The Codger Whisperer

Just got home from my shift with the combative ex-alcoholic that lives at the CrapDorable facility that I used to work at and hated. Whew!

Let me tell you, walking into a place, saying "I'm here to pick up Mr. Codger for his doctor's appointment" and hearing "Ohhh, yeah, he's in a really bad mood. He was out here in the lobby but they took him back to his room to use the bathroom because he can't use the main one." (??) That's not how you want to greet any outside providers that come into your facility. If I hadn't known what I was getting into, I'd have been tempted to walk right back out.

The receptionist remembered me from my brief and hellish stint there months ago, and gave me her key so I could go find Mr. C myself. Which I did. Sitting in his wheelchair in his room with 2 aides trying to pee in a urinal & yelling at us all to get the hell out. I grabbed the paperwork I needed from his room and did so, waiting out in the hallway to work on it there. After his urination, Mr. C seemed in a better mood, and he and I sat in the lobby of the CrapDorable facility chatting while we waited for Dial-A-Lift to come pick us up (you know, those bus system buses that will take you door-to-door if you're disabled and have a wheelchair lift on them). Bus came, we went, he crabbed the whole way there. Arrived, read to him from a travel magazine in the lobby (his favorite topic) and got him all cheerful and pleasant for his appointment.

Then the doctor, who looked to be my age or younger, walked in. And told Mr. C he was there to consult on whether or not to remove his toe. OMG. They pulled out the offending toe, and I'm no expert but it looked like a good candidate for removal to me; lots of necrotic black flesh, and ooze, and bleeding. Yuck. Apparently Mr. C didn't have any pain from it though. Then came the awesome part, in which the doc said we needed to transfer Mr. C to the exam bench, Mr. C refused, the doc seemed completely unaware that his patient had dementia, and I pulled the MA and the MD out into the hall.

"Look, I just met this guy today, but I picked him up from a dementia care facility. He has dementia. He also gets physically and verbally combative. He is a 2-person transfer and can't walk or really bear weight. So we can transfer him if it's absolutely necessary, but he may not like it."

They came back in, we tried, Mr. C grabbed on to his wheelchair, refused, and started swearing at us all. At this point, I figured we were just going to have to do it anyway, but the MD backed down and said never mind, even though he was supposed to be examining the codger in other areas for cancer. Some people might consider follow up to a biopsy a little bit IMPORTANT.

Instead, he chickened out and said "Uh... well, we won't make any decisions about that surgery, and I'll have you come back in 3 weeks so we can take another look at that toe." and he and the MA rushed us out of there as fast as possible.

Sheesh. So the codger just spent a bunch of money for this appt. plus someone to shepherd him there and back, and all he got was a clean dressing for his horrible toe. Great.

We then had a half hour to kill before our ride back to the CrapDorable, so I chatted and read to the codger until then. He freaking loved me. Just not anyone or anything else, today, unfortunately.

I brought him into the facility with an admonishment to behave ("I find it difficult when you aren't here, dear") and watch his language, and then set about coordinating his follow up appt. I told the homecare agency CareCo that I'm happy to take him BUT
1. He needs to be premedicated, because clearly dermatologists are afraid of pissy old men who swear at them. If he gets premedicated, he probably won't do that.
2. I want CareCo to call ahead to the doctor's appt. and make sure the physician understands what's happening and what needs to be done.

Jeez, people. How scary can one wheelchair bound old man be?

Um, what??

First, my favorite thing a resident said to me today:

I was at my cart getting meds out for the dinnertime pass when Wendy sidled up to me and quietly asked "So, have they reserved a rope and a tree for me yet?" I immediately burst out laughing and asked her where that question came from, to which she replied "I don't know, I just thought it up." and laughed as well.

