Tag Archives: depression

Physician Heal Thyself

Yet another doctor has committed suicide recently. The 3rd in the past year in the UK that I know about. There are probably more. It is so sad. On the face of it, many people might think what do doctors have to be so depressed about? The public still imagine that being a doctor comes with a good job, good income and the respect of the population in general. Those of us in the profession and our loved ones know better. For most doctors, the work is relentless. The NHS is no longer fit for purpose. There are too many patients with less resources to care for them. There is more and more paperwork borne out of the NHS having too many ‘managers’ who analyse medical errors and harm and feel that creating another form to fill in will prevent future incidents. They fail to realise that what is needed is more funding to employ enough staff for the numbers of patients we treat. They fail to realise that they need to invest in their staff and make them feel appreciated and valued for their hard work and for doing more than they are contracted to do. They need to examine the levels of sickness and absenteeism and realise that burnout is real and so is depression. Above all, they need to realise that without preventative measures, doctors will continue to work themselves until they simply can’t.

Although the UK rates highly in a lot of economic and living standards indices, being a rich developed 1st world nation, it doesn’t do so well with mental illness. The positive news is that the UK had made it into the top 20 of the world’s happiest countries in 2017 (it was previously 23rd and is now 19th) for the first time since 2012 when the world happiness report started being published annually.

In March 2017, the Mental Health Foundation commissioned a survey to look into prevalence of mental health in the UK and to identify the factors about individual that make them vulnerable to suffering from a mental illness. It found that 7 out of 10 women, those aged 18-34 and those living alone had a mental illness. Only 1 in 10 of the whole population are happy most of the time. Women are 3 times as likely as men to suffer a mental illness. Stress is a growing problem. Majority of people suffer from either a generalised anxiety disorder, depression or phobia. Self-harm and suicide are not classed as mental disorders but are a response to mental distress usually cause by mental illness that has not been recognised and treated.

With these statistics in mind, it is easy to see why young female doctors are at risk of mental illness. Couple that with the fact that medicine attracts people with a type A personality who are high achievers and do not like to admit they have a ‘weakness’ or that they need help. I have already described working conditions in today’s NHS. No wonder so many young female doctors are struggling and every year, we lose a few to suicide. What I find particularly difficult with this is that when colleagues pay tribute to those who have died, there is always a huge sense of shock. Unfortunately, these women hide their illness so well that often even their closest confidants have no idea how much despair they are in. Their friends often describe them as ‘superwoman’, someone who ‘has it all’, always helping others, taking on incredible amounts and managing to ‘juggle it all’ somehow. They give so much to others that they forget to give their selves.

Caring. Freedom. Generosity. Honesty. Health. Income. Good governance. These are the things that increase happiness and promote mental well-being according to the Mental Health Organisation. I would sum it up as friendship. I think human beings are social creatures (yes, even the introverts) and need to have at least one good nurturing relationship. This is intrinsically linked to self-worth. Many people who have attempted suicide and lived to tell their story say that depression and anxiety eroded their self-worth to such an extent that they felt useless and that the world would be better without them in it. Depression interferes with rational ordered thinking. When it is severe, it is like being in a deep dark hole, full of doubts and lacking in any hope. Far from being selfish, I believe people who contemplate suicide are (in their warped thinking) being selfless and believe in that moment that they are un-burdening those around them.

So is there anything we can do to turn the tide? Most experts agree that by the time a person has planned to commit suicide, it is probably too late to do anything. The depression has taken over and has them fully in its grasp. Where we can make a difference is at a much earlier stage. We need to prevent people with low mood going on to develop depression. We need to be that friend who validates their self-worth. The one who lets them know in words and action that their presence is very much appreciated in your life. We need to talk about mental health more so that someone at the early stages of depression feels able to confide in someone and seek help. If mental illness is so prevalent, why do we not talk about it more? Why are we ashamed to say, ‘I am depressed, I need time off work to get treatment/rest to get better’? Would any of us feel ashamed to call in sick at work if we developed appendicitis, had to have surgery and needed a few days to recover? Just because mental illness is invisible doesn’t make it less valid. I think this ultimately is what will turn the tide. Talking about it, admitting we have a problem and asking for help early, taking time out now to prevent getting to the point where all hope is lost and we feel like we have no other option other than suicide.

