trauma is hard. i go to work every day and am thrown into the middle of some of the most horrific situations that one can imagine. and yes i get frustrated with the incompetence of certain residents, and yes i occasionally get patients and families that are so ridiculously demanding that it makes me rue the day i became a nurse, but that's not what really wears on me. the hardest part about trauma is that it's just so REAL.
we're all taught that life is full of second chances. you don't like something about yourself? change it. you can be what you want to be, and you can do what you want to do. make mistakes!! no apologies, no regrets.
do you know what's really hard? coming to terms with the fact that this carefree, consequenceless life that we're all encouraged to live is a total lie. some things are just irreparable. some mistakes can't be undone. there are lapses in judgement that, when made, can change the course of your entire life. and there are things that happen in an instant that can ruin you.
cases in point: two 21 year olds on a motorcycle. they crash, unhelmeted. he's in the ICU fighting to live with a chunk of his skull missing and she's on the floor with me barely responsive.
the tension in her room is palpable. will she wake up? will she ever be the same again? and will her boyfriend live? will he have permanent deficits? what are the odds that these two will ever be what they were?
so much is unknown. so we wait. and she IS getting better, every day. and he's still breathing, still fighting.
it bothers me, that these two got on a motorcycle without a care in the world, probably thinking how great it was to be so young and wild and free. and in an instant, life turned on them. and that's how life is, i guess. but it just seems so incredibly cruel.
maybe these two will get a second chance. or maybe only one will. either way, their lives will never be the same again. and they will never be quite as young or carefree as they were.
Thursday, June 14, 2012
Tuesday, June 12, 2012
hand holding and other frustrations.
i would like to announce that i have become a surgeon!! oh no, wait a minute...i'm just doing their jobs because THEY ARE TOO STUPID TO EXIST. seriously. seriously. it's june, should i really still be holding your little hands and walking you through your job step by agonizing step? show some initiative!! get out there and be a doctor!!
the following is a list of things i should not have to do:
1. tell you to assess your patients. how do i know you're not assessing your patients? well first of all, your note is the same every date, cut and re-pasted. secondly, if you were assessing your patient you would notice things...for example, that his arm is hugely swollen and that he probably has a giant chunk of windshield in it. i'll take a thank you for pointing that out, and also for giving you the opportunity to cut something open which is, in reality, the only thing that you really care about. oh? no thank you? only a barely concealed hostile glare for daring to imply that you need to enter a patient room? so sorry for the inconvenience.
2. tell you to give your patients the plan of care. hey, do you know who should not be telling people that they're going for a procedure/surgery that you have not bothered to discuss with them? me. do you know who is not supposed to be interpreting test results/reading scans to patients? also me. now i understand that you couldn't possibly manage to go and report the results of a CT to a patient's family without needing to be reminded, but honestly, do i need to pick you up, throw you over my shoulder, and carry you to the bedside? should i really have to tell you to talk to the family, and then tell you to talk to the family again an hour later, because now they're mad and we all look bad and unprofessional? the answer is NO.
3. diagnose your patients for you. i can't help but notice that you're obviously not the brightest crayon, but lets for a minute assume that you actually did go to and pass medical school. your patient has a fever, and a white count, and a CT from yesterday that reads "basilar opacities in the lower lobes of the lungs, left greater than right, most likely indicative of pneumonia". so what's the diagnosis? THE ANSWER IS NOT BACTEREMIA!! blood cultures are great and all, but i'm guessing that they're not going to prove his pneumonia, you know, seeing as how they're not a chest xray. but that's ok, lets just hang out another day and see what happens before we actually treat the real problem.
bang. my. head. against. the. wall.
the following is a list of things i should not have to do:
1. tell you to assess your patients. how do i know you're not assessing your patients? well first of all, your note is the same every date, cut and re-pasted. secondly, if you were assessing your patient you would notice things...for example, that his arm is hugely swollen and that he probably has a giant chunk of windshield in it. i'll take a thank you for pointing that out, and also for giving you the opportunity to cut something open which is, in reality, the only thing that you really care about. oh? no thank you? only a barely concealed hostile glare for daring to imply that you need to enter a patient room? so sorry for the inconvenience.