Secondly, this is a note to myself:

Before accepting home care shifts, ASK A FEW QUESTIONS! I agreed to chaperon some dude to his doctor's appt via the local bus system's Dial-a-Lift on Monday. Then I got home and read the plan of care and ...
a) he lives at the CrapDorable place I used to work at briefly! Oh no. I hate that place. And the staff there, if they haven't all turned over by now, know it. So that's awkward.
b) his plan of care makes him sound like a freaking nightmare. Recovering alcoholic, combative toward staff at the crapdorable facility he lives at, multiple divorces ("DO NOT DISCUSS SPOUSES WITH CLIENT") and has threatened to kill his adult child and said child's spouse ("if this comes up, caregiver to redirect"). Oh my lord, this is going to be the longest few hours of my life.
c) he's wheelchair bound (hence the dial-a-lift) and apparently continent but is a 2 person transfer. So should he get the urge to go to the bathroom during the 4 or so hours I have him, I have to tell him ... what? "I hope you just have to pee, here's a big gulp cup you can use for a urinal." "Go ahead! All wheelchairs are destined to be pooped in anyway." "Let's see if I can get the nice receptionist to help me transfer you." Plus, given the quality of care at the crapdorable facility, chances that he'll be recently toileted and ready to go when I arrive are slim to none.

So, yeah. Polly, in the future, ask questions, you dumbass!

but yeah, I'm too broke right now to cancel this shift, so I'll just be crossing my fingers and counting my money in my head while I'm doing this terrible job

Bathing the Reluctant: a How-To.

It's my first day off (finally!) after being on for 6 days in a row, so I'm predictably spending the day at home. On the couch, in the bed, or the bathtub. I plan to do laundry and roast some vegetables later, but that's about as enthusiastic as I'll get today. I'm Tired with a capital T.

So when I got a call from the HomeCare agency this afternoon (I'm still "on call" with them, though I've yet to actually go and work a shift for them since switching from regular employee to on-call) I screened it. And then was pleasantly surprised when it was a voicemail from the office staff saying that my former client Gary has recently begun refusing to bathe for his caregiver, the one that took over for me when I left. She wanted to know if I'd be willing for Gary's new caregiver to call me and talk it over with me to see if I could help. Sure!

So now I'm feeling like a (tired) Shower Expert. And wanting to share my super-important knowledge with the world. So if you've ever wondered "how the hell am I going to get that cranky old coot to take a shower?", this one's for you.

Step 1: Assess the need/reluctance:
Lots of elderly people don't like to bathe. They truly don't need to as often (2x a week is just fine - they have thin skin and tend to perspire less than younger folks, and dry out easily if you wash them too frequently). They hate being cold, don't want to get naked in front of anyone, are afraid of falling on a wet, slippery floor, and may have medical equipment (indwelling catheters, ostomy bags) that make showering a hassle. No wonder they say no when you ask them to go hop in. So think about it first; do they actually need one? If yes, do you need to shampoo their hair as well, or can you give them a shower cap and just wash their body, and shampoo their hair in a sink later? Figure out the bare minimum of what needs to happen today, so you know what you're willing to negotiate down to.

Step 2: Prepare.
Before you even mention the word shower to them, go get it set up. Heat up the bathroom so it's uncomfortably hot for you. Make sure their shower chair/stool is in there, as is their shampoo and everything else. Bring more towels than you think you'll need. If possible, put bathmats down from the toilet to the shower. Bring in the clothes you'll be dressing them in afterward.

Step 3: Approach.
Hopefully you already have gotten to know whoever it is you're trying to bathe, so you know what approach works for them. Some people hate surprises, so you really need to tell them ahead of time where you're going. Pitch it in a positive way, with a smile and enthusiasm, "Hey Betty! Guess what? Since today is your shower day, I went and got your bathroom all nice and warm for you, and pulled out that lavender soap you like! C'mon, let me show you what I did!". Others, it's a mistake to mention the word shower until they're already in the bathroom. I have several residents like this. For them, I just say "Let's go use the restroom" and walk them in there. Once they're seated on the toilet, I go ahead and remove their briefs, pants, shoes and socks (this is where the bathmats come in; no bare feet on cold floors). Then and only then do I say, "Okay, Bill, we've already got you halfway ready, which is great! Today is your shower day, so I've got the warm water running, and if you just walk along these mats to the shower, I'll help you get settled in and get all warmed up in there."

Step 4: Overcome resistance.
Once you've pitched the idea, you'll probably get some resistance. Common ones, and responses to them are things like

"I don't need a shower, I just took one"
"It's hard work being beautiful, isn't it?"
or "Time flies, doesn't it? Today is Tuesday, so it's been about a week since last time. It's going to feel so good to get that warm water on, isn't it?"

"Why are you in such a hurry to get me wet?"
"We're not in any hurry. But I want your skin to be clean and healthy, so we need to get you washed up for that to happen."