If you are reading this post and can identify with the desperation that mental illness can induce, please reach out to somebody. Ask for help and support. If you are in the UK, there are some very good resources. Your GP should be your first port of call. If you are feeling suicidal, call the Samaritans on the free phone 116 123. Mind has help pages online that can be accessed at https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/helping-yourself-now/#.WX8lFojyvIU as does Turn2Me at https://turn2me.org/?gclid=EAIaIQobChMIvKCtr8Sz1QIVT5PtCh2D7QnCEAAYAiAAEgKyyPD_BwE. The Mental Health Foundation has some great guides for promoting mental wellbeing which can be accessed on https://www.mentalhealth.org.uk/your-mental-health . The app Headspace comes very well recommended for dealing with stress, anxiety and depression.

If you are a medic, there is a wonderful Facebook group called Tea & Empathy for peer support for all those working in healthcare. It was founded after we lost another one of our young doctor colleagues a couple of years ago and is a brilliant space full of supportive caring people. The Wales Deanery has published a booklet specifically aimed at helping medics cope with the stress of the job. You can access it here: https://www.walesdeanery.org/sites/default/files/bakers_dozen_toolkit.pdf.

Finally, I want to say to you all: You matter. You are loved. You are not alone. Be kind to yourself x

 

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The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen

My Legendary Granddad

We all call him Baba. He is 84½ years old and still going strong. He was born in Girei, a small town not far from Yola. He went to the famous Barewa College back in the day and he has lived in many many places over the years. Many Nigerians know him or of him because he was around when Nigeria got Independence from the UK and back then he was a Permanent Secretary for Education to the Federal Government of Nigeria and was involved in a lot of the well done legislative processes related with forming a new Government structure. Unfortunately, a lot of the good work done then has been unravelled by our unscrupulous Governments but enough said on that one!

Nowadays, he is just a farmer. I say just because all my life, he has been a farmer but he was also working full-time in Civil Service and an active board member of several companies and institutions. His farm is massive. It’s many hectares of prime land in Fufore…I used to think it was as big as Yola but maybe not. It stretches from the main road to Fufore from Yola to the mountains in the horizon. Within it are a lake and a large pond. There is the round house, the abattoir, the horse stables, the building that houses the tractors and other large machinery, the barns for the cows, the clusters of huts and bungalows housing all the farm staff. As a Fulani man, his main focus is the cattle. Of course. He has cows for beef but his love is dairy cows and he cross-breeds cows from all over the globe to make them better milk-producers. He is also big on his fish farming these days so has 3 other farms with fish ponds etc. Over the years, he has kept horses, rabbits, chicken for eggs, sheep, goats and more. To feed his large herds, grass is obviously a necessity so a lot of the land is given to planting of grass and making hay. He also routinely plants rice, maize and beans. The beauty of it is that a lot of our food at home is fresh from the farm. We have fresh milk which we make into yoghurt every evening at home. We have fresh meat and fish whenever my granddad decides we are due some. We get large sacks of maize, rice and beans every year so we never have to buy some things.

One thing that stands out about Baba is his discipline and strong will. I found out that he used to be a heavy smoker until he was in his 40s. I was stunned to find that out because as far as I knew he was too strong to be addicted to anything. I am told that he woke up one day and decided he did not want to be a smoker anymore. He went into his room, got his stash of duty-free cigarettes and gave it to one of the house staff and told them to take it away. He never, to our knowledge, smoked another cigarette. Now that is how you go cold turkey. He also used to drink strong black coffee every afternoon at 4pm on the dot. I would have sworn then that he was addicted to his coffee but apparently not so because nowadays, he can do without any coffee for days.

Back in the day, his Yola daily timetable was almost military. He would wake up and leave for the farm at 6am every morning. He would come home for 8am in time for breakfast which he expected to have on the table at 08:00. After breakfast, he was a little flexible and would go out to visit people, have meeting, work in his home office etc. Lunch was at 1pm followed by a siesta which ended around 3:30pm. He would wake up and play solitaire on his bed (back then using real cards) until about 3:45 to 3:50pm when he would get dressed and go into the living room to await his 4pm coffee. He was in the car for the farm at 4:15pm and then back at 6:00pm. So basically, it was a strict timetable from 6am to 6pm daily.

