Tag Archives: guilt

The Things I Never Knew About Childbirth and Having a New-born

I love to read so during pregnancy, I signed up to a few baby sites. They sent information through weekly and I read it all. I like to be prepared. I felt prepared but still I have had many surprises that I am going to write about. Mostly so when my daughter asks me in 25 years’ time, I will have a reminder of those ‘whaaaat?’ moments.

  1. The Pain: I already mentioned in previous blogs about birthing positions but it was such an eye-opener that I feel I must mention it here. First, I will acknowledge that pain is subjective and every woman experiences it differently. Having said that, the labour pain I felt was manageable despite being induced and on a syntocinon drip (which is meant to make it more painful). Until I made the mistake of lying flat on my back. Those minutes of being in that position where the most painful, second only to the post-birth examination. Upright was a million times better. Again, I’ll reiterate the hell the post-birth examination was. It was the single most painful part of giving birth and nothing to do with the baby. When the midwife had to examine me for tears/lacerations, it was all I could do not to scream the house down. After 8 hours of labour where I barely made a peep. Horrible. Steel yourself. Don’t be like me and mentally heave a sigh of relief once the baby is out. Hold it for that final examination to be over and pray you don’t need to have stitches.
  2. Inability to make decisions: even before the exhaustion and sleep deprivation peaked, I struggled with making the simplest decisions. Specially to do with the baby. First, I couldn’t decide what the room temperature was. I’d spent most of pregnancy feeling like I had a very hot water bottle strapped to me. I simply couldn’t tell if the ambient temperature was just right or if it was cold but that suited my constantly hot self. And it was important as there was a little baby who couldn’t tell me how she felt and she didn’t have much fat to insulate her in those first few weeks. I also struggled to decide what to dress her in, what to eat and when to eat it and when it was best to ask my mama to have her for an hour so I could try to have a nap. It took roughly 3 months to reset my brain into first gear. I’m nearly back to full capacity 9 months later.
  3. The sleeplessness: I thought I understood that a baby sleeps for short periods initially day and night but as time goes on, the intervals get longer and longer until you can manage some (few hours of) deep sleep. My baby never seemed to need much sleep. First two months, it was mostly 1-2 hours sleeps for her which means less for me as I was feeding, putting her to sleep then laying down and listening for too long if she was going to stay asleep. By the time I drifted off, she was beginning to surface so I was barely getting any quality restful sleep. Daytime was worse because whilst at night she would let me put her down, in the day time there was none of that (there still isn’t). She seems to have an internal sensor that is on in the day time. This sensor alerts her when she is asleep that she is being removed from human arms. As soon as her head touches down, her eyes spring open and all traces of sleep are gone. My mama was here for the first 6 weeks and she found a way to put her down for 1 nap a day. The idea was to give me the best chance of some sleep. Did I sleep? Not much. I would lie down and listen to even the minutest sound in the house. Eventually the exhaustion would come over me but usually I would have wasted an hour so that if I got 1 hour, I was lucky. By week 2, I felt like a zombie and that feeling didn’t leave until she was over 3 months old.
  4. The guilt: every time she cries, I feel guilty as hell. I can’t seem to rationalise the fact that babies cry. You can do your best and do everything you can think of and then some and still, they cry. Even when I ignore her and carry on with my essential tasks, my heart feels so heavy with guilt hearing her cry. Even when I can see she is faking it (they learn these tricks way too early) and there are no tears, I feel this overwhelming guilt. I spent the first few months focusing all my energy on her and avoiding her cries. So much so that I would forget to eat, drink or have a wee until my body was desperate. A couple of months after my mama left, I had to have a word with myself. It was only after I reminded myself that a few tears wouldn’t harm her that I started to get on with everyday tasks. In the early days when I was trying to get her to sleep in her basket, it was tough. She would wake every hour and I was exhausted. Lots of people advised just letting her cry herself to sleep once I was satisfied she was fed, had a dry nappy and the room temperature was just right. I struggled on and on until I thought I had to try it. That night, I settled her down in the basket and lay in bed next to her. She was up within the hour so I didn’t pick her up. I let her cry. She cried and cried and cried some more. She was not stopping! I lay awake listening to her and after about 5 minutes, I started to cry myself. I rocked her basket but didn’t pick her up. I left her for as long as I could (probably 15-20 minutes) and the guilt nearly killed me. I didn’t try that again for a month. Again, she just continued to cry until I gave in.
  1. The joy: so many little things that I always thought were cute in babies now bring me the most intense joy. When my daughter wakes up, searches for me and smiles the biggest happiest smile because I am there. When she reaches out her hand to touch my face as if to check I am real. When she laughs joyfully, as only children can. When she fakes a cough to get my attention. When she notices I am off-guard and pulls my glasses off with glee. When she grabs my sleeve/hip/belt as I walk past her highchair. When she splashes in the bath. When she comes back in from a walk with daddy and her face lights up on seeing me. My heart is always full to bursting with all the little joyous moments each day. And full of dread for when I must leave her and go back to work.
  2. The pride: Every time she does something the first time…the first social smile, the first proper belly laugh, the first babbles, the first time she rolled over, the first time she sat up without support, the first time she crawled, the first time she pulled to stand. I watch her figure out how do something the first time, the intense concentration on her little face as she works it out. I watch to see the triumphant expression on her face when she succeeds. I watch the surprise on her face when she falls over or bumps into something and how hard she tries not to cry. I was so impressed that when she was immunised on 3 separate occasions, she cried for less than a minute each time. Same with when she got her ears pierced. I know I am biased but she is such a brave little girl. Her joy, her determination to learn new skills and her bravery make me such a proud mama.

