to Toronto!

Once in the T we visited the Eaton Center (big shopping mall), the CN Tower, plus an old distillery district where they do a whole holiday nights program. We stayed downtown and road the subway all over. It was a great first day.

PS - I am reminded that while at the CN Tower we also took a virtual adventure ride to the HIMALAMAZON! and got sprayed by the water in this 4D spectacular!  ALSO, we ate artisan grilled cheese sandwhiches and saw these cool rubics cube mosaics!

Spending some time in Dallas telling youthworkers about Motown Mission. Missing Anna this weekend and kinda thinking it was a mistake to drive down here. But lots of good connections made plus some funny pictures with fake mustaches. Cheers!

Living on Borrowed Time

Daylight Savings Time is a strange event, especially in the fall when you have an extra hour in your day.  It is many individuals' dreams come true.  Another hour in the day to do whatever it is you need to do.  The twitterverse and news-streams were aflutter with suggestions on how to use the extra time and how not to waste it.  Strange isn't it?  How much of a difference does one hour really make?

But it does.  If only we were to live every day as productively as our extra hour.  And to always think of every hour as borrowed time, I wonder how productive we would all be?   Or how rested?  Or how well read?  It seems that we are not utilizing our 24 hours wisely, but if we get the chance to have 25 well...that makes all the difference.

For most people the extra hour is a blessing.  For those on call that night, it means an extra hour of call shift.  I pray that those individuals get an extra hour in between that shift and the next.  Or they get the next holiday off or something.

I think what we need is to have this extra hour every day, whether it is at 7am-8am or 10pm-11pm, or whenever.  I think each of us would do well to think, what am I going to do with this special hour of my day that is meaningful to me?  If we thought about that every day, I think our life satisfaction would increase, because we'd be spending our time intentionally.  So, what are you going to do with your extra hour tomorrow?

Lance Armstrong no longer super-human

I know that the Lance Armstrong news has been pushed under the rug, what with the election debate and the World Series going on right now, but I would like to take a moment to reflect on this issue.  The reports have been damning of the man and his teammates but I just wanted to take this opportunity to thank him and those that exposed this new development in his story.  It gives me hope that I am doing okay.  I'm not superhuman and haven't won seven titles of the worlds toughest race, but then again, neither is Lance Armstrong.  He needed extra help to do that...and so would I.  So thank you Lance, for exposing the normal-abled, non-superhuman that you really are.  It makes me feel better about myself and I hope others will realize what this means also.  

Radical Hospitality

This month marks the second round of the Wayne County land auction of 2012.  That means, if you want to get your hands on an as-is house for $500, now's your chance.  Or you could pay slightly more and possibly get something livable.  It has become a yearly tradition for the Detroit hipsters and entrepreneurs for acquiring cheap buildings and land.  You can check out the available sites at whydontweownthis.com.  Some use this as a tool for establishing or growing their business.  Others use it as a cheap way to own a home.  Yet for others it is a really scary time as the county begins to sell their homes right out from under them because they couldn't pay their taxes.

A friend of mine bought a house last year from the land auction.  I couldn't tell you how much he paid but I have a feeling he may not have a mortgage.  But the thing is, when he bought the house it was already being lived in.  By a man who was born there and whose parents were the ones who built the house.  It had been in his family for generations but they had come upon hard times as many Detroiters have.  It's hard not to miss some tax payments when after the auto bailout many took a 50% pay cut and others were downsized.  

An amazing thing happened however, probably the best that this family could hope for in their situation.  This friend of mine who bought the house, instead of posting an eviction notice (which would be within his rights), he came and met the former owners of his new property and came to an agreement.  And a few months later, he moved in with them.

It has been about nine months that they have lived together and I don't know the details of how it is working out but man, can you imagine?  I know many who have trouble living with chosen roommates or family, let alone a total stranger that the only thing that brings you together is happenstance.  I am truly inspired by this act of hospitality.  Not only on the part of my friend but also the family that already lived in the house that agreed to take this guy on.  It will definitely be a challenge for anyone to share their most intimate places with others but as Christians and followers of Christ that is what we are called to do.

