Month: November 2016

Follow-up to “Touring the Mediocrity Factory (meeting with principal of rich suburban public school)“…

I went to a parent-teacher organization (“PTO,” an upgrade from the former “PTA”?) meeting at the Happy Valley public school (“Happy Valley” is a rich suburb west of Boston).

Two principals spoke. One, a former performing arts teacher, handles K-4 and the other grades 5-8. The headline topic was a “school improvement plan.” I had been told that it would be about academics, so I showed up to learn what plans were being made to prepare our kids for a globalized world. Would there be a shift to topic-based learning, for example, as apparently is happening in Finland? (Washington Post)

The principals opened by saying that their #1 goal is “behavioral and emotional. We’ve spent more than a year getting to Happy Valley Cares Values.” This is apparently analogous to a corporate mission statement. The principals explained that lessons will be taught in every class using the Values, especially about conflict. The K-4 principal added: “Nobody wants it and yet it is part of our everyday life. I feel like if you’re bad that means you’re not good and that’s not true.” Now that the values statement (not to be confused with a mission statement) was drafted, could the principals move on to academics? The answer was “no” because the values statement was budgeted as a 2-year project, but really should be “a 5-year cycle” (not to be confused with a 5 year plan).

The second topic concerned what the principals characterized as the teachers “taking a tremendous risk.” At a previous coffee with the principal, I had learned that a teacher essentially cannot be fired even if he or she does almost nothing. Was the “tremendous risk” then something like hanging out the side of a helicopter hovering-out-of-ground-effect to maintain a high-voltage power line? The “tremendous risk” and “huge undertaking” turned out to be that, twice per week, students, possibly from different classes within the same grade, would be organized into groups by ability and then taught, e.g., math, for 45 minutes.

Was this the end of risk-taking by teachers? The principal for grades 5-8 said that it was not due to the issue of kids not being sufficiently sheltered from news and cultural events (e.g., the Trumpenfuhrer addressing the Reichstag). It wasn’t explained what teachers were going to do about this, but we were assured that it was “really really hard.

Kids stressed out? The good news is that there is a “wellness teacher”.

The principals explained that they “want to look at homework in a 360-degree way. This is work we are going to take on as a school council (parents and teachers/admins together).” It turned out that a full 360-degree view wasn’t necessary because there was a single overriding factor of concern to the K-4 principal: the time homework prep and grading would take for teachers. This was consistent with a parent’s point that, while the middle school teachers said that students should do homework, they don’t bother to check even whether or not it is turned in: “they let their assistants check twice per week.” Her child was inferring from this that homework was not in fact important.

One parent asked “how much do you want us helping them?” The Grades 5-8 school principal said that she never did homework with her child. “I just pay [the town after-school program]. I don’t want to get anywhere near homework.” It wasn’t explained why she parks the kids in the after-school program if her job is substantially over when school gets out. But perhaps the principal must work longer hours than teachers? A parent volunteered that the $15/hour young people who staff the after-school program can’t really help kids with homework. The principal responded with “that’s what I am finding out.”

It was the same answer when a parent asked about a “flipped classroom.” The principals said that it was working well for one teacher but nobody else has adopted it because it is too much work (for the teacher). It was’t explained what the extra work was. Do teachers have to record themselves giving a lecture? Or do they just have to assemble a playlist of lectures for students to watch and then discuss in class?

A parent from Sweden suggested that comparative religion be taught. The principals said that the Massachusetts curriculum mandates this starting in 7th grade. The Grades 5-8 principal said that she was worried about preserving family values if the school teaches something. A mother then suggested that “we can teach tolerance in second grade more than substance of religion.” (maybe borrow curriculum from the Cambridge Public Schools where they have a full-time diversity and tolerance program that the Tsarnaev brothers attended?) It turns out that we can’t, actually, because “sadly these days education is driven by accountability,” responded the Grades 5-8 principal.

A mother asked if parents could sit in on some of the math lectures to learn how problems are supposed to be solve. She offered that her husband was completely useless. The K-4 principal sympathized that she is “a recovered math phobe” but expressed pride that she was recently able to help a second grader with a math problem (see The Smartest Kids in the World regarding a Calculus-free guy who “figured the best way to become a [football] coach was to become a [high school] math teacher.”)