Our journey together is at its very infancy so I am certain I will discover many more unknowns along the way. Suffice it to say, I am loving motherhood and I cannot wait to see what our tomorrows will bring. What fun!

Advertisements

The Cycle of Life Part 1

As I said in the bit about me, I am a realist with a healthy dose of optimism. Apologies that I am again going to write about death. It may seem morbid to my blog followers but I do not always find talking about death negative. I dwell so much on it because it is my way of not forgetting those who have left footprints in my heart. Also because unfortunately, for someone who has been fortunate not to be from areas where death is a daily occurrence, I have seen more than my fair share. In the old and in the young. If you are squeamish, this may not be the blog for you.

I write this in the living room of my sister’s flat in Abuja and this was prompted by another blog I just read and also by a conversation I had with my sister. It was a long conversation but it ultimately lead us to discuss our mortality and how death can strike unexpectedly, about being a parent and planning for that eventuality to ensure your children are taken of and about writing wills etcetera. Despite the gravity of the conversation, it was quite an uplifting one. The words to follow are snippets of memories centred mainly around 3 deaths that have literally changed my life. These are young people who no one expected to die and their manner of death changed the way I think about death.

The first was of a classmate from Queen’s College, Lagos. It happened in 1999. She (I will call her Eve here) was not a girl I was particularly close to or even fond of. But I had known her for nearly 3 years when tragedy befell her. Eve was the daughter of a quiet unassuming teacher who I will call Mr Brown here. Mr Brown was the complete opposite of his daughter. Where he was quiet, she was loud. Where he was always serious, she was always laughing, finding the humour in things even when it wasn’t appropriate. She was tall for a 12-13 year old and he was a short man. She was fair where he was dark skinned. The comparisons were striking being that they were father and child. Anyway, Eve was the class joker. She was always loudly laughing or telling a joke. She was always planning the next prank or calling out funny witticisms from the back of the class. Sometimes, it was distracting so I wasn’t always laughing with her but I never thought her to be malicious.

We came back for the 3rd trimester of JSS3 and Eve didn’t. Soon rumours began to circulate about her being unwell. Then we heard that she was in fact really quite sick and was admitted in hospital. Then we heard that she had been victim of an acid burn. The extent was unclear but we did not expect how grave it was. Why we asked? And we kept asking. She was only a young girl. Why would anyone do this to her? I was pretty sheltered so I had never heard of acid attacks nor did I know the usual motives behind them. My more streetwise classmates told me that normally jilted or scorned (adult) men were the perpetrators were and the victims the poor unfortunate girls/women of their affections. It was mainly a Southern thing back then so I had never come across this despite my mother’s job.