Following Christ is not the rewarding, self fulfilling picture that Joel Ostein preaches where if you believe in Jesus and are a generally pious person then you will be blessed with a big checkbook and a fancy car.  It often is sticky and really hard.  It will put you into situations where you are massively uncomfortable.  But there it is.  Jesus was a radical.  He made the powers of his day mad because he was so.

So how are you showing radical hospitality in your life?  Are you?  I could probably use some work in this area and I know that the friend I am referring to in this blog is doing a much better job.  I guess  that is why I wanted to mention it because it is an example of something we can all strive towards.  Not that we all need to buy a house on the auction and move into a house that is already lived in but it gives you an idea of what a picture of hospitality really looks like.  

No one is above the grace of God.

In the past five or so years, I think since starting medical school really, my faith in Jesus and in God has wained.  I have found more excuses to avoid going to church, I have put my trust in myself and other places instead of in God.  I have become judgmental of those who frivolously give their trust to a story that although beautiful in its execution, right now is still just a story to me.

The world is a scary place right now.  With talk of nuclear power and possibly warheads coming to Iran with Israel and possibly the US trying to get in the way of that venture.  With people losing their homes to foreclosure and the US losing it's entire manufacturing base to places like Mexico or China.  With murder and killing rates being elevated in the city of Detroit.  With mass shootings in Aurora and bombings at the US Embassy of Libya.  With Russia jockeying for power by controlling much of the worlds fuel resources.  With North Korea and China, Japan and others trying to display their rights to the Pacific ocean.  With mothers who have to drive their kids to school who once upon a time would have walked because they have fear that someone might harm them.  With all of the hand sanitizers and CDC or WHO releases on what next big epidemic is coming.  We live in a world of fear right now.

It is strange I find myself questioning God's presence during this time, because it always seems that folks are more faithful during times of trial than times of prosperity.  It is these times that we realize our inability to manage our lives and the world by ourselves.

During my freshman year of college my faith was strong.  I had been diagnosed with a unpredictable tumor and my dad had suddenly passed away of a heart attack.  My faith was so strong at that time I had an ichthus fish tattooed on my ankle to remind myself that if God could get me through those two hardships, God could get me through anything.  Unfortunately that ankle was also the one I lost to amputation six years later, so I no longer have that tattoo as a reminder of my faith and what God has done for me in the past.

I have recently been reading the book by Don Miller, Blue Like Jazz.  I had hesitated reading this book many times as I didn't want to be one of THOSE kinds of christians.  It seemed like the predictable thing to do.  I had seen him speak once at a combination concert with Derek Webb.  I didn't buy the book then because I was judging the type of church that hosted the event.  I somehow thought of myself as more authentic because I didn't worship in a large warehouse type building out in a cornfield in Midland or Saginaw or wherever it was, with people that dressed like Adam Hamilton or wore glasses like Rob Bell.  It was hubris on my part.  After starting to read this book I have been humbled to find how many things I have to learn; from people like Don Miller, or Rob Bell or whoever I have judged to be less authentic then myself.

Don Miller talks about a moment when he was being taught a lesson.  He was asked by a friend about what he could pray for him.  Don mentioned all of the friends and other worldly problems that he wanted to pray for but didn't mention anything about his own life.  When the friend presses him about something in his own life, he says something to the effect that his life is going pretty good and didn't really need any prayers right then.  The friend rebutted that no one is above the grace of God.

This was a strong lesson for me to learn as well.  Right now, although life is going okay, I need the grace of God more than ever.  I need it because of my judgement of others whose faith has surpassed mine.  I need it so that as I am here, questioning and doubting God, I can somehow find my way back to faith.  It is hard to get off this pedestal of mine and really examine what in my life needs grace.  But by doing just that I am one step closer to God.  I am no less or more deserving than the homeless man who stands on my way home from work, or the teenager at the box church who raises their hands to praise God in a predictable way.  No one is above the grace of God.  Its a good thing we cannot do or say anything to earn the grace of God because it seems like for a while now, I have been rejecting it.