The above meeting was held the day after the Trumpenfuhrer’s election and the PTO head closed it by saying that “the last 24 hours show that conversation is more important than ever.”

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Here’s a photo of Mindy the Crippler, taken with the iPhone 7 Plus in “portrait” mode:

What do folks think? This is straight from the camera with no corrections. Fairly crummy indoor light. I like how the puppy’s eye is sharp.

[Separately, note that, as in the movie Spinal Tap, this was not taken with my iPhone 7 Plus. You can’t dust for JPEGs.]

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After the latest batch of 10-minute visits with the pediatrician I am wondering why people seek to become primary care doctors. We are told that in the good old days, at least in movies, the primary care doc was a respected member of the community who knew every family. Visits with patients included catching up on family news and potentially discussions of wider topics. Today, however, the primary care doc sees so many patients per hour that he or she surely cannot learn that much about the typical family. One of the things that I like about being a flight instructor is getting to know someone through 100+ hours of interaction through a rating (might be only 50 hours of actual flying time). This pleasure would appear to be denied to a typical American family doctor.

Maybe this is already happening, but if you’re just going to see patients in short little glimpses why not become a specialist and make 2-4X the salary?

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All That Man Is by David Szalay doesn’t offer a lot of great choices for men. There aren’t a lot of great jobs and, when you get older, employers probably will find you superfluous. Here’s a guy from England who moves to Croatia and lives off the rent from his house in England:

And when they asked Murray what the fuck he was doing, he said, ‘I’m just taking it easy. Enjoying life.’ ‘Where you doing that then?’ the Pig said. ‘Croatian Riviera,’ Murray answered. ‘I’m semi-retired,’ he told them. ‘Semi-retired? What’s that mean?’ ‘Means no one’ll give him a job,’ Rainey quipped, adding an empty to the many on the table and turning his head towards the bar.

A rich Russian businessman is defrauded of most of his wealth. His wife leaves him after it becomes clear that, under UK divorce law, she can take the houses and most of the cash. He’s left with nothing to do:

‘No,’ Aleksandr says. He has never had a hobby – in his Who’s Who entry, he had listed his ‘interests’ as ‘wealth’ and ‘power’.

Guys who go down the responsible family-man route are freighted down with mind-numbing tasks:

Yes, Macintyre has several kids. No wonder he seemed so threadbare and fed up. So tetchy. Some little house somewhere in outer London, full of stuff. Full of noise. He and his wife at each other’s throats. Too worn out to fuck. Who wants it?

On Saturday, though, he was short-tempered. Last week, in high winds, a substantial piece of chimney fell off the house – stove in someone’s new Nissan Qashqai which was parked in front. An insurance nightmare. Miranda had been on the phone all week to the insurers, without much to show for it. Just to sort out the chimney, even that seemed problematic. He spent most of Saturday in the low bed under the sloping roof, peering at small print on a tablet screen, furious at having to spend his time on it. So many overheads these days, that’s the thing. Mortgage. School fees. Laima’s salary – the Lithuanian nanny.

What would be described in the U.S. as rape/sexual assault is portrayed by the victim in a favorable manner:

[a 40-year-old hostess in Czech Republic] starts to tell them about how she lost her virginity with a swimming coach, in a hostel in Italy, when she was fifteen. ‘He was older than me,’ she says. ‘That was nice, you know.’ Simon sits with hunched shoulders, not seeming to hear, smoking. ‘It is nice, first time, with someone older,’ she says to him.

(Wikipedia says the age of consent is 15 in the Czech Republic and 14 in Italy so this wasn’t criminal.)

The book is kind of dark and not exactly action-filled, but I think it deserves your attention if you’re in a serious mood.

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“Perils of Climate Change Could Swamp Coastal Real Estate” is a NYT story that looks at the question I asked seven months ago: Are markets so inefficient that global warming isn’t being priced properly?

Buried in the article is one possible explanation: taxpayer-subsidized flood insurance…

Roy and Carol Baker, who now live in Sarasota, Fla., recalled trying for several months to sell their home in nearby Siesta Key in 2014. Interested buyers kept backing out of the purchase when they found out that the annual flood insurance premium was roughly $7,000, they said.

This experience will become more common, economists say, as the federal government shifts away from subsidizing flood insurance rates to get premiums closer to reflecting the true market cost of the risk.