His military tendencies also extend to punctuality. If you say to Baba I will see you at 7pm, he will call at 07:05pm to check why you haven’t yet turned up. If he asks when to expect you and you say between 7pm and 7:30pm, he is a little better but again, he will be on the phone or go out at 7:35pm because he will get impatient at your ‘lateness’. Travelling by road with him can be a hard trial too. Even if the journey is for a holiday somewhere 4 hours away, he will insist that you set off at 6am in the morning and woe on you if you are more than 5 minutes late getting to the car. He once invited a young woman friend of his to join him on a trip to Gembu in the Mambilla which is one of his favourite places to go in Nigeria. He asked her to meet us at home at 6am to set off. He never mentioned to us that he was expecting a guest so no one knew anything about her. Off we went to Gembu that morning and we were there at around 1pm. He decided he wanted to go check out his farm and see the cows in an hour. Now, my sister and foster sister were there too and we were sharing our room and bathroom. We also had to use a kettle to boil some hot water for our baths because there was no working heater. Suffice it to say, Charo (my sister) and Bilky (my foster sister) managed to have their baths and I was last so at 2pm, I was just about to step into the bath when my granddad gave the order for the troops to assemble for departure. Knowing my granddad, I said to the girls ‘you go without me’ and took my time freshening up. I was mooching in the kitchen trying to find some food when there was a knock on the door. I hesitated for a second and then went to investigate. There was a strange woman at the door with a guy. Apparently, they had driven down from Abuja to join us on the Mambilla trip and they had turned up at the house in Yola 30 minutes late and found we were gone. It took them 2 extra hours because they kept getting lost (no sign-posting and no satnav then) but here they were. I shook my head and took them out with me to find lunch. LOL.

Baba decided when I was in Primary school that because I had an aptitude for mathematics, I should be an Economist. He didn’t share his brilliant ‘plan’ though until I got to midway through secondary school when I had to make choices on subjects. One of the many choices was Economics which I opted not to do because I was into my sciences, biology and agriculture in particular. When he found out over dinner one evening that I was not going to be studying Economics, he wasn’t impressed. I was like ‘why do you care?’ Then I found out he thought I would make a brilliant economist. Sadly for him, I am a girl who knows what I want and I knew from the age of 4 that I was going to be a doctor. He is still somewhat sad that I chose to become a doctor and not an economist.

Baba is a type 2 diabetic and has been since he was in his 40s. He was so good with his lifestyle modification regime that he did not need any medication for decades and he has only in the last 3 years or so started using insulin. However, about 2 years ago, he became naughty with his diet. I went to Yola for 6 months in 2012 and one day, I came to the kitchen and found bottle of diet coke in the fridge. Now there are never pop/fizzy drinks in our home unless there is a dinner party or a wedding or something so this was highly unusual. I questioned the cook and found out that Baba had taken to sending the boys out for bottle of coke after I had gone to work when I was on-call or after I had retired to Mammie’s side of the house for the night after work. I was shocked. Why would he after 40 years of being good suddenly opt to start drinking probably the unhealthiest drink on earth? Of course, I took all the coke bottles out of the fridge and gave it away and I never allowed him to store any in the fridge. I am not sure whether he snuck some past me into his bedroom and drank it hot but I know there was no way I was going to let him kill himself slowly through high blood sugars and the attendant miserable complications. Oh dear!

Another stand-out thing about Baba is his vigour. By that I mean his physical stamina and strength. As I have described, he would spend hours every day on the farm and still does when he is Yola (he is not in Yola most of the time these day). He used to walk at such a speed that we had to trot alongside him to keep up with him when we were younger. My grandmother Mammie had tiny size 3.5 feet and walked quiet slowly (don’t know whether it was because of her baby sized feet or just that she was such a dignified lady that she never rushed). We found it quite comical this contrast between Mammie and Baba. I remember once bumping to them on Oxford Street in London. Well, I say bumping into them loosely. We bumped into Baba as he hurried down the street and asked where he had left Mammie. ‘Oh she is back there somewhere’ he said, pointing vaguely in the direction he was coming from. So we had a brief chat and he moved on whilst we went searching for Mammie. We found her about 300m away, calmly walking and window-shopping as though she wasn’t supposed to be with her husband. When we teased her, she shrugged and said ‘you know what he was like’. Yes we do.