I have yet to get back to a place of true faith, the place where I was in College or even prior to that.  But I am inching my way.  Luckily, although I have abandoned God for a time, God has never left me.  As I think about the future and the possibility of bringing children into this world, it scares me.  Because who knows what the next fifty to 100 years will bring.  But I hope that before that happens I can come to a place of faith, and humble myself enough to realize that many things are out of my control.  I just need to have enough faith in God that there will be something better for our children, and that as a disciple of Jesus Christ I am vetted with the task of helping make that so.  And I am no more suited to do that than the next guy, because Box church or cardboard box,  not one of us is above the grace of God.

5 Years!

This weekend we are celebrating our Cinco de AnnaNCarl-versario! It was so nice that friends Drew and Catriona honored us by also getting married this weekend. we danced the night away and had a great time with Anna's friends gathered from far and wide.

Then today we had the amazing chance to have a holiday off (lucky Anna, don't tell the Gods of Call). So for a special day we took off for Point Pelee National Park in Ontario, CA. Isaac stayed south because we couldn't have asked for better weather. What a beautiful place. Good job Canada.

And here they are in no particular order, the top five reasons we love being married to each other:

5. Exploring the world - near and far.
4. Someone to catch you when you are about to fall
3. The joy of each other's family and friends
2. Having each other to laugh at when you are stupid and laugh with when you are funny.
1. Creating home together.

No longer the Medical Student

Today was one of those realizations that kind of scares you.  I had a medical student following me around today for the first time, and after I slowed down to realize enough that I was supposed to teach I was like "Oh yeah!  I'm supposed to teach!"  It is the first time that I realized that I may have something to offer. 
    Remembering back to my third year when I was a brand-new bright-eyed student on their first rotation and said things like "This is so cool" when we were signing out patients.  It is actually somewhat refreshing to have her around.  After only one week of being on the floors (almost a week and a half really, feels like years), being yelled at till I cried only twice (you can't make me cry!  You'll never make me cry!), and having to tell my best friends that I couldn't make it to their wedding rehearsal that I am supposed to be in because I couldn't get anyone to cover for me, well, I have been getting a little bit cynical.
   It is nice to be reminded of how exciting it all once was and why I got into this in the first place.  Now certain aspects that have become so routine and are something that is annoying to me could be a teaching moment.  Stuff that I think is so mundane that others obviously should know the same things, but sometimes they don't.  After being followed around for two patients where I just hastily wrote notes for fears that the attending would get there before I was finished with the chart, I finally realized, I know some things that this girl doesn't yet. 
  I hope that in this process I can be able to learn and teach at the same time.  She watched me sign a prescription today and said "That is awesome!  You sign your own prescriptions!"  I told her how our days usually go, we do sign out, then we break to go see our assigned patients, and write a full SOAP note, get to know everything that happened and all the new information from overnight, then go over your plan for the day with the attending, make the changes, put in orders, (yeah, I can put in orders now), have some lunch at some point, and then in the afternoon follow up on anything you may need to re-check or that you ordered.  I told her to document when you see the patient and talk to them, so that everyone knows the work you did (including billing, your supervisors, your senior residents, and god forbid, lawyers).  She actually seemed like this was all news to her so I think I wasn't telling her something she already knew. 
  I guess the hard part is finding out what the students know already, and what you can teach them.  But also, knowing that I was not to distantly in their shoes--that maybe they can teach me something too.  Like today, Bianca reminded me to enjoy medicine because although it scares the shit out of me right now, gosh darn-it, this is pretty cool.

Interns 101

“Since I was a kid, I've been able to sleep through anything -- storms, sirens, you name it. Last night, I didn't sleep.  I guess I get a little goofy when I'm nervous. You see, today isn't just any other day. It's my first day. [proudly, to his reflection] I'm the man. And four years of pre-med, four years of med school, and tons of unpaid loans have made me realize one thing...' Nurse:'Good. Could you go drop an NG tube on the patient in 234, and call the attending if the lavage is positive?'... 'I don't know jack.”

These are the opening lines of the show Scrubs. Possibly the most accurate depiction of what it is like to be a medical intern of any television show that I've seen.