….

To make matters worse, the National Flood Insurance Program is more than $20 billion in debt. After several major coastal storms, Congress tried to fix the program, passing a law in 2012 requiring that insurance premiums be recalculated to accurately reflect risk. Coastal homeowners rebelled, arguing that the legislation made insurance unaffordable, and in 2014 Congress repealed parts of the law.

George Kasimos, a real estate expert in Toms River, N.J., said homeowners had good reason to react. “A homeowner may be approved for a $300,000 mortgage with a $3,000 a year flood insurance premium,” he said, but the same person’s loan application would most likely be rejected with a $10,000 flood insurance premium. As insurance prices rise, some home purchases will become cash only, squeezing more middle-class and lower-income buyers out of the market.

It would seem that, since you can’t buy flood insurance on a long-term basis, a beach house could become worthless overnight (federal insurance rate goes from 1 percent of house value up to 30 percent). Yet wouldn’t we expect this risk to be priced in, assuming that sea level rise is imminent? Why would anyone pay more than about 10 years of rental value for a house right on the beach? Or maybe it is and the $8 million houses in Ft. Lauderdale that I saw would actually be worth $25 million if not for the climate risk and flood insurance rate change risk?

[WSJ responded to this article: “Shoreline Gentry Are Fake Climate Victims”…

Only in the second half of a 3,099-word opus is the truth not so much revealed as hinted. Halting and piecemeal reform of the federal flood-insurance subsidy program that has so benefited wealthy seaside homeowners is why beach-front housing prices are being reset.

Estimates vary, but sea levels may have risen at two millimeters a year over the past century. Meanwhile, tidal cycles along the U.S. east coast range from 11 feet every day (in Boston) to two feet (parts of Florida). On top of this, a “notable surge event” can produce a storm surge of seven to 23 feet, according to a federal list of 10 hurricanes over the past 70 years.

… When Teddy Roosevelt built his Sagamore Hill on Long Island, he did so a quarter mile from shore at an elevation of 115 feet not because he disdained proximity to the beach or was precociously worried about climate change. The federal government did not stand ready with taxpayer money to defray his risk. … A FEMA study from several years ago found that fully a quarter of coastal dwellings are liable to be destroyed over a 50-year period.

]

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From our anonymous insider…

This week: White Coat ceremony; an exciting heart dissection lab; and our first real patient interactions.

In anatomy lab our goal was simple: remove the heart. Most textbooks depict the heart as a vertical organ, with the left and right atria lying on top of the muscular left and right ventricles. Our trauma surgeon described this as one of the greatest illusions of human anatomy. Instead, the ventricles are anterior to (in front of) the atria. We began by opening the pericardium, revealing the great vessels leaving and entering the heart. The aortic arch got several “oooh’s and aww’s” as we constricted this massive 1-2-inch-diameter thick-walled vessel. Once all the great vessels connecting the heart to the body were cut, the student would run around holding a human heart in the air, like Simba was held up in the Lion King.

Lectures detailed the embryological development of the lungs. Lungs begin developing at around 20 weeks gestation (18 weeks after fertilization; gestation is measured from the last menstruation). However, due to a lack of sufficient gas exchange sacs to sustain respiration, the lungs do not become pre-viable (sustainable out of the womb) until 23-24 weeks. Even after 24 weeks, a baby’s lungs are barely developed, and the most common cause of death is respiratory distress. The slightest complication, for example, a respiratory infection, could lead to death.

Our patient case was a baby born at 24 weeks, about 16 weeks before she should have been born. The mother detailed how she was having a healthy first pregnancy when she suddenly went into a rare form of premature labor. An emergency C-section saved the baby and herself. “Kate” was brought into the world at 1 pound, 6 ounces (normal baby weight is 6-8 pounds).

