Doctors don’t know everything. Just ask one – gently. I imagine your doctor will tell you in one way or another that doctors are not all-knowing. If he or she claims to be the exception to the rule, find a new doctor – immediately.
The idea for this post has been bouncing around in my head for a long time. I was inspired to put it into writing this past week during a great lunch with my friend, Paige. We talked about the shortcomings of the medical field and the hope each patient has that his or her doctor is looking out for the patient’s best interest.
We discussed how our culture teaches us to respect authority. In addition, we put a high value on education. The more education one gets, the smarter one must be. Doctors find themselves somewhere near the top of the educated heap. The rest of us fall somewhere below that level, especially in the field of medical education. No, Google and WebMD aren’t good substitutes for a medical degree.
When these two facts are combined, many well meaning people take a back seat in their own healthcare out of respect for the doctor. After all, they know more than we do.
Unfortunately, our healthcare system has just the opposite approach. The system expects us to be in the driver’s seat of our healthcare decisions, not our doctor. The doctor is more like the navigation system, it’s up to the driver to accelerate, brake, or turn and any mistakes that navigation system makes don’t affect it, they affect the driver.
Francis and I learned this lesson the hard way, but the important part is that we did learn it. We learned that the most important thing you can do in a consultation with your doctor is to be a skeptic. Don’t be afraid of skepticism because, frankly, it could save your life.
I’m not advocating for patients to be know-it-alls. No one likes a know-it-all.
What I am saying is that we all need to get back in touch with our inner three-year-old when it comes to our doctors. We need to ask, “Why?” Over, and over, and over, and over, and…you get the point.
I’m raising a three-year-old. I hear this question a lot during my day. I suspect it should be as commonplace in a doctor’s office as it is in my home. I also imagine that, in the course of a day, patients don’t ask that of their doctors as often as my son asks me that question in the car to and from preschool.
Everything your doctor recommends should be met with a three-year-old’s sense of curiosity and eagerness to learn. After all, it’s your body and your doctor doesn’t have to live with it.
While stretching yourself to be a skeptic, don’t be afraid to ask for a second opinion after a diagnosis. As a matter of fact, that should be your first instinct. Even if that doctor giving the second opinion arrives at the same diagnosis and course of treatment, consider it a learning experience. Each time you talk about your medical situation you learn something new. Embrace that knowledge and don’t be afraid to be a skeptic with them either. The doctor giving the second opinion is probably expecting it.
Then, ask for a third if the first two doctors don’t agree. And this is important, tell your doctor what you’re doing. Don’t go behind their back and sneak off to another doctor. You’re not cheating on them. Your first doctor could have valuable input about who to see. Even better, they could be willing to call and discuss the case with the other doctor.
If your doctor gets angry or defensive, that’s a really bad sign. Doctors should be taking the lead from you. The best doctors gave Francis referrals to other doctors for second opinions and then called and discussed the case with them.
Two heads are better than one, and three are probably even better. There is a reason that places like Mayo Clinic and MD Anderson operate with a team approach to diagnosis and treatment. Much can be gained by sharing ideas, debating diagnoses, and challenging treatment options.
We should question everything we are told until we have a complete understanding. We should be asking “why” until our curiosity is quenched.
Take a notebook to every appointment with all of the questions you want answered, no matter how mundane the question seems to you. Don’t be embarrassed to ask anything. Don’t let them rush you out of the office before you’ve asked every question in your notebook.
After waiting over three hours past our appointment time on our first visit to MD Anderson, we were told by another patient that we should relax and stop watching the clock. The appointment time there is merely a suggestion. The doctors there take the time needed to answer every question a patient has. Be thankful if your doctor does the same with you, and try to be patient in the waiting room. I admit that I still struggle with being patient, but I do expect them to make time for me to be a skeptic.
I’ll close by driving this point home, be sure to take your inner three-year-old to the doctor’s office with you. Then go ahead and set him or her free to unleash a barrage of whys. A good doctor will appreciate it.
We got our surgery wake-up call this morning at about 5:30 a.m. (CST). I decided to stay overnight in Francis’s room so that I would be sure I was here when they took him down to prepare for surgery.
When the nurse notified us that “they” were on the way to get Francis, we changed out of our jammies and gathered up the rest of the loose belongings from Francis’s room. At about 6:00 a.m., we were headed to the surgical holding area.
