Category Archives: Family Caregiving

Knock Knock

Whenever I hear this now I reluctantly respond in a slow monotone of “Whoooo’s there.” At one time I may have gleefully replied in a more excited tone of eager expectation of the often witty response. But at 60, I have heard the usual responses hundreds of times and rarely hear something new or funny. But today, as I considered the topic for my blog title, I overheard someone on the television say “Knock Knock.” Not knowing the context of the words on the TV show in the background, I suddenly realized the value of the statement as it pertains to quite a different subject.

Weekly, my wife and I take turns blogging about all the issues surrounding conversations we hope to generate among our readers and the general population about end of life needs, care, and desires. Knock Knock, now has an entirely different meaning for me.

So, who’s there, really? Ask yourselves, who is really there. When you are talking to someone you love, and you are interested in establishing a plan for how to attend to the needs of their changing health, finances, and function, who are they really? More importantly, who are they now? As my time in health care continues I have often heard the comments: “We have done that.”, “I have done that,”, or “I/we hope/want to do that with so and so soon, this Thanksgiving, at Christmas, during vacation.” The question is this: Do we feel comfortable with the level of comprehension of their feelings. It’s important to consider what may have changed since our last conversation. I have found that very few people have continued discussions and make adjustments to their living wills and documentation over time.

There are lots of resources available to give guidance to someone wishing to explore planning for end of life. There are social workers, physicians, and clergy. Numerous on-line options exist on how to plan and prepare for the multitude of situations people can and will face in the care for the transition of life from independence to dependence. None of these tools are going to be helpful if the person who is being cared for has not been involved on some level. I am constantly telling my patients and their families: “We can’t help if we don’t know.”

Caring Choices asks everyone to please Knock! Find out who’s there. Start to ask questions early. Document the answers in a clear and easy to understand style that can be quickly found and accessed by family, friends or health care professionals. Get to know your loved one’s thoughts on where, how, and what type of care and arrangements they are comfortable with. Please do not let decisions that can affect the remaining quality of life become subject to some standard response like it is of no more importance than an old joke.

Life Intervened

Well, we’ve missed two of our weekly blogs. Life intervened. Two weeks ago on a Saturday morning I awoke with what felt like razor blades in my throat. Couldn’t talk; could barely swallow. Spent the weekend that way and then went to my doctor on Monday who said it was just the “viral crud” going around. I didn’t buy that since I know my body and I know that I’m prone to sinus and ear infections … but figured I’d let it run its course. Then, another life intervention, over the next 36 hours, I had fevers (which I almost NEVER get) and other (more gross) symptoms, so I placed a call to my doctor’s office and received a boatload dose of antibiotics for 10 days. I’m feeling much better now!

Life intervention two: This past Tuesday, Jim was involved in a motor vehicle accident when a young woman rear-ended him in the Subaru while he was waiting to make a left turn into his office parking lot. Fortunately he wasn’t seriously hurt (bruised back with some spasms – muscle relaxants are interesting!) Car has some damage, but it’s fixable. Just goes to prove – you never know what will happen to throw your life out of whack for a bit.

This week, I had the pleasure of providing two educational sessions for family and community members at work. The presentation was titled “Decision Making for a Loved One” and I was happy to see that 20 people attended since this is usually a daunting topic that keeps people away. Our family members at the nursing home where I work are awesome. They are actively involved and engaged in the care of their loved one (most typically