The family expressed pure love for the neonatologist who “gave life to” Kate in the Neonatal Intensive Care Unit (NICU). “You should all become neonatologists,” exclaimed the mother, “and if not neonatologists, then obstetricians!” The young couple had thought that the birth was the difficult part, but at 26 weeks Kate had a severe hemorrhage in the developing pulmonary vessels. As the neonatologist and nurses scrambled around the incubator, the parents were stunned. The neonatologist absently muttered, “This is not good.” As the mother recited this trauma, she paused and broke out in tears. The father continued, “We did not know what was happening. One moment it was fine, the next, lights were blinking everywhere, sounds going off, people running.” Blood vessels in the lung had ruptured. There were two serious concerns: first, the ventilator, which is breathing for the baby, gets clogged. The neonatologist and nurses frantically tried to vacuum blood out of the airways to prepare to insert another plastic trachea tube to ensure the airways remain open for respiration. After this was successful, the neonatologist knew the longer-term threat: stopping a massive bleed causes a sudden large volume return to the heart. When the heart pushes this additional blood into systemic circulation, immature blood vessels in the brain can rupture. If the baby does not die, this causes severe brain damage roughly half the time.

The neonatologist and family spent a nervous night waiting for to know if this cerebral hemorrhage had occurred. The family described their euphoria when the smiling and crying neonatologist came into the room with the test results: the blood vessels of the brain did not leak. The whole class crowded around as the family showed pictures of Kate today: a healthy, albeit slightly small, energetic toddler.

The White Coat Ceremony is a tradition dating back to 1993. Friends and family descend on the medical school to watch deans help each student into a white coat. The 1.5-hour ceremony was followed by a reception where parents snapped away with smartphones. The next day I would wear my white coat with my first patients, shadowing a Primary Care Provider who had trained in the Navy, but left after his four-year service obligation.

After the nurse took vitals, I introduced myself as a student, giving each patient the opportunity to demand a fully trained doctor (nobody did!). Then I interviewed the patient and performed any exams I felt pertinent, such as listening to the heart and lungs. I then reported back to the physician and we would return to the room together for discussion with the patient. It was empowering to walk into the patient room with my white coat on and a stethoscope around my neck!

Our first patient’s chart indicated an alcoholic smoker with Chronic Obstructive Pulmonary Disease (COPD). An episode of pneumonia had put him in the hospital for a week and he was here for a follow-up to confirm that his lung tissue had recovered. The lungs looked as good as they were going to get, so we sent him home. Next we treated a child’s ear infection, saw a type 2 diabetic, and checked on a hypertensive patient. Our last patient, in his mid-20s, had knee surgery nine months previously and was prescribed oxycodone for post-operative pain. He had been transitioned to tramadol, a less intense opioid, and, after reviewing the chart, the physician and I agreed he was likely asking for a refill, which should be denied. I asked if I should remain outside. My attending said, “No, you should see this. As a doctor you’ll deal with it too much.” After a brief exam of the knee, the conversation quickly turned to the subject of getting a tramadol refill. The doctor said that it is time to transition to a different pain-management strategy. The patient asked, aggressively, “Why? This is working. It’s the only thing that helps with the pain. How could you do this to me?” When the physician would not budge, he put his hands over his head in desperation.

The four-hour clinic taught me to make sure to get the full list of prescription drugs each patient is on. We had to consider four drug interactions when evaluating a switch to a new hypertension pill for our patient with high blood pressure, who was already on 12 different medications. None of my classmates were surprised by this story; one shadowing a neurologist said, “Two of my patients were on over 17 drugs.”

Statistics for the week… Study: 14 hours. Sleep: 6 hours/night; Fun: 1 outings, class halloween party! Medical school budgets bring out homemade costumes. My favorite was Ron Burgundy and Veronica Corningstone of Anchorman.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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Who else loved the Deepwater Horizon movie? Supposedly the filmmakers built an 85-percent scale model of the drilling rig and put it into a water tank. This helped push the budget to $156 million.

Personally I was happy to see the Bristow heliport and the Sikorsky S-92 helicopter. The aviation radio calls did not seem plausible and the bird strike 50 miles offshore was also odd. What would the bird have been doing out there anyway? Why couldn’t a bird see and hear a 56′-long helicopter? Then there was the fact that the pilots were prepared to take off again without shutting down and inspecting the bird damage.

The rest of the movie is apparently mostly accurate (TIME; Washington Post; History vs Hollywood), with the exception of it all being BP’s fault (funny how it works out that a movie made by Americans assigns 100 percent of the blame to a British company!).