This was the perplexing issue to us, her classmates. Why would a girl so young attract such affection? Soon, we again heard that the attack was aimed at her older sister (also in our school but nearer 16 or maybe 17 year old). We were told that Eve opened the door to their home unsuspectingly and she had acid thrown in her face. We were told that she was badly burnt and had been admitted to the hospital weeks before we were hearing of it and was in a serious condition. We talked about her non-stop for a week. There was a sombre mood in the class. It was as if no one felt right to take over her role. So there was no joking or pranking in those days. We all feared the worst as the news we heard was comprised solely of rumours. Like Chinese whispers, we were unsure who to believe.

One morning, the Day students (as opposed to us Boarders) came in talking about the 9 o’clock news on NTA (Nigerian Television Authority channel, national news broadcast). Eve had been mentioned as there was an appeal for funds. The attack on her and the resulting serious injuries were so serious that the doctors in Lagos could do no more and I think the thrust of the news was that her family was appealing for donations to take her abroad. This was when we realised just how bad things were. We sat around in silence, praying for some news. Mr Brown turned up in our class that morning. For once, no one needed to ask for silence. We all sat in our seats and looked at him expectantly. He spoke to us in his quiet voice. His eyes were red…from exhaustion or from tears – it was hard to tell which. He confirmed the rumours. Eve had been the unintended victim of an acid attack. She had been home alone when the men called and as she was so sick, she could not identify her attackers. She was in hospital in a stable but critical condition. He left. For the next few weeks, we continued to whisper about Eve. What did critical mean exactly? More rumours about who the intended victim was and the suspected attackers. About the extent of her injuries. Some adults had been to visit and they all agreed it didn’t look good. Despite all our fears, she remained alive but in a ‘stable condition’.

End of term for us JSS3 students came early and on our last day, some kind soul had organised a bus for those of us who felt up to visiting to go and see Eve. Most of the Northern girls declined to come. I was the only Northerner to get on the bus. In total, out of 90+ classmates, the bus held less than a dozen of us plus a couple of adults. The bus ride was made in total silence. You could smell our fear and the tension was palpable. I mouthed prayers, praying that I could handle whatever condition she was in. I don’t remember much of the usual Friday traffic and the heat. I remember walking off the bus in a single file and how much I was dreading what I was about to see. The smell hit me first and I felt my gut roll. My nostrils curled inwards, as if to block off my nose and the smell with it. I thought I would faint. It was the smell of decaying human flesh reaching the corridor outside her room. I could hear someone whimper and start to sob within our group. We all marched on following the adult leading us in. We stopped by the door as she announced our entrance. When she opened the door, the smell hit us harder followed closely by the sound of Eve taking breath after painful breath. My knees locked and a part of me wanted to bolt. I remember telling myself sternly that I could face anything. If she had to be here, I could visit her. Even if only for a minute.

On wobbly legs, I followed. I inhaled and held my breath. The bedside cabinet was groaning under the weight of medication. Mostly topical and oral stuff with cotton wool and forceps in a metal tray. She was barely visible. Her head was uncovered and there was a lady (her mother?) whispering in her ear. Asking her to be brave, not to scream in pain as she had begun to do. ‘Your classmates have come to visit’ the lady whispered into the hole where her outer air should have been. She seemed to hear her and she lapsed into her painful breathing again. The rest of her body was covered. It was beneath a metal cage over which a sheet was draped. I could not see underneath but I was certain she had burns all over her body, which was why she was lying so. To prevent clothing coming in contact with her skin. We all took turns to step up next to her and tell her who we were. Her eyes were covered, she clearly could not see. The hair on her head was badly singed and what was left of it was in a clump, stuck to her skull. All of her skin was badly damaged. You could see bits of colour imbedded in the skin of her face and neck, clothes melted into her skin. Her nose was gone…there were holes for breathing but no nostrils. Her ears like I already mentioned were missing too. All that was left were holes leading to her middle ears. Her lips were also damaged and her mouth was hanging upon as she struggled to get air in. Through her open mouth, you could see her blackened shrivelled tongue.