The check-in nurses in the holding area informed us that the operating room was scheduled for 8:00 a.m. (Yay, more waiting!) The consent forms were checked, the anesthesia team arrived to start fluids and talk about their role, and we did our final hug and kiss.
At 7:50 a.m., Francis got some happy juice (valium) in his IV and they rolled him through the double doors.
We were told that the procedure would last until about midnight tonight (again, central time). I will post updates periodically throughout the day as I am given information by the nurses.
We can feel all the prayers and thoughts, and cherish each and every one. Stay tuned…
We have big news! We’re headed to Houston today. Francis and I decided that the best thing we could do last Friday morning was go ahead and make the transfer to MD Anderson Cancer Center (MDA) in Houston, Texas.
Doctors and medical staff at Tallahassee Memorial Hospital (TMH) were putting pressure on Francis to have a new IV line placed, and we didn’t feel comfortable with the speed with which they were moving. Francis also wasn’t fond of being stuck, and especially when he was a little concerned with the potential of the sticking being redone once he arrives at MDA if they wanted it done differently.
Paperwork started being written and processed on Friday (2/1). We knew things weren’t likely to move quickly because Karen Beaty (Dr. Keith Fournier’s PA), informed us that MDA’s hospital was at capacity with patients needing beds. A transfer was unlikely before Saturday or Sunday.
If you aren’t familiar with the hospital transfer process, it goes something like this…
The doctor here contacted the surgeon there to confirm he was willing to accept Francis.
After doctors speak, the doctor here tells the caseworker here to process the transfer. The caseworker speaks to the hospital there, faxes them paperwork and faxes paperwork to the transfer center at TMH. (Seems like we could find something more efficient, not to mention clearer for reading purposes, than fax machines. Wait a minute…didn’t we invent something called the internet?)
Then, the transfer center at TMH connects with the transfer center at MDA. Once a bed becomes available, MDA lets the transfer center at TMH know and the nurses on our floor get the call to finalize details and get Francis prepped.
We waited through the weekend, and found out Monday morning that MDA only had capacity to take emergency cases through the weekend.
Francis doesn’t qualify as an emergency patient because he’s stable and his symptoms and side effects of the intestinal obstruction are fairly easily managed. This is something for which we’re very grateful, but thoroughly unhelpful in speeding up the transfer process.
I stayed in email contact with Karen through the weekend and early this week. She told us Monday evening that Dr. Fournier was in contact with the transfer center at MDA to try and have Francis moved there in a day or two. Today is day two.
Very shortly, we expect to be transported to Tallahassee Regional Airport for an air ambulance transport to MDA in Houston. We have to be there by 5:00 p.m. Central Time for Francis’s bed reservation.
We aren’t sure what the rest of the day holds for us once we arrive in Houston, but we know we’ll be one step closer to Francis’s healing.
Surgery happens one week from today, so stay tuned for updates as we prepare for a long day on February 13 and the recovery that follows.
If you’d like to send mail to Francis in Houston, you can send it to
1333 Old Spanish Trail, #3127
Houston, TX 77054
I took a bit of time away from the hospital this afternoon to grab lunch, collect my thoughts, and run an errand. While driving alone in the car with no sound other than the wind rushing by (a rare thing with 2 kids), I began to reflect on the way the experiences of the last 9 months and the last week have impacted me. There is an update in here, so skip to the bottom if you just want the update.
I’ve always been afraid of heights, at least as far back as I can remember.
As a kid, I used to love the good, old-fashioned swings that have since been removed from most playgrounds for safety reasons. I loved pumping my legs until it felt like my head was soaring above the crossbar of the swing set.
At this point, my fear of heights would kick in. When all of my friends would swing forward again and sail through the air to the ground I would continue to be securely on my swing’s seat, gripping the chains with white-knuckled fear while the brief free fall commenced.
All of us who have ever flown this high on a swing know that when you get that high the chains slacken and for a moment you feel as if you’re falling, not swinging. Then the chains snap tight at the bottom of the fall and swing you back the other directions.
For some reason, having that snap happen while swinging backward when you can’t see what’s ahead is far more terrifying than the jolt when swinging forward.
This is really what this whole cancer experience has been like for me: terrifying when we can’t see what is ahead, manageable when we can.