2. tell you to give your patients the plan of care. hey, do you know who should not be telling people that they're going for a procedure/surgery that you have not bothered to discuss with them? me. do you know who is not supposed to be interpreting test results/reading scans to patients? also me. now i understand that you couldn't possibly manage to go and report the results of a CT to a patient's family without needing to be reminded, but honestly, do i need to pick you up, throw you over my shoulder, and carry you to the bedside? should i really have to tell you to talk to the family, and then tell you to talk to the family again an hour later, because now they're mad and we all look bad and unprofessional? the answer is NO.
3. diagnose your patients for you. i can't help but notice that you're obviously not the brightest crayon, but lets for a minute assume that you actually did go to and pass medical school. your patient has a fever, and a white count, and a CT from yesterday that reads "basilar opacities in the lower lobes of the lungs, left greater than right, most likely indicative of pneumonia". so what's the diagnosis? THE ANSWER IS NOT BACTEREMIA!! blood cultures are great and all, but i'm guessing that they're not going to prove his pneumonia, you know, seeing as how they're not a chest xray. but that's ok, lets just hang out another day and see what happens before we actually treat the real problem.
bang. my. head. against. the. wall.
Saturday, June 2, 2012
four years
for the last two and a half years, the floor has been my home. i've learned SO much there, about nursing sure but also about life in general. the lessons that i've learned about death and loss will stay with me forever. the patients that i've met and the situations we've gotten through together have made me different. two and a half years ago i was a quiet girl who would do anything to help anyone. most days, i cried because nursing was so hard. i threw my heart into everything i did and just about killed myself to be good at my job. well that sort of dedication can't be maintained for long, and here i am. i am exhausted. i have the "alligator skin" that was promised to me when i started on the trauma floor, but it came at a price. more and more i have been feeling that who i've become is not who i AM. i am increasingly negative and unsympathetic, and some days i don't even recognize myself. in short: i am burning out. fast.
i recently found this post that i wrote awhile ago, but never had the heart to put out there. at the time, i was applying for ICU jobs because i was losing it on the floor. i was in a place where i was trying so desperately to make my career what i wanted it to be, what i felt that i was PROMISED in nursing school. i wanted to feel like i made a difference. i wanted to be treated like i wasn't a brand new nurse. i wanted to be respected by my peers, my patients, my residents. i wanted perfection.
well, turns out it doesn't go like that.
i was told that the first year of nursing was the hardest. and it was really hard. seriously, i cried almost every single day. i cried in the utility room, in the med room, in the pharmacy office, in the bathroom, and when i was still unpresentable to patients i would turn off the lights so they couldn't see me and cry in their rooms while i was passing meds. in retrospect, it's shocking i didn't have some sort of nervous break...but i made it!!
so when i was done with my first year, i expected to feel as if i had "arrived". well, joke was on me, because after the first year THINGS WERE STILL REALLY REALLY HARD. at about a year and three months, i had a patient throw a PE and code in front of my face. and that messed me up for a long time. i felt all the things you feel when someone in your care dies: shock, and guilt, and fear that i would have to see that again. and for a long time, i wasn't really sure that i could 'do' nursing.
after i had been a nurse for two years, i felt like i could breathe a little. but it still wasn't easy. i got a little lost in the middle, hence the above post. if all i did was cry the first year of nursing, then all i did the second was vent. in short, i felt cheated. like everything they told me in nursing school was a complete lie. all the "nursing matters" and "nurses make a difference" propaganda was just that: pretty words. i wasn't making a difference, i was treading water. but i kept on going.
after i had been a nurse for three years, it finally started to click for me. i had enough seniority to start throwing it around a little and making some changes in my patient's treatments. the trauma team started to recognize my face and (i hope) see me as someone who is competent. because of our crazy turnover rates, i was one of the most experienced on my shift. i was the one to ask questions to, the one who got called in times of crisis. and i was finally done crying, and done ranting (err...mostly?) and done being angry because nursing was not what i thought it should be.
and now i've been a nurse for four years. the past six months have been so...sweet. finally things aren't as hard as they used to be. so much of what i do is habit, muscle memory, things that i can do in my sleep. and this means that i can focus on the things that i REALLY want to do, like connect with my patients. critically think about them and make changes and advocate for what they need. have discussions with the team and present ideas and make good arguments for my requests. THIS is what i thought nursing would be. THIS is what i signed up for.
now trust me, not every day is roses. i still have to clean up c-diff poop 6 times a shift, and drop everything to run for the bed check and some patients are still crazy/entitled/really crazy. but it's better.