She grunted when each girl said her name. We retreated to the back of the room and stood silently for some time. Her carer took a bottle from the cabinet and dropped it onto some part of her face when she started to complain of pain again. Soon, her bravery was unable to contain her pain any longer and she began to whimper. This very quickly turned into screams of anguish. She was clearly in unbearable pain. We all had tears in our eyes as we were ushered out. Her carer came to us and said ‘thank you so much for coming. I know Eve appreciates it’. None of us replied, we were too busy crying. We got back on the bus and gave way to emotion. I remember staring unseeingly out of my window as tears coursed down my cheeks. I wept for nearly an hour, until we got back to school. When I got off the bus, my face was dry. It was obvious I had been crying but the tears stopped. I had to be brave. I got my things and I went home. I did not speak much of it over the next few days except my family would ask how I was doing whenever the appeal for help with medical costs was broadcast. Her death was announced on the Tuesday after we visited. Although I didn’t say it out, I sent a word of thanks to God for answering my prayer. My prayers on the bus after we left was that He put her out of her misery. I was sad but life went on.

About a month later, 2 of my older male cousins, my foster sister, my sister and I had one of our late nights of playing cards by the light of a lantern on the veranda whilst most of Yola slept. It was around midnight and Yola was definitely in bed by then. We were suddenly famished and we rooted around in the kitchen to no avail. We decided to go out and buy some food. We walked in the quiet to the night market (‘kasuwan dare’), fearless in those days of anything untoward happening. Yola was that kind of town. Despite the fact that 3 of us were young girls, we felt safe enough in the company of 2 older boys. We bought food and came home, had a merry little feast and were in the middle of telling jokes and laughing when it suddenly dawned on me that Eve was dead. Just like that. She would have no more holidays, no more jokes, no more laughs. She was gone. Forever. The enormity of it hit me. The pain she was in, the senselessness of her death (her murder come to think of it) and the grief her family must be going through. How had she felt just before the attack happened and when she had the acid thrown at her? How had she borne the pain for so long? Could she smell her own flesh decaying? Did she realise how badly she had been hurt? Did she know she was dying?

From laughter, I dissolved into tears and I could not stop. The more I thought about her, the more I wept. The others were concerned. I told them through my tears not to worry. I was just remembering Eve. They were worried I could see but also understanding. This carried on for maybe half an hour. Eventually, my sister suggested that the boys go home. My sisters would look after me. I smiled through my hysteria and tried desperately to compose myself. I remember rocking as I sat on the ground, hugging my knees and trying not to hyperventilate. I was sobbing out loud, my eyes closed as I got flashbacks of Eve in her eventual death bed.

My sisters asked what the matter was when I did not show signs of stopping. I said ‘I will be fine. I don’t know why I can’t stop crying.’ Actually I did know. I could not stop imagining myself as her. Going through that ordeal, surviving for over 3 months with all the pain. Unable to talk, unable to move, unable to ask why. I thought mostly of her mother, who had to watch her daughter go through this. I thought about the inadequacy of treatment, how she was clearly in pain but there were no painkillers strong enough to control her pain. I thought of her sister, who was rumoured to be the intended victim. How did she feel? Did she feel bad her little sister had taken her place? Did she feel guilty by association? I thought of Mr Brown and his wife. I knew they would be devastated. I had seen it in their eyes. How were they carrying on? How could they bear the pain? If the pain I was feeling was so deep and I wasn’t even that close to her, how must they feel? How could they bear to be alive?

It took over an hour for me to calm down and stop the sobbing. I still cried. Until dawn that day but silently as my sisters lay next to me and went to sleep. I got it all out then and not once since have I shed a tear over Eve but I remember her whenever I think about life and death. The details are unclear to me now but I think her attackers were caught. Her sister was a witness in the case. I don’t know if they were convicted and what happened to them afterwards. We never got to go to the funeral because it happened over the summer holidays.

Life moved on when we returned to SS1. Without Eve. She had never made it out of her pinafore and into the skirt we were now wearing as senior students. Whenever someone said someone funny, we would refer back to what Eve would say. Mr Brown, bless him, looked devastated whenever we saw him, which wasn’t often. He did come to say thank you to all of us for our prayers and our parents’ donations. He especially wanted to say thank you to those of us who visited. He said we helped Eve. I hoped so. As the days turned into weeks and weeks into months, we gradually moved onto other topics. Other girls soon took up the mantle of class clown and the laughter returned. Still, I never forgot and I know at least within my circle of friends at least, none of us will forget her. She lives on in our hearts. What a senseless loss!

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