Last winter and early spring we were swinging along high in the air, excited about what we saw on the horizon. New baby on the way. New house we purchased and into which we were settling nicely.
Then Francis is diagnosed with an aggressive type of colon cancer that we later learn is Stage IV. That horrible backward floating happened for a long time while we learned to navigate surgery, recovery, chemo, chemo side effects, etc.
Then the reassuring snap of the swing catches us and we’re safely headed back to a point where we can see what lies ahead when we learn about an exciting treatment known as cytoreduction and HIPEC.
We feel freed to build dreams, plan vacations, think about where we’ll be 5, 20, 40 years. We’re flying forward again to the height of the swing set’s crossbar. Little did we know we were nearing the top of that climb.
Then Thursday night and Friday brought that terrifying backward freefall again. The terrifying moment when we didn’t know the seriousness of the situation in which Francis found himself. Not knowing whether the chains would actually fail to catch our weight this time.
But today, the chains caught us. Karen (Dr. Fournier’s PA) called our doctors who arrived in our room with her on their cell phone speaker. She told us all that Dr. Fournier was comfortable with the program of treatment currently outlined.
Francis will remain on TPN, a nutrition fluid given through an IV that is the equivalent of approximately 2100 calories. The NG tube will remain in place to remove excess fluid from his stomach and keep his intestines resting. We will continue to hope and pray that his blockage diminishes or disappears as a result of the rest so that he may go home.
Finally and perhaps most importantly when we feel completely out of control, we’ve been given full control over whether we go to Houston now or whether we wait. They’ll take us if and when we say we’re coming or just as planned in February.
As far as we all know, the major surgery that is scheduled for February 13 will be done as planned and if the blockage remains it will be addressed at that time.
Again, thanks to all for your thoughts and prayers. I will continue to update the blog if there are any changes or new developments.
Sorry for the delayed post. I know everyone is antsy for an update, so here you go…
First and foremost, there has been no change in condition for Francis or the blockage. Francis was able to rest a lot yesterday thanks to some medication for the hiccups. He’s been awake and up today, even sitting in the chair some. He even felt like washing up, so we spent time carefully working around his new hardware to get cleaned up today.
Yesterday I spoke of frustration trying to get the two bureaucracies talking. It appears that they have made initial strides toward a transfer if that’s the best option at this point. With the foundation in place, the paperwork processing will hopefully move much faster if the decision is made to transfer.
Dr. Hasan Mohiuddin, one of the doctors on the team here in Tallahassee, also spoke with Dr. Fournier at MD Anderson yesterday afternoon. Dr. Fournier expressed his desire to see the CD personally. As a result, Dr. Mohiuddin ordered radiology to work up the CD and have it returned to the nurses’ station on Francis’s wing of the hospital if it couldn’t overnighted directly.
The charge nurse let me know the CD was there. She had been
bugged by me working with me all day, but not without a lot of pushing and prodding on my part. When it came to the CD, I saw that I had finally won her over. She called and yelled at radiology about how ridiculous it was that they couldn’t send the CD overnight themselves. Radiology was less than helpful and I was able to bond with the charge nurse in our disappointment with their helpfulness.
I personally took the CD to the FedEx store. At least I know it was done right and I had the tracking information. It arrived in Houston at 10:30 this morning, but we’re still awaiting word from them.
The wait is excruciating at this point. The doctors on the team here are wanting to start nutrition, while we’ve been told by others that Dr. Fournier doesn’t want them to do that or anything until he sees the scan.
We just saw the attending physician. I wish I could report that she had a lot of news, but she knows about as much as we do at this point. She explained that they want to start Francis on TPN (total parenteral nutrition) by IV today. He’ll get that tonight at 8:00.
Since he hasn’t eaten since Thursday, this will be much needed nutrition and hopefully will help his energy level improve.
The biggest thing we need right now is some direction from MD Anderson and direction with enough working time in the day here to move the bureaucratic wheels as needed.
When we were here before the move to Mayo Clinic, Jacksonville, we faced the frustrating experience of trying to get a transfer done before everyone leaves for the day. The case workers leave at 4:00, so we have a hard deadline with that and we’re also an hour ahead of Houston. This is causing a great deal of anxiety for both of us.
Here’s the updated list of specific needs if you’re keeping track…
1.) Blockage to disappear or diminish – still no change here.