THANK GOD IT'S FINALLY BETTER!!
and i'm hoping that it will get better still.
i recently found this post that i wrote awhile ago, but never had the heart to put out there. at the time, i was applying for ICU jobs because i was losing it on the floor. i was in a place where i was trying so desperately to make my career what i wanted it to be, what i felt that i was PROMISED in nursing school. i wanted to feel like i made a difference. i wanted to be treated like i wasn't a brand new nurse. i wanted to be respected by my peers, my patients, my residents. i wanted perfection.
well, turns out it doesn't go like that.
i was told that the first year of nursing was the hardest. and it was really hard. seriously, i cried almost every single day. i cried in the utility room, in the med room, in the pharmacy office, in the bathroom, and when i was still unpresentable to patients i would turn off the lights so they couldn't see me and cry in their rooms while i was passing meds. in retrospect, it's shocking i didn't have some sort of nervous break...but i made it!!
so when i was done with my first year, i expected to feel as if i had "arrived". well, joke was on me, because after the first year THINGS WERE STILL REALLY REALLY HARD. at about a year and three months, i had a patient throw a PE and code in front of my face. and that messed me up for a long time. i felt all the things you feel when someone in your care dies: shock, and guilt, and fear that i would have to see that again. and for a long time, i wasn't really sure that i could 'do' nursing.
after i had been a nurse for two years, i felt like i could breathe a little. but it still wasn't easy. i got a little lost in the middle, hence the above post. if all i did was cry the first year of nursing, then all i did the second was vent. in short, i felt cheated. like everything they told me in nursing school was a complete lie. all the "nursing matters" and "nurses make a difference" propaganda was just that: pretty words. i wasn't making a difference, i was treading water. but i kept on going.
after i had been a nurse for three years, it finally started to click for me. i had enough seniority to start throwing it around a little and making some changes in my patient's treatments. the trauma team started to recognize my face and (i hope) see me as someone who is competent. because of our crazy turnover rates, i was one of the most experienced on my shift. i was the one to ask questions to, the one who got called in times of crisis. and i was finally done crying, and done ranting (err...mostly?) and done being angry because nursing was not what i thought it should be.
and now i've been a nurse for four years. the past six months have been so...sweet. finally things aren't as hard as they used to be. so much of what i do is habit, muscle memory, things that i can do in my sleep. and this means that i can focus on the things that i REALLY want to do, like connect with my patients. critically think about them and make changes and advocate for what they need. have discussions with the team and present ideas and make good arguments for my requests. THIS is what i thought nursing would be. THIS is what i signed up for.
now trust me, not every day is roses. i still have to clean up c-diff poop 6 times a shift, and drop everything to run for the bed check and some patients are still crazy/entitled/really crazy. but it's better.
THANK GOD IT'S FINALLY BETTER!!
and i'm hoping that it will get better still.
the lord is testing me.
tomorrow i plan on waxing poetic about how much i love my job. so, naturally, tonight i will get all my wrath out.
i swear, the ED has a personal vendetta against our floor. ok, so maybe that's dramatic. what it comes down to is the ED has 95% great, smart, savvy nurses who provide their patients fabulous care and are fun to chat with on the phone. then there are the other 5%. i'm not sure that they actually have degrees, come to think of it. they may be homeless people off the street. or circus clowns. these are the nurses who send up suicidal patients without sitters, who transfer ICU patients to the floor on accident...also the nurse who sent me the patient once who was about 85% dead. these are the nurses who i curse today.
so we get this ED admit. long term trach, oriented x 0, biting and hiting and crazy. yum, my favorite type of patient. she rolls up to the floor flat on her back with a trach just bubbling with secretions. according to transport, she's been like this since they left the ED.
oh no you DIDN'T.
ABCs, people, and A does not mean admit patient to floor so you can go about your business. AIRWAY. as in what this patient is unable to use because she needs to be suctioned like 10 minutes ago.
so we suctioned her, and of course she immediately begins to vomit up bile that smells like stool and is now coming out of her trach. ooo, lookie!! aspiration pneumonia. greeeaaaaaaaat.
let me break it down for you.
1. please suction your patient. thanks.