"I don't want to get in there! I don't want to get wet!"
"I know you don't always like it, but I set everything up really nicely for you today. I think you'll enjoy it. Give me 2 minutes to try it out, and if you don't like it, I'll help you get out and get dressed."

"I don't want my hair wet!"
"Okay, here's a shower cap"
or if that's not an option "Here's a dry cloth to hold over your eyes. I'll aim the water so it stays off your face."

If your patient has advanced dementia and can't really talk or be reasoned with, still set it up nicely, talk them through it in a positive way. They're likely to get combative when you start to undress them, so it might be best to get a buddy to come and help you get through that part as quickly as possible so they don't get any more riled up than they have to. It's fine to leave on socks, for example, if they really won't give them up. They'll want them off later once they're wet.

Step 5: Bathe.
Do whatever it is you promised to do. If you promised not to wet someone's hair, don't surprise them by suddenly hosing down their head. That's not nice. Get them settled on the shower chair, check the water temperature on your inner arm (above your gloves). Chances are, most elderly people will want their shower cooler than you'd take yours. Approximately body temperature. Have them check the temp with their hand first. If they're not able to do that and give you feedback, start at their feet and move up slowly, so they get a chance to acclimate before feeling the temperature on their chest or back. Have them help and participate as much as possible, even if that's only to hold a washcloth to (hopefully) stop them from punching you. Keep talking through what you're doing in a gentle voice "Okay, Sally, here's some warm water for your back. Now I'm going to wash your back with this cloth, and then we'll rinse off all the bubbles. Good! Next let's do your chest" etc. If they're freaking out, do it as fast as possible, and concentrate on armpits and pericare.

Step 6: Finish.
As soon as you turn that water off, cover them in towels as much as is possible. If they walk, put down a dry towel on top of the (closed) toilet lid and help them walk over to it and sit down. If they don't, wrap up their shoulders and back, drape one over their lap, and keep one to start drying their arms and legs. Get them dry, lotioned and dressed as quickly as you can. Usually once they realize you're putting clothes on and not off, they'll relax and help more.

Pat yourself on the back, wipe the sweat off your face, pick up the zillions of wet towels, and spray down that shower with bleach. You did it!

Faves Roundup

Today as I was using the equipment at the new job (still love it!) I got to thinking about how foreign all these object seemed to me at first, and now they're second nature. Though they have some at the GreatRep which are new to me as well (when I saw "nosey cup" on the dining room protocol list, I thought "WTF??"). Turns out they're cups with a cutout for your nose so you don't have to tilt your head back at all to drink from them. They're good for people who can't/won't tilt their heads and can't/won't drink from straws. See:


The things I'm listing as faves are mostly for in-home use, though you can have them in facilities too, especially in a family member's apartment or room.

For mobility challenged (if someone is missing a leg, or just plain getting old, or whatever):
This is my favorite kind of bathtub/shower bench. I like it because when you put it in a bathtub, it sticks out onto the regular floor so that all someone has to do is back up to it, sit down, and you can swing their legs up and into the tub after they're seated. Then you tuck the shower curtain around it, and use a handheld shower nozzle to wash them. To be extra nice, put down a hand towel so it's not cold on their bare hiney.

Also for mobility challenged people, this seems really simple but it's awesome if they can't bend down very well; it's just a little half tube with a rope on it, and you put the sock on it, then drop it on down, slide the foot into the sock, and pull it up. I had a lady with a recent leg amputation who used this so she could put on her sock without falling over, and I was amazed by how much easier it made her days!

For incontinence, if you have somewhere you can put it safely so that no one will get into it and hurt themselves (it really doesn't get hot, but it's an electric appliance that involves moisture) a wipe warmer is great. That's always the worst part of changing and toileting someone, especially in the middle of the night - coming in, taking off their warm blankets, and then swabbing them down with a cold wipe; no wonder they get mad! These are made for baby wipes but you can put washcloths in them as well, for cleaning hands and faces, or if you're earth friendly enough to use washcloths for pericare.

Also for incontinence, washable cloth waterproof pads are a must for beds. They're sturdy enough to last a long time and are strong enough to use to reposition people once they're lying down.

Last incontinence thing: Bag Balm. For barrier cream. Seems to work the very best, I don't know why. It's cheap, too!