2.) Pain controlled and Francis comfortable – still well managed.
3.) Hiccups go away and stay away – thanks to medication as needed we’re able to address this. So far today without medication, he’s only had a 2 or 3 at a time a couple of times an hour.
4.) Rest for Francis – again, the hiccup medication was immensely helpful on this. Planning to nap this afternoon, barring too many interruptions. Naps also helps pass the time.
5.) Wisdom and cooperation for the doctors and medical staff – much improved in this area over where things were this weekend and yesterday morning. Never helps to keep improving this area, though.
6.) Grease the bureaucratic wheels – we may need this one, big time, in the near future.
7.) Patience for both of us – I now realize this list isn’t necessarily in the order of importance because this would definitely be up there at the top today. If I could, I would physically shuttle between Dr. Fournier in Houston and Dr. Mohiuddin here. I could really use a teleporter if anyone has a spare one in a closet somewhere.
Here’s an update to the post from yesterday. Today is much more rough. Francis took a turn for the worse overnight. Read on for the details.
Yesterday Francis had a pretty good day. All the worry about the reinsertion of the NG tube yesterday morning was unnecessary. Upon removal, we discovered that the tube was kinked, so repositioning would have been worthless.
Francis was very combative after the removal, and I was a little worried he may throw the nurse in Incredible Hulk fashion if she tried to reinsert the tube right away, so we asked for a break and some Ativan.
When the nurse returned from asking the doctor for the Ativan, she said the doctor told her to hold off reinsertion as long as there was no nausea and Francis was comfortable. Woohoo!
After that news, Francis slept most of the day. By mid-afternoon he was awake and alert, and we actually walked a lap around the floor a couple times.
Francis suggested I go home and have dinner and spend the evening with Couper and Riley and relieve Melissa, our babysitter. I left him comfortable, in good spirits, and settling in for a nap.
I spoke with Francis briefly, and he had the chance to talk to Couper on the phone around 7:00 PM. We got interrupted by a nurse, so I told him I’d call him after I got the kids in bed.
When I called Francis around 8:30 or 9:00, I woke him up. Bad wife! To make matters worse, there wasn’t anything to report.
At 12:30 AM, Francis texted to let me know they were reinserting the NG tube. He told me he was bloated and that they made the decision to address that promptly.
I slept as fast as I could and got up at 5:30 so I could be in his room when the doctors made rounds this morning.
Francis is pretty uncomfortable and very tired. Between increasing pain and intermittent hiccup attacks that are plaguing him, he’s been unable to rest most of the night. He’s had some bouts of nausea, but the doctor ordered more anti-nausea medication which seems to be working.
The doctor is going to discuss Francis’s case with the radiologist and surgeon to determine what the best course of action should be. He also told me that he would likely need to contact information for our team at MD Anderson so he could reach them directly to consult with them and discuss treatment here or a possible transfer to Houston for further treatment.
My mom is flying down to Tallahassee this evening. So we’re getting more reinforcements, not to diminish the continued support from family and friends. We have great family and friends who continue to encourage, comfort, love us and most importantly love our children when we need to be here at the hospital and focused on Francis’s healing.
This brings me to the hopes and goals for today: 1.) Blockage disappears or diminishes, 2.) Pain is controlled and Francis can stay comfortable, 3.) Hiccups go away and stay away, 4.) Sleep for Francis, 5.) Safe travels for my mom, 6.) Wisdom and cooperation for the doctors and medical staff as they begin to craft a new treatment plan for today.
After a nice hiatus from planning over the holidays, we are in full preparation mode for a family deployment of sorts. Francis originally was scheduled for surgery in Houston on February 15, which meant we would likely need to be in Houston by February 13. Just last week, the physician’s assistant for Dr. Keith Fournier, Francis’s surgeon, called to ask if we could move the procedure up to earlier that week.
So, the procedure is now scheduled for February 13. Did we get upset/stressed/worried? Goodness, no! (Thank you, Pete the Cat. If you’re not familiar, listen here. A great lesson about going with the flow.) I’m doing my best to try not to get too stressed out about any of this – not easy. Realistically I’m a miserable failure, but I’m not giving up yet!
We plan to leave Tallahassee on February 9 or 10 and drive part of the way to Houston before finishing up the drive in time to be there for Francis to have blood work done at some point on the 11th.