2. if your patient has been suctioned and still sounds like she's drowning, maybe someone should come with her on transport so she doesn't die. yeah, i know you're busy. send a tech. or better yet, send a respiratory therapist. frankly, i don't care if you send a circus monkey that knows how to work a yankaur suction, anything would be better than nothing.
3. also, would it kill you to give meds for the BP that's over 200 systolic? or maybe you want this patient to have a stroke too? (18 hours and an ICU transfer later, we found out that this patient did actually stroke out).
seriously, i looked at this patient and i wanted to take the time to trek over to the ED and back just so i could smack that nurse upside the head. i really had to hold myself back.
but then i was too busy to plot my revenge, as the patient began to drop her sats and continue to aspirate on her vomit. so then we called a rapid response, sunk an NG, took a million vitals, and suctioned her. like 10 times. and then she basically became a 1:1 floor patient (my favorite, again) and was continuing to be unstable with pressures of 250s/130s as i dragged my sad tired self home.
thank you, incompetent ED nurse, for ruining my night and almost killing your patient. i look forward to our next rendezvous, in which you will undoubtably continue to act as if you are indeed a garden gnome and not a licensed professional.
i swear, the ED has a personal vendetta against our floor. ok, so maybe that's dramatic. what it comes down to is the ED has 95% great, smart, savvy nurses who provide their patients fabulous care and are fun to chat with on the phone. then there are the other 5%. i'm not sure that they actually have degrees, come to think of it. they may be homeless people off the street. or circus clowns. these are the nurses who send up suicidal patients without sitters, who transfer ICU patients to the floor on accident...also the nurse who sent me the patient once who was about 85% dead. these are the nurses who i curse today.
so we get this ED admit. long term trach, oriented x 0, biting and hiting and crazy. yum, my favorite type of patient. she rolls up to the floor flat on her back with a trach just bubbling with secretions. according to transport, she's been like this since they left the ED.
oh no you DIDN'T.
ABCs, people, and A does not mean admit patient to floor so you can go about your business. AIRWAY. as in what this patient is unable to use because she needs to be suctioned like 10 minutes ago.
so we suctioned her, and of course she immediately begins to vomit up bile that smells like stool and is now coming out of her trach. ooo, lookie!! aspiration pneumonia. greeeaaaaaaaat.
let me break it down for you.
1. please suction your patient. thanks.
2. if your patient has been suctioned and still sounds like she's drowning, maybe someone should come with her on transport so she doesn't die. yeah, i know you're busy. send a tech. or better yet, send a respiratory therapist. frankly, i don't care if you send a circus monkey that knows how to work a yankaur suction, anything would be better than nothing.
3. also, would it kill you to give meds for the BP that's over 200 systolic? or maybe you want this patient to have a stroke too? (18 hours and an ICU transfer later, we found out that this patient did actually stroke out).
seriously, i looked at this patient and i wanted to take the time to trek over to the ED and back just so i could smack that nurse upside the head. i really had to hold myself back.
but then i was too busy to plot my revenge, as the patient began to drop her sats and continue to aspirate on her vomit. so then we called a rapid response, sunk an NG, took a million vitals, and suctioned her. like 10 times. and then she basically became a 1:1 floor patient (my favorite, again) and was continuing to be unstable with pressures of 250s/130s as i dragged my sad tired self home.
thank you, incompetent ED nurse, for ruining my night and almost killing your patient. i look forward to our next rendezvous, in which you will undoubtably continue to act as if you are indeed a garden gnome and not a licensed professional.
Thursday, May 31, 2012
teachable moments
hello, i'm your friendly trauma nurse and i would like to take this opportunity to teach the general public how to not be so stupid. please pull up a chair and make yourself comfortable.
may i start out with the cardinal rule: never tell your nurse you want to kill yourself. don't even imply it. and when you do start making foolish comments about throwing yourself out of the window (um, ground floor, try again), don't be surprised that you get a sitter and a psych consult faster than you can say 'suicide risk'.
another rule of thumb: please avoid attempting to punch hospital security in the face. though it's entertaining to watch you being tackled to the ground, i'm guessing that your fractures don't feel any better with 200 pounds of the law sitting on your back. for the record, assaulting hospital staff is the fastest way to get tied to your bed, or in this case handcuffed until the sheriff can come and arrest you.