Specifically for people with Alzheimer's/Dementia: a picture phone. You program it and put little photos on the buttons so that when they want to call someone, all they do is pick up the phone and push the picture of who they want to speak to. I think it amplifies the sound too, so they can hear you better.

Ta da! My favorite home medical care products. I don't have any specific brands to recommend, aside from Bag Balm. Also, if you need some of the durable equipment, your county might have a medical equipment bank. Mine does, and I'm sure it's a big help. It's also a good place to get rid of crutches, wheelchairs, shower chairs, etc. that you don't need anymore, if you've got them cluttering up your house.

"Dinner For Schmucks", Reviewed By Bev

For some reason, the local theater changed their scheduling, greatly limiting today's choices for my movie date with Bev. It was down to Step Up 3D, Dinner for Schmucks, Toy Story 3, and Charlie St. Cloud. You can imagine why I was on pins and needles waiting to see which one she'd choose. I was pretty sure she'd rule out children's movies, and sad movies (thank God, I don't need to spend 2 hours crying and looking at Zac Efron).

As I described the choices to her, Bev said, "Well, I guess that leaves us with the Dinner Party one. What's a schmuck?"

Don't ask me how a Jewish woman from New York doesn't know what a schmuck is, but she was genuinely stumped.

"It means an idiot, a goofball, a buffoon."

"Oh!" she said, laughing already "What a crazy title! All right, Schmucks it is!"

Bev giggled throughout the movie, leaning over to me several times, saying "There's the schmucks!"

As we walked out of the theater, Bev was still laughing, and exclaimed, "Craziest picture I ever saw! And the wildest title, too! Schmucks! I'm going to call my daughter today and say, 'Jill, do you know what a schmuck is?' and see if she does. Funniest picture I've seen in a long time!"

"Bev, did you ever know anyone like that? Did you ever meet any schmucks?"

"Oh, no dear! Well, there was this one woman. She was an accquaintance, not a friend. She asked me what my name was, and I told her Beverly. She told me I could say Bev-IRE-lee and I said NO I cannot! She was kind of a schmuck."

"Oooh, you could be Bev-IRE-lee and I can be POLE-eyanna, and those can be our schmuck names, Bev!"

"That's a good word for it. Schmuck! Oh, that was the craziest picture! I hope we see another one like it next week."

"Me too, Bev."

Dr. Bill

Dr. Bill is a homecare client that I had way back when. He had been a client of CareCo for a very long time even then, so I assume he still is - I just don't have him on my roster right now. Dr. Bill was a retired doctor who lives in a swanky gated retirement community. He also has Parkinson's. But unlike Bitsy, his Parkinson's seemed to have skipped through the more common symptoms (stiffness, tremors) and gone right into dementia. Don't get me wrong, he had some slight mobility effects, and was very stooped over, so much so that child-sized furnishings would have been no challenge for him. But all of that paled in comparision to the big, bright banner of paranoia that Dr. Bill carries with him at all times.

To begin with, you should know that Dr. Bill believes himself to be an employee, not a client, of CareCo. When caregivers come to his home, he often believes us to be conducting trainings, meetings, or on a break. Dr. Bill drafts endless letters to the CareCo staff, quitting over and over again, and blaming his Parkinson's on the workload he shoulders at CareCo.

Sometimes he writes these out longhand, in his tiny, cramped, Parkinson's "microscript". Sometimes, apparently I am his secretary, and he dictates them to me on his home computer. Sometimes he settles for leaving voicemails at the CareCo office line. But Dr. Bill is always certain he doesn't want to work there anymore, and that they keep trying to stop him from quitting.

Apart from these obsessive resignation letters, Dr. Bill's other main hobby is reading and rereading his bills, and trying to call and argue with any bank, credit card, or utility company foolish enough to send him one. I really don't know why his family doesn't have them sent to a PO Box instead so they don't occupy his mind so much, but perhaps they like him to stay busy in his own way.

Sometimes these two processes mix in Dr. Bill's mind, and sometimes his other preoccupation, the fear that someone is stealing his pills, creeps in there as well. That's when the letters get really exciting. Scrawled on envelopes, legal pads, catalogues, are things like "Last count: 62. Must make a list of HI suspects. Big Boss Betty. Office Assistant Annie. Caregiver Cathy. Bill for VISA $33.86. What is this for? Cost of replacing missing pills? Call police."