I’ll go through the big logistical items about which we’re most frequently asked.
HOUSING: We’ve entered into a short-term lease in an apartment building near the Houston Medical Center that caters to medical stays. They have a three-bedroom, furnished unit that will be “home” for Couper, Riley, and me when Francis is at the hospital and all of us just before the surgery and the week or so following discharge from the hospital before we’re cleared to journey back home.
CHILDCARE: Thanks to the continued support of both of our families and friends, we’re covered here once again. My mom will be flying to Houston to stay as long as we need her, although we’re all hoping it’s shorter than we’re planning. If she needs to get back to work after several weeks with us, we have many more family members and several friends who have also offered to help us with Couper and Riley.
CATS: I’ve mentioned before how great our babysitter is. ‘elissa, in Couper speak (Melissa), has become a very important part of our family. She’s smart, warm, kind, energetic, loving, and a wonderful young woman who we’re sure makes her parents very proud. She has agreed to stay at our house while we’re gone and take care of our two cats. We’re thrilled to have someone we trust taking care of them and also keeping the house “lived in” while we aren’t here.
MAIL: Having moved twice in a nine month period, we’ve discovered that mail forwarding isn’t a perfect system. I still wonder how much mail didn’t get to us and marvel at how much mail we have gotten for the previous tenant of our apartment and now owner of our home. That said, we’ve decided to have Melissa fill a FedEx box with our mail and send it to us periodically. I trust Melissa and FedEx more than the U.S. Postal Service who lost $15.9 billion during the last fiscal year, but I digress.
While February seems to be quickly approaching in terms of preparing a family of four to move for approximately two months and every day I wish we had a bit more time to prepare, when it comes to getting rid of Francis’s cancer it feels like an eternity. So, we need plans to continue to fall into place quickly and Francis’s cancer to pause its progress or disappear on its own between now and February 13.
I think that about covers where we are right now. We continue to be excited, hopeful, anxious, and terrified about what lies ahead. We thank you for your continued support, concern, and prayers.
Francis came through the exploratory surgery this morning just fine. The anesthesia is still wearing off, so we’re resting in our hotel room before returning to Tallahassee and Couper and Riley tomorrow evening.
Thanks to all for your comments, emails, texts, and prayers. I wish I could respond personally to all the messages, but am a bit overwhelmed by all the news from today and what lies ahead. Just know that the encouragement and kind words do not go unnoticed, and we cherish our friends and family for continuing to be there for us when we need you.
Now to the details. The surgeon, Dr. Keith Fournier, met with me following the procedure to let me know that things looked good, all things considered, and that there were no surprises. He shared pictures of what Francis’s abdomen looks like on the inside, and for the first time I got to see what this horrible beast looks like.
To describe it as best I can, imagine a little ball of white lint about the size of the end of a ball point pen. There are several of them that cluster around each other, some touching and some not, looking like a bad case of acne. In places where the cancer is more advanced, it looks more like a thin, narrow piece of elastic that has been stretched out between two points.
All in all, we received a bit of an early Christmas present today. After getting eyes on the cancer, Dr. Fournier determined that Francis is a good candidate for the tumor debulking and HIPEC procedure.
It isn’t a magic bullet, and there’s still a chance that Dr. Fournier could get into the abdomen and decide it isn’t possible to do the procedure. However, Dr. Fournier is at least comfortable enough to make the large incision and schedule all the supporting cast (urology and plastic surgery) to perform their various roles to protect necessary organs and functions and to repair areas of the body that will be damaged in an effort to remove all of the cancer.
We’re thankful for the good news about a plan to move forward. We’re hopeful that this is a great option for us to see the end of this cancer and for Francis to have a long and healthy life after clearing this very large hurdle.
Thank you again for your concern, and for reading this blog. I’ll continue to update the blog with more information and certainly through Francis’s next surgery and recovery. Feel free to share with family and friends, and encourage them to sign up to follow the blog if they are interested in getting the latests posts by email as soon as they are posted.
We wish you all a very merry Christmas!
When we started down this road with Francis’s colon cancer diagnosis, we often discussed going to the best facilities and the best specialists. The long term prognosis for advanced stage colon cancer like Francis’s is frightening, and we’re determined to try every option we have available to us until we find a cure.