this next tip might be common sense to some, but recent events prove that it deserves mentioning. if your mother is a morbidly obese diabetic on dialysis who lives in a group home, YOU SHOULD NOT BE GETTING HER DRUNK. seriously. day passes are for cute mother/son dinners and trips to church, not for slamming back 40s until mama's so plastered that she falls and breaks her face. three times the legal limit people...no lie.
it never ceases to amaze me how people are bound and determined to find new ways to totally screw themselves and the ones they love.
may i start out with the cardinal rule: never tell your nurse you want to kill yourself. don't even imply it. and when you do start making foolish comments about throwing yourself out of the window (um, ground floor, try again), don't be surprised that you get a sitter and a psych consult faster than you can say 'suicide risk'.
another rule of thumb: please avoid attempting to punch hospital security in the face. though it's entertaining to watch you being tackled to the ground, i'm guessing that your fractures don't feel any better with 200 pounds of the law sitting on your back. for the record, assaulting hospital staff is the fastest way to get tied to your bed, or in this case handcuffed until the sheriff can come and arrest you.
this next tip might be common sense to some, but recent events prove that it deserves mentioning. if your mother is a morbidly obese diabetic on dialysis who lives in a group home, YOU SHOULD NOT BE GETTING HER DRUNK. seriously. day passes are for cute mother/son dinners and trips to church, not for slamming back 40s until mama's so plastered that she falls and breaks her face. three times the legal limit people...no lie.
it never ceases to amaze me how people are bound and determined to find new ways to totally screw themselves and the ones they love.
Tuesday, May 29, 2012
try again.
so when you've been missing from the floor for five hours, i'm really not going to believe you when you tell me you were "just chillin in the parking structure". as we have had security and management looking for you for the past two hours, i think that we can all agree that you are lying to my face. so where were you? oh, that's right, YOU WENT HOME. with your dad and your aunt. and it was very unfortunate for you when the car broke down in the middle of the monsoon thunderstorm apocalypse outside and you were stranded out in the rain. because, you know, you're sick. and, newsflash: when you're sick enough to be in the hospital, you need to stay there. like, until you're discharged. what part of that is difficult? did we really have to tell you that you can't just have your homeboys load you and your wheelchair up into the back of the truck and drive you around for awhile? you still have a foley. your neck is broken. i'm not sure you're to be trusted with your IV out in the 'hood. and the whole parking structure facade? seriously? LIE BETTER next time, or at least close your door when you tell your girlfriend about your fun joyride. because I CAN HEAR YOU.
thank you and goodnight.
Thursday, May 24, 2012
dreams
i get asked all the time if i'm a floor 'lifer'. i guess it's because i've been on my unit for just shy of four years, which is an eternity in the land of trauma. in four years, i have the most seniority on the PM shift. when our veteran day RN retires in august, i'm up first for day shift. but here's where it gets tricky.
i don't want it.
i hate days, always have. when my eyes open before 8 am my first thought is 'kill me now, i just want to die'. i hate driving when everyone is on the roads and the commute back and forth to work is an hour instead of 30 minutes. i hate the thought of being a day vampire in the winter, where you go to work in the dark and come home in the dark. i hate everything about day shift, and while i'm young, single, and childless i don't have to feel guilty about living the PM life...sleeping in, staying up late, going out for drinks after work at midnight if i feel like it. days is out for me.
and don't even get me started on grad school. if there's one thing i do know for sure, it's that i belong at the bedside. i have lots of respect for NPs, i just am not meant to be one. we'll leave it at that.
but i'm starting to feel stagnant. i've watched nurses leave the floor for ED or ICU or float pool for years. i know i could never do float pool...changing floors everyday would make me crazy. and ED is not a place for someone who is (yeah i'll say it) kind of high strung. but the ICU...now that calls to me.
well, it calls quietly.
truth is, i'm terrified of leaving the floor. i still don't feel like i've got it all together there. i learn new things all the time. codes still make my heart beat practically out of my chest. i don't know how i could possibly be ready for the ICU. and when i start thinking about having to start all over? forget it. if i knew four years ago how hard this job would be, i don't think i would have done it. i would have found a library and started shelving books, living out my librarian dreams. and the thought of changing jobs just when i'm finally almost comfortable? sickening.
i'm so jealous of people who can make the ICU transition without even flinching. who don't think twice about all new coworkers, or being faced with vents and pressors and half-dead patients, or starting out paying their dues on the night shift.