Why was this amazing effort and achievement of moviemaking not rewarded at the box office? I appreciated being given the opportunity to experience life on the rig before and after the disaster. Critics on Rotten Tomatoes and audience members gave the movie a mid-80s rating. Why didn’t more people get off the couch and into the theater to learn about one of the worst examples of humans not being as clever as we thought we were?

Theories:

1. Americans don’t care about any story unless there is a hero who saves the day.
2. The movie was released shortly before a presidential election and Americans were preoccupied.

[Thinking back to the actual event, I remember that all of my friends without technical training said “If only there had been more government oversight the blowout wouldn’t have happened.” My friends with technical/scientific training said “What did you think the flip side of drilling the world’s deepest oil well would look like?”]

Related:

• The Deepwater Horizon accident, predicted in 1984

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According to Wikipedia, Barack Obama has handed out more Presidential Medals of Freedom per year in office than any other president. Does this reflect lower standards or simply a larger population?

There are five awards that fall into the “computing” category. Cerf and Kahn are there for developing the Internet protocols, but why not Bob Metcalfe for the underlying Ethernet hardware? Gordon Moore got an award, but not any of the folks listed as having been instrumental in developing microprocessors. Why not Jack Kilby instead, for developing the integrated circuit that made microprocessors inevitable? Why not the Bell Labs folks who built the first semiconductor transistor? The situation in software is curious. Grace Hopper (COBOL) and Margaret Hamilton (assembly language code for an obsolete-five-years-before-it-was-built NASA computer) won awards this year. Why not any of the Americans who’ve won the Turing Award? John Backus for getting most of the world (except for NASA!) out of the assembly language business. Ivan Sutherland for the computer graphics and virtual reality that makes sharing a small piece of land with 325 million other Americans bearable? Fernando Corbato for building the modern operating system on which we rely every day. The RSA inventors for enabling Internet to be used for commerce? What about my personal heroes, the folks who made the RDBMS? E.F. Codd, Michael Stonebraker, and perhaps Larry Ellison (not a Turing Award-winner, but maybe has a good shot next year due to being Trump’s kindred soul?).

[Bill Gates won an award this year, but not for computer nerdism. The White House says the following:

Bill and Melinda Gates established the Bill & Melinda Gates Foundation in 2000 to help all people lead healthy, productive lives. In developing countries, the foundation focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, the mission is to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. The Gates Foundation has provided more than $36 billion in grants since its inception.

If most of the money spent by the foundation is for health care in foreign countries then essentially Bill Gates is getting an award for avoiding U.S. capital gains and estate taxes and sending a massive amount of capital out of the U.S. If the $36 billion had instead been passed down to his kids more than half of the money would have ended up in the hands of federal and perhaps state government (capital gains taxes, gift taxes, estate taxes, income tax on dividends received, sales and property taxes on items purchased with the money, etc.).]

Readers: Ideas for the next batch of computing-related awards? How about Steve Jobs (“Nerd Jesus”)?

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From our anonymous insider…

We started our exploration of the respiratory system in anatomy by using bone saws to remove the chest plate, thus opening the thoracic cavity. Half an hour after we started sawing, I was holding a human lung: heavy, fluffy, yet slippery to the touch. Unlike textbook depictions, they are asymmetric. The three-lobed right lung is larger while the the left lung has only two lobes. The aortic arch and descending aorta carve out a large groove in the posterior left lung. Comparing cadavers, it wasn’t hard to spot a smoker’s lung: copious amounts of black specs on the exterior plus one cadaver had burst alveoli. If you see a doctor smoking you’ll know that he or she really loves cigarettes.

My group finished early and snuck a peek by opening up the pericardium (membrane that covers the heart). The heart is surprisingly small, about the size of a clenched fist. We don’t have any information about how our cadaver donor died (aged 97), but we noticed a dark red spot on the left side of the heart, surrounded by firm white tissue. Our instructor explained that this indicated a left ventricular myocardial infarction (“heart attack”) and said that, if the patient had survived, the affected area would have remodeled into tough scar tissue. One small spec on a small organ is the difference between life and death.

We learned in lecture that the breathing system is like two springs: (1) the lung, which wants to collapse, and (2) the chest wall, which wants to expand. The lungs are stretchy, with a third of the elasticity from the tissue itself, and two-thirds from surface tension of the copious fluid coating the airways. They’re constantly being pulled open by the pleural membranes, connected to the chest wall. We disrupted the balance when we cut through a rib, which sprung outward, no longer constrained by the recoiling lung.