After several rounds of chemotherapy and a couple of CT scans, we began to discuss more seriously the likelihood of a trip to Houston, Texas, to visit MD Anderson Cancer Center. Ranked as the #1 best hospital for cancer care by U.S. News and World Report, we began to work toward getting a second opinion from their doctors.
After eight rounds of chemo, Francis had to take a break from treatment. Among the variety of outwardly visible side effects are a myriad of unseen side effects of chemotherapy. Chemo causes the body to have difficulty producing red blood cells, white blood cells, and platelets. The morning of the ninth planned round of chemo, Francis’s blood work showed a low platelet count. It wasn’t completely unexpected, but it’s still not what we wanted to hear. Fortunately, the level was not dangerously low and his blood work was otherwise normal.
Francis was grateful for an extra week “off.” The outward side effects from the particular chemo regimen he is on cause him to have gastrointestinal upset, neuropathy (tingling and numbness) in his hands and feet, and peeling skin and blistering on his hands and feet. There are other side effects that may or may not make an appearance after each round.
It is common at some point during the three week treatment period for Francis to experience nausea. It’s never the same, and it can come on with little or no warning.
After the first round of chemo back in June, we rushed to the car and drove straight back to Tallahassee from Mayo in Jacksonville (about 3 hours). Pulling into our neighborhood, Francis mentioned that he was beginning to feel ill. We raced onto our street and into the driveway. Francis couldn’t make it into the house, jumping from the car to get sick just outside the garage. Fortunately, that’s the last time that has happened like that.
He’s gotten sick a few times since, but thankfully the anti-nausea medications he’s been prescribed help us keep the nausea mostly in check.
During Francis’s week off from chemo, we heard back from MD Anderson that Francis would have a series of appointments the following week. We quickly made travel arrangements and my mom did the same so that we could meet in Houston in just a few days time.
After reviewing the scan, we met with Dr. Fournier to determine whether Francis would be a candidate for a radical and somewhat controversial surgical procedure known as tumor debulking and hyperthermic intraperitoneal chemotherapy (HIPEC).
Debulking and HIPEC takes an average of 10 hours and is followed by an average hospital stay of 22 days. The procedure requires the opening of the abdominal cavity and removal of each individual cancerous spot in the cavity and removal of any affected organs that aren’t necessary for the body to function.
After the tumors are removed, the abdominal cavity is flooded with liquid chemotherapy that is heated to approximately 107 degrees while the patient lies on a cooling pad to maintain a safe body temperature. The chemotherapy stays in the abdomen for approximately 90 minutes before being flushed. Radiation may also be done during this treatment phase of the procedure. After the surgeon is pleased with the progress and outcome of the debulking, the abdomen is closed and the patient is moved to recovery.
In many cases, the patient is placed into the intensive care unit of the hospital. There is a high likelihood of complications from the procedure. Many patients experience infections at the wound site because chemotherapy prevents the skin from healing normally.
It seems that this is the best hope for removal of the cancer, and while Francis is feeling well, we want to be as aggressive as possible. Outcomes from this procedure aren’t well documented, but the statistics we’ve seen are very promising and have given us a lot of hope for beating this horrible disease.
So this brings me to today. Francis and I have left our babies in good hands (Mawmaw Holdman’s) in Tallahassee to make the trip to Houston for an exploratory procedure to determine whether Francis is a candidate for the debulking and HIPEC. Dr. Fournier wants to get his own eyes on the cancer to make the determination.
We’re excited, nervous, hopeful, anxious, cautiously optimistic, and desperately missing Couper and Riley. To be frank, we need to be excited, nervous, hopeful, anxious, and cautiously optimistic before a much bigger procedure (debulking and HIPEC) happening sometime early next year. After what feels like a whole lot of bad news about Francis’s health this year, we could really use some good news.
Many people have asked what the goal is and how to pray for us, so this is what we need now. We need to get through tomorrow’s procedure safely without any complications so we can head home and then enjoy a wonderful Christmas with family. We need good news that Francis is a candidate for the debulking and HIPEC procedure. If not, we need guidance on what to do next.
Thanks in advance for thoughts and prayers. I will do my best to update everyone as soon as we have any news. We are hopeful that we’ll have the surgeon’s decision after the procedure, but we may not get that until after the holidays. In the meantime, we wish you all a very Merry Christmas and a happy and healthy 2013 (assuming the world doesn’t end this week)!