i hate change, HATE it. passionately. but i also hate feeling like i'm settling. i hate feeling like i've plateaued, like i'm doomed to live a dreamless life of quite complacency.
i am a damn good floor nurse, let me tell you. floor nurses don't get any credit, usually. people think that we're not smart, and doctors often don't take us seriously. the floors are the trenches, people. i have 5 patients to take care of, no big glass rooms so i can see them all the time and no continuous monitoring. i hang heparin drips to treat PEs and take care of VACed open abdomens and give blood and have patients with four chest tubes and three broken extremities and my patients are busy. if this were ten years ago, these patients would be in the ICU. heck, if i didn't work at a level 1 trauma center, these patients would be in the ICU. but how i would love to collaborate with a physician about patient care instead of being treated like an annoyance. and how i would love to do some of the things i hear about from the ICU nurses...mass transfusion protocols and codes with cracked chests at the bedside and hypothermia...wow.
now i'm not one for cheesy quotes (ok so i am. don't judge.), but lately i've been thinking of one. if your dreams don't scare you, they're not big enough. i haven't been scared for awhile.
but maybe it's time.
so back to the question: am i a trauma floor 'lifer'? four years ago i would have said yes. four years ago this was my dream and i was scared. every day. but now i'm not so sure. and that, for now, is as close to an answer as i have.
i don't want it.
i hate days, always have. when my eyes open before 8 am my first thought is 'kill me now, i just want to die'. i hate driving when everyone is on the roads and the commute back and forth to work is an hour instead of 30 minutes. i hate the thought of being a day vampire in the winter, where you go to work in the dark and come home in the dark. i hate everything about day shift, and while i'm young, single, and childless i don't have to feel guilty about living the PM life...sleeping in, staying up late, going out for drinks after work at midnight if i feel like it. days is out for me.
and don't even get me started on grad school. if there's one thing i do know for sure, it's that i belong at the bedside. i have lots of respect for NPs, i just am not meant to be one. we'll leave it at that.
but i'm starting to feel stagnant. i've watched nurses leave the floor for ED or ICU or float pool for years. i know i could never do float pool...changing floors everyday would make me crazy. and ED is not a place for someone who is (yeah i'll say it) kind of high strung. but the ICU...now that calls to me.
well, it calls quietly.
truth is, i'm terrified of leaving the floor. i still don't feel like i've got it all together there. i learn new things all the time. codes still make my heart beat practically out of my chest. i don't know how i could possibly be ready for the ICU. and when i start thinking about having to start all over? forget it. if i knew four years ago how hard this job would be, i don't think i would have done it. i would have found a library and started shelving books, living out my librarian dreams. and the thought of changing jobs just when i'm finally almost comfortable? sickening.
i'm so jealous of people who can make the ICU transition without even flinching. who don't think twice about all new coworkers, or being faced with vents and pressors and half-dead patients, or starting out paying their dues on the night shift.
i hate change, HATE it. passionately. but i also hate feeling like i'm settling. i hate feeling like i've plateaued, like i'm doomed to live a dreamless life of quite complacency.
i am a damn good floor nurse, let me tell you. floor nurses don't get any credit, usually. people think that we're not smart, and doctors often don't take us seriously. the floors are the trenches, people. i have 5 patients to take care of, no big glass rooms so i can see them all the time and no continuous monitoring. i hang heparin drips to treat PEs and take care of VACed open abdomens and give blood and have patients with four chest tubes and three broken extremities and my patients are busy. if this were ten years ago, these patients would be in the ICU. heck, if i didn't work at a level 1 trauma center, these patients would be in the ICU. but how i would love to collaborate with a physician about patient care instead of being treated like an annoyance. and how i would love to do some of the things i hear about from the ICU nurses...mass transfusion protocols and codes with cracked chests at the bedside and hypothermia...wow.
now i'm not one for cheesy quotes (ok so i am. don't judge.), but lately i've been thinking of one. if your dreams don't scare you, they're not big enough. i haven't been scared for awhile.
but maybe it's time.
so back to the question: am i a trauma floor 'lifer'? four years ago i would have said yes. four years ago this was my dream and i was scared. every day. but now i'm not so sure. and that, for now, is as close to an answer as i have.
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