Our patient for the week had been morbidly obese, which led to sleep apnea, which led to pulmonary hypertension. Excess weight on her chest and neck obstructed airways and elevated thoracic pressure. Prescribed a CPAP oxygen machine, her compliance was haphazard, which is typical with this immensely uncomfortable contraption, despite the patient’s ability to choose her favorite mask color. Sleep apnea, with its intermittent decreased blood oxygen saturation, can lead to increased pulmonary artery pressure. This had caused her right heart to work harder pumping deoxygenated blood into her pulmonary arteries. Over the years this made it impossible for her to exercise. She felt continuously exhausted, unable to walk up a few stairs or stay awake during any prolonged meeting. She quickly used up all her vacation and sick days and had to quit her job, moving in with her sister 200 miles away. Her new doctor recommended she speak with a pulmonary hypertension (PH) specialist, a relatively new field spurred on by the rise of obesity and sleep apnea. The PH Doc described his reaction after the first visit: “I did not expect her to live for more than two-years. I thought her right heart would fail.” He continued by explaining the unfortunate truth for PH. “Pulmonary hypertension was an inescapable death sentence until the late 1990s. There is no surgical intervention and no drugs. Studies showed that over 50 percent of patients with severe PH die within two and a half years.” In the late 90s, pharmaceutical companies developed new classes of drugs to treat left heart failure and hypertension. Some of these turned out to temporarily reduce pulmonary hypertension, giving patients a brief window in which to lose weight. Our patient was able to complete an aggressive exercise and rehabilitation routine. Five years post-diagnosis, she is no longer morbidly obese, exercises daily, and has gone back to work part-time.

The PH Doc ended by reminding us not to be blinded by obesity in a patient: “Doctors too often blame all symptoms on obesity, even if there are other pathologies that can be treated.” For color he told us about the challenge of not offending a patient while saying “we need to send you to the zoo where there is a larger-sized scanner…”

Sunday evening a few students were invited to my favorite professor’s cabin. She is a never-married woman in her late 60s who has dedicated her life to the craft of trauma surgery. She entered medicine expecting to go into family practice. While a third year student, she requested to be sent for her family medicine rotation to a rural area. She drove into the mountains to a small mining town of 10,000 with two family physicians. Although regretting her decision at first, it was here that she learned to love emergency medicine. Sitting around the bonfire, she shared vivid memories of driving the ambulance up moonlit dirt roads to a mine and going down the shaft to retrieve injured miners.

What has changed in trauma surgery? “Well the cases have changed,” she answered. “I started out treating young males in high-velocity, multi-trauma injury cases: car accidents, gunshot wounds, stabbings. Now it is mostly low-velocity cases: an elderly patient who has fallen. The family feels terrible for not having been there when the trauma occurred. The family flies cross-country to say ‘Do everything you can to keep Grandpa alive,’ not understanding what this requires doctors to do. Too often they ignore palliative care.” She’d learned about hospital funding priorities: “It is easy to find donors for a state-of-the-art pediatrics wing; there is no money to remodel a decrepit geriatrics ward.” Her bonfire advice to us: (1) find a field where you will get more interested in it as you go on; (2) you can be happy in more than one residency field (i.e., don’t cry if you don’t get your first choice).

Statistics for the week… Study: 8 hours. Sleep: 6 hours/night; Fun: 2 outings. Example fun: Camping with Jane and Sunday BBQ at trauma surgeon’s cabin.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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Things I’m grateful for this year…

• the healthy and supportive family
• the scientists and engineers who pulled us out of the nosedive of human welfare purportedly initiated by the Agricultural Revolution (see No farms; plenty of food)
• the aviation friends who’ve helped to keep me alive by (a) fixing/maintaining aircraft properly, and (b) planning/copiloting
• the friends who’ve kept me entertained and educated
• the readers who have supplied more interesting comments than my original postings

Readers: What about you? What’s tops on your gratitude list?

[And my favorite exchange of Thanksgiving 2012:

• Mom: “I feel sleepy. What’s that ingredient in turkey that makes you sleepy?”
• 9-year-old son: “It’s called ‘wine’, Mom.”

]

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