Last week I started out on the floor for my orientation of what it's like on inpatient medicine.  I had my first call shift, I wrote my first script, I admitted a few patients and discharged a few.  I may have even made one decision on my own.  It was terrifying.

This week I saw my first patient in the office, while being shadowed by my advisor Dr. Otsuji (36+ years in practice).  Carl said it best "They shouldn't call it shadowing, they should call it... scrutinizing."  After about five minutes of talking to the patient I looked at him with the thoughts in my head "Well, you're the doctor..what should she do?"

It is a big leap from fourth year of medical school where you are always under the guidance of others, and they make all the decisions, to intern year where the nurses call you doctor and ask you to write medicines for patients.  Now I'm expected to know things, and make decisions and all of that crazy sh*t.  It's been rough getting used to introducing myself as Dr. Gladstone.  It feels phony.

I have also learned that my work personality is shy.  I was told that by our orientation director, Dr. Zeltzer.  Interestingly enough, I've never been called shy in my life.  I guess you learn something new about yourself all the time.

Another line from the first episode of Scrubs goes like this: "So, what's it like being a young, hot-shot doctor?' 'It's like... Did you ever go see a movie that everyone told you was great, and then because of all those expectations, you ended up totally disappointed?' 'Movies nowadays have too many special effects.' 'Yeah, that was pretty much my point.'"  And I totally know what he means.  Well, if you don't hear from me for a long time that is because I am a medicine intern and I have no life outside of the hospital.  Wish me luck!

Let's Get Along

   When people ask me where I'm from, I say Detroit. But well, I grew up in Ann Arbor. Then they ask me where I live, and I say Corktown. They nod and say how much they love Slows. I think I may have had more street cred when I lived in Grosse Pointe Park on Barrington, one street outside of Detroit. Then I could say I lived near Jefferson and Alter. After living in Detroit for almost two years, I have fallen in love with the city but I can hardly call myself a seasoned Detroiter.

   I have been reading Detroit: A Biography by Scott Martelle. Which hardly makes me an expert, but a certain theme continues to pop up throughout the history and disintegration of this city: Racism. In the 40s and 50s when a black family moved to a neighborhood, the value of all the houses went down. You know someone has to decide the value of those houses right? It doesn't just happen that they devalue. So white people moved to other neighborhoods. They formed bands of roving mobs to punish the blacks for moving in on their turf. They formed “neighborhood coalitions” to dictate who could and could not move into their hood. If you think that young black boys in gangs originated turf wars, think again.

   Who was it that said “Those who don't learn from history are doomed to repeat it.” Well, I have an idea on how we can save Detroit. Lets forget the racism. And classism. Lets forget whose neighborhood this or that is, and lets all just get along. Why can't we all just get along?

I was really saddened by this article in Curbed Detroit (http://tinyurl.com/clx2mhk) not because I don't agree that it is sad that the Imagination Station burned, but because it was written as if this is somehow worse than all of the house fires ever before in Detroit. Thank God no one was hurt. Like in this story from just a few days ago (http://tinyurl.com/bt3b76r) or in March of this year (http://tinyurl.com/bnyo83o). Or how about in December last year when two people had to jump out of a window? (http://tinyurl.com/7tmrvlv) ?? The comments on the page of the Curbed article got ugly and defensive, and racist.

   Why can't we improve on the city without suppressing others? During the Fireworks this year almost 300 youths were arrested and detained for violating a curfew that many of them did not know about. Sometimes it's hard to get the news if you don't have a paper, or an iphone, or a TV, or a computer. Was that really necessary? Why do we have to arrest young Detroiters in order to make it safe enough for out-of-towners to enjoy the fireworks? I'm sure there is a better way.

   So how about this? Veteran Detroiters, why don't you join Mr. Mongo of Cafe D'Mongo's Speakeasy when he corrects his friend who said “These white kids, takin' over the city.” Mongo told him “Naw, they fill in the gaps. They left first, we filled in gaps. Then we left for the suburbs, now they fillin' the gaps.” And you, New Detroit Hipster Crackers (I'm definitely a cracker, I don't know how hipster) why don't you stop using the fact that you live in Detroit like a badge of honor? And don't get so defensive when someone questions your understanding of the city's pain. Maybe if you sit and listen, you will learn something and become a better person.