Adding to all this is the fact that Dr. Bill has one of those printer/scanners that can function as a copy machine. So if Dr. Bill has, say, two envelopes full of his rantings that he decides should belong on one sheet of paper together, he photocopies them onto one. Over and over. And then rolls up the paper into a long tube, puts a single rubber band around it, and stores it in his closet for further rumination later on. He had a large supply of these crazy collages.

As you can imagine, Dr. Bill goes through a lot of office supplies this way. So one day, he asked me to drive him to the office supply store for more rubber bands and printer paper. We successfully got his supplies and were on our way back to his home for me to prepare him some lunch, when a two-story dental office caught his eye as we drove by.

"Pollyanna! Stop the car! Turn around! That's where I need to go!"

Gamely, I swung the car around, and drove by again, more slowly.

"There! That's the place. I gotta call them and tell them I need to see them. The real office is on the second story, but YOU'RE not supposed to know that."

Always wanting to be polite and humor him, I just replied "All right Dr. Bill, we can look up their phone number when we get home."

I turned the car again, taking a side street to get reoriented in the correct direction.

"Wait, Pollyanna, there was something else there too. Where did it GO? Dammit all anyway."

Luckily, Dr. Bill has a sweet tooth and can always be redirected with promises of pastries. Especially at lunchtime. So we made it back to his place, supplies in hand, for lunch and then more photocopying. Just like always.

Eclipse, reviewed by Bev

I have a new home care client by the name of Bev. Bev is over 90 (not sure how far over 90) and every Sunday, I pick her up, we go to a movie, and then I take her home to the assisted living facility she lives at. To meet her, you wouldn't think Bev is sneaking up on a century of life. She uses a walker, sure, but she carries a cute little purse that I'd bet money she bought in the teenager department, will only wear sandals because she hates real shoes, and has plenty of energy. She hires caregivers to take her out and about because she likes to stay very busy and her kids and grand kids don't keep her quite busy enough for her liking. Bev's a little Bubbe, complete with New York accent and hebrew plaques adorning her walls.

The first movie date we had, I wasn't at all sure what Bev would want to see. Turns out, she wanted to just pop over to the theater and go to the first movie that was starting when we arrived. She'd been hoping to see Salt, she confided, but the timing wasn't going to work out that day, so we saw Ramona and Beezus instead. This last weekend, I printed out the movie times for our local theater in big print, listing only the showings that fell within our 3 hour movie date parameters.

Bev ruled out all children's movies, and had already seen Salt ("it had a terrible ending - she dies!") and Inception ("just marvelous"). This left us with The Twilight Saga: Eclipse. I warned Bev that it was about vampires and werewolves and tragic love, but she said "as long as the good guys win at the end, the rest is all right".

Bev and Eclipse got off to a rocky start, with her saying "I don't want to see this" during the opening vampire attack scene. However, a quick cut to sparkling love in a meadow saved it and we didn't have to leave the theater after all. She greatly enjoyed Bella awkwardly telling her father she is in fact, a virgin. As we left the movie, Bev broke it down for me:

"What was the name of that movie? Eclipse? What does that mean?"
"You know, Bev, like when the moon gets between us and the sun and it gets dark during the day."
"I know what the word means but how did it relate to the movie? Well anyway it was very unusual. Very well done. But very unusual!"
"Bev, did you ever punch anyone for kissing you, like Bella did?"
"Oh, no dear, I said 'more, more, more'!"

Bev's favorite parts of the movie included the Washington scenery, and the love story. She was neutral about all of the fighting, and greatly relieved that it wasn't sad enough to make her cry.

So see, sometimes my job is very easy! If Bev and I see any other standout films, I'll keep you all posted on her thoughts.

Bitsy

Bitsy is a homecare client that I had a few months back, who holds two special honors:
1. She is the MOST positive, optimistic person I have ever met.
2. She's the one that kindled my newfound love of football.

Bitsy is in her late seventies, but looks a little older than that because she has Parkinson's which causes her a lot of stiffness and difficulty walking or moving. She also has a few little spasms and tics, which, this being Bitsy we're talking about, are completely adorable; a prissy little head shake, ramrod posture, and a tiptoed gait.