He was on his way out in his home in Abuja about 4 years ago when he slipped and fell down the marble staircase. My mother found him unable to put his weight on his leg and when examined, they found he had an open fracture of both his tibia and fibula (the 2 lower leg bones). He was flown to London for surgical repair and then had to learn how to walk again. He went stir-crazy and sent my poor mother up the wall by refusing to do anything. He must have been depressed and scared because he refused to co-operate with physiotherapy for many days and just wanted to be left alone despite claiming he had never felt any pain except at the moment he broke the leg. When he finally made it out of bed and was confident enough on crutches, he was sent home with the plan to use the crutches for 6 weeks until the wound was fully healed. He called me 2 weeks later to ask permission as a doctor to ditch the crutches. I asked what the Consultant Orthopaedic Surgeon had instructed and he brushed off my question and insisted he was fine to walk. I refused to give him the go ahead to go crutch-free so soon. It didn’t make the slightest difference. To my mama’s misery, he threw out his crutches and was back to walking in no time. He is now almost back to pre-fracture vigour and only if you look closely will you notice that when he has to step down when walking, he hesitates ever so briefly as the memory of his accident comes back to him.

As I already mentioned in another blog, I inherited my facial features mostly from my grandmother Mammie. I did however inherit some things from my grandfather. His toes which my mum has and I have too with the funny 4th toe. Also the vein-iness of our hands and feet. All of us (my mum, sister and I) have a funny patch 2/3rd of the way of one of our eyebrows which has coarser longer haywire hairs that like to stick out rather comically. Mama studiously ignores her eyebrows and bats our hands away when we try to smooth the funny patch down. My sister gave in to the eyebrow shaping. I am resisting shaping my eyebrows and usually brush them into order but these days, there are usually 1 or 2 really stubborn long pointing hairs that I have to pluck out. A big thing I have inherited from Baba is my stubbornness. I prefer to call it tenacity, determination, decisiveness or ‘knowing what I want’. Most of the Joda grandchildren exhibit the same characteristic to one degree or the other. I have been called hard-headed a few times in my life. I never back down from an argument if I know I am right. I will do things the right way even if it will make my life awkward as long as it is right to do it that way. I would face the scariest person down if they lie about me rather than be quiet for an easy life. I will plan and work hard for years to achieve a goal or dream.

The last thing I have inherited from Baba is his principled ways. As you probably know, for anything to work in Nigeria, you need money and the more money, the better. That is why corruption is so rife. People want to get things done for personal gain and the more they want, the more money they need to accumulate to pay for it all. Sadly, many of these people are the people governing Nigeria so a vast chunk of all of our wealth (and it is vast being one of the largest oil-producing countries) is diverted into personal accounts and safes in homes and spirited away to offshore accounts in Switzerland, the Caribbean Islands and Asia where it can be kept private from inquisitive eyes. Baba is often accused of being a ‘bature’ because he will not make a penny more from a job than the contracted amount. A ‘bature’ means a white person which in the Nigerian context means the colonising Brits. So when you are accused of being a bature, they are suggesting that you follow the white man’s laws and are transparent in a way that is not natural in the Nigerian tradition. 3 out of 4 of his children are just as principled when it comes to earning their way the honest way and I strive to be like them. To me, money is nice to have and necessary to provide the basics of life but my ambition has never been to be rich. I just want to be comfortable. Baba is also straight-talking. If you want to know something, you ask him a direct question and you get a direct answer. Unless he doesn’t know, in which case he will say so. I too am a straight-talker…although people have called me precocious, abrupt and even rude because of it on occasion. To be honest I don’t really care what people say about me unless they misconstrue what I say and get mad. And fair enough, rarely I am intentionally rude because someone is being mean, unhelpful, unfair or verbally abusive at work.

Anyway, I digress again! I will finish by saying that I know Baba is lonely these days because at nearly 85 years, his friends and all of his friends have died. Most of his brothers and sisters are gone too so he feels alone a lot of the time as his children and grandchildren are busy leaving their lives and many of us are not even in the same town as he is. He had diabetes and hypertension and several other organs are beginning to show signs of old age. He keeps losing interest in all of his old interests and every day, he has a new project that gets abandoned when he dreams up something else. Despite all that, I pray that he stays with us until we can have an even bigger party on his 90th birthday compared to his 80th. Because I want to have children and for him to meet them and look at them with the wonder with which he looks at my nephew, his first great-grandchild.