   All in all, my point is that when you live in Detroit. There is bound to be some losses. I had two bikes and a car stolen in less that two months. And nearly 300 youths were arrested on fireworks night for being out and about. And Jerry Paffendorf's Imagination Station burned. And someone's brother was shot and killed. And... So let's not compare our losses. But why don't we share in the dream of Detroit?  

Tourist in Detroit #2

Well, this weekend was another successful Detroit ho-hum good time.  Last week was Carl's and his intern's first week of Motown Mission Experience 2012!  75 youth and counselors came from as far as North Dakota to live and work in Detroit for a week.  They managed to work hard in the Cody/Rouge neighborhood in Detroit and no major mishaps.  Although he did send all of them to the record breaking Tigers game where the Rockies scored 8 runs in the top of the 10th inning.  Seriously Detroit, what is going on?  Didn't we put out a record breaking contract for Prince Fielder?  Where are those results?

Strange sign to have in a Photography Gallery

But while those kids were at the game we had a leisurely evening at the DIA Friday Night Live event.  There was Solanye Caignet y Sergio Medina from Mexico which felt extremely appropriate to be listening to in the Diego Rivera court.  Also there is a fun photography exhibit by Patti Smith right now.
  I can't wait until July 15th when the Picasso and Matisse show opens.  And when we were walking around Carl said aloud "We are members here?"  It is hard to believe especially since he was still wearing his clothes from a long day on the job and I was wearing camouflage shorts.  Maybe next time we will dress the part a little more.  What an amazing place we have right here in Detroit.
Then on Saturday during the day Carl and I diverged, he went to Ohio to see Lakeside and the Ohio Conference's "Youth Annual Conference" of the United Methodist Church and I attended my cousin's graduation party in Vicksburg, MI.

In the evening it was a Detroit sports evening.  We volunteered at the Detroit City Futbal Club game shagging balls, and then Carl and his soccer team Cass Corridor United (CCU) were the half-time show shooting Jorts (jean-shorts) into the stands and waving their "Suck It" flag.  "Suck it" has become CCU's official team motto.  After that we walked across Cass Park to the Masonic Temple where the Detroit Derby Girls Championship was taking place.  And the Detroit Pistoffs took the title for the second year in a row.  After our trip to Portland and visit with their Derby Girl bout we figured we should go see the girls who are featured in the film Whip-It!  What a funny group of folks we have here!  It was a blast.

Cool Venue for a sporting event!

Then for a nightcap we stopped at Motor City Brewing Works, had a pizza and some beer and met a nice woman named Shawn.  She was super fun and also asked us to pray for us because she is still struggling from the loss of her mother.  We could relate to that, and agreed to keep her in our thoughts and prayers.  We also ran into our friend Devin Hanson.  What a fun city to live in.  You get the experiences of a big city (Major league sports, big concert venues, lots of restaurants) but every time you go out you run into someone you know and it feels like a small town.  I love this city.
Sunday for Father's Day we went up to PoHu (Port Huron) for Rev. David Gladstone's last sermon before retirement and then spent the afternoon of father's day at the Henry Ford touring the Titanic Exhibit.  Carl and David perished in the sinking of the ship, but the ladies managed to survive.  "Woman and Children First!"  What a somber exhibit it was.
All in all, it was a productive and eventful weekend!

A tourist in your own town...

After our awesome trip to Portland, seeing all of the sights, it struck us, our town is pretty awesome, too.  It's funny how you take things for granted when you live there.  So I made it a goal to be a tourist in my own town.  Here is Day 1 of Tourism in Your Own Town from Last week:

As the kickoff to summer, Memorial Day weekend opened with an awesome Tigers Game W (we listened to it on the radio, but we went to a game last week, does that count?)  While they were playing, we too were playing with our favorite four and six year olds Casey and Sam at Zap Zone!  We got some awesome prizes due to our joint effort in the Deal or No Deal game (1007 tickets, what what??)  It was great to be included as part of the family outing for Sam's Big 4.