Bitsy was living with one of her daughters when I began taking care of her, and her boundless bright-sideyness is even more striking considering that before she came to live with her daughter, she spent a few months in an adult family home where she was neglected. That neglect came at a time when Bitsy was recovering from a broken knee, and nearly permanently cost her the ability to walk. If you're curious about adult family homes or what's being done to rectify that type of situation, there's a great series called Seniors for Sale that covers the main points. And if you're thinking "no way in hell am I clicking on something that depressing" then that's just fine too. No judgement here; it really is sad.

By the time I got to know Bitsy she was regaining her ability to walk using a walker as long as someone was there to hold onto her gait belt just to be safe. She said the first time she was able to walk outside after moving in with her daughter, she was so happy she cried with joy. Bitsy is so funny and adorable, I think the best way to describe her is by sharing some of her quotes:

"That lemon-lime sports drink is delicious, but it's so rich! I'm as full as can be!"

"We went to Kmart the other day to find some cute pants for these long legs of mine, and did you know they had a wheelchair there for just anyone to use? It was the best thing! I was getting too tired with my walker but they let me use that wheelchair, and I got to see all the clothes there. Kathy Ireland has clothes there! And it's air conditioned! And it's so big, and so organized. It's really just beautiful. And we stayed so long with that wheelchair of theirs, it really felt like I was on a vacation!"

After watching a Christian stand-up comedienne DVD, Bitsy laughed and clapped at how "She talks about regular everyday things like going to the grocery store but she makes it SO FUNNY!"

Bitsy regularly marveled over the deliciousness of jello, how delightful it is to watch baseball games on television, how well the "little fellow over at the church" rings the bells every Sunday, and how funny the nurse that helped deliver her youngest child was all those years ago.

Looking at things the way Bitsy does is pretty great. And if you want to feel like you're right there with her, here's a clip of one of her favorite groups singing one of her favorite songs. Watch it and imagine a prim, idiosyncratic lady with giant knitting needles sitting next to you and singing along.
The Cathedrals "Movin' up to Gloryland" on YouTube

First Day

Although I'm a nursing aide now, I consider my first day in the medical world to be my first day as a caregiver for elderly folks. At the time, working at CareCo* was just an in-between job, to hold me over until I found something better in social services. After all, I'd taken care of my own grandparents, and one set of dentures is the same as another, right?

After a short training video and a background check, I was on my way to the Golden Gables* retirement campus to meet my first clients, a couple in their 80's named Ginny and Peter Smith **. My Brand New Boss Betty was to meet me there and introduce me to the Smiths, then I would come in and keep them company, maybe tidy up the house a bit, prepare some supper, see them safely into bed, and be on my way. Sounds simple, right?

Only when I pulled into the driveway of their Golden Gables Duplex, Betty hopped out and said "Mr. Smith had a fall, you know how to get to Sacred Heart's ER*, right?". When I shook my head no, startled, she hopped back into her car, calling "Follow me!". Shortly, there I was in an ER exam room with Betty and the Smiths, both of whom looked impossibly skinny, wrinkled, and helpless. Betty handed me the client book with all their info in it, said "Good Luck! Stay with Mr. Smith until he's either sent home or admitted, and then take Mrs. Smith home. She has dementia, so be sure you remember how to get there, because she won't be able to tell you. I'll talk to you tomorrow to figure out your schedule for the week." and walked out the door.

I faced the two people I was now responsible for, wondering what the hell I was supposed to be doing. Over the next few hours, I tried to make polite conversation with Ginny, and keep her and Peter from bothering the nursing staff too much. I tried to distract Ginny to keep her away from Peter long enough that he could have a bowel movement in private in the exam room, in some toilet contraption I'd never seen one of before. And finally, when Peter was admitted, I took Ginny home to her Golden Gardens Duplex that was anything but golden inside; they had a small dog, a cat, and a bird, all of which defecated EVERYWHERE due to neglect. Overwhelmed, I picked up the worst of the poop with my CareCo provided disposable gloves, and sat on the couch with Ginny watching television until the poor woman who was taking over for me arrived.

And astonishingly enough, I went back the next day, and the next. And now, almost a year later, I not only know that toilet contraption is a bedside commode, but how to get someone on and off of one, and how to clean it out when they're done. Without even gagging.



Until next time,
Pollyanna


*not the real name
**also not their real names. Nothing in here will be named by real names, so I'll quit it with the footnotes from here on out.
*** okay, one more, I couldn't resist - who else is a Scrubs fan here?