Saturday Morning was started with a trip over to Good Girls Go to Paris Crepes.  Even though it was the Susan G. Koman Race for the Cure, the line wasn't too long.  I love the taste of Crepes in the morning:)

After that I popped over to the Eastern Market, which was crazytown.  But that is okay, I like it when all those awesome folks come in from the burbs:)  But the new Devries & Co., however NOT Hirts it may be, have made a few improvements.  And I am glad I could return my Calder Dairy Bottles there.  Makes me feel more authentic to buy Milk in a glass jug.  Then it was on to the Detroit City Futball Club game at Cass Tech.  But wait, it was pouring rain.  Too bad, that didn't stop the fans from showing up.  And they pulled off a stunning 3-0 win against the Erie Admirals.  Way to go Le Rouge!!!

This week was also an exciting time of Tourism in our own town.  It started on Saturday after getting back from a week of camp.  I had learned the dance for the proposed flash mob in support of the Ruth Ellis Center.  It was to be done at Motor City Pride.  But it literally rained on our gay pride parade.  Boo.  So no flash mob, maybe next year?  But the Ruth Ellis center does really cool stuff and I was excited to participate.  I rode my bike from Hart Plaza to Metropolitan UMC which was quite the sociology experiment.  I left from the GLBT Pride event, then drove past the Tigers fans during a rain delay, then up to Midtown where the DSO was about to start (fancy, Meh), and then through New Center which is pretty shut down during the evening.  It showed me all the different people that belong to this city.  Pretty neat.

Monday night I went to my first ever Magic Stick concert.  But first we attended Happy Hour at Roast's Bar...very reasonable!  And what a burger for $4! Then we saw the Punch Brothers!  They were awesome.  And if you don't know them, check um out.  They are the new rendition of Chris Thile's (of Nickel Creek) band.  It was very fun.

Tuesday brought us to Detroit City Futball League's game night.  My mom came in for the game and wanted a hot dog....so I took her to Lafayette Coney Island, which was actually my first time.  I still have not done the challenge (compare Lafayette to American) but now I can at least say I've eaten at the original.  And let me tell you, they are not popular because of their service (NO) but it was quite an experience nonetheless.  Sorry to say, Cass United Lost but not in spirit!  The afterparty at Nancy Whiskey was fun and we even got a visit from Detroit Pleasure Society, one of our local Party Marching Bands.  Here is a quick clip (doesn't do the energy justice):



And on Wednesday Laura McLaughlin and Jamie Delp came in to join us for a Tigers Game (no W this time).  We went to Seva Detroit, sat on the patio and they have quite a nice Happy Hour as well:)

Broken windows, shattered dreams.

There has been a rash of vandalism on our street this week. A few of our neighbors have had passenger windows shattered or sideview mirrors broken off. It is truly an act of pointless vandalism. Nothing stolen, just broken. It makes me feel so hurt, like the boy in Extremely Loud and Incredibly Close who can't understand why someone who has never met his Dad would run a plane into a building and kill his Dad, or how Carl described the first time he experienced and understood meanness as a kindergartener and just wondered "why would anyone do that?" When pointless meanness exists in the world, it shows we must have really failed someone along the way.

I have started listening to Detroit: A Biography by Scott Martelle and in the preface he points out that 3/4 freshmen in Detroit Public Schools will flunk or drop out. That's 75%! 75% is passing in most schools, so we are passing at the failing test. We have succeeded in failing these children. It breaks my heart, but I have no idea how to help.

Here I am in my Detroit home feeling helpless and having no idea how to help this problem. How do we motivate kids to care about school? How do we improve the curriculum on such a small budget? How do we change a culture of dropping out to one of finishing and going on to higher education? How do you foster a respect for strangers? How? How? How? If anyone has any suggestions, I am open to them. I am ready to take action, I just don't know how. And I'm not talking about vigilante justice here. We need to travel up the river to find out where all the dead are coming from, instead of just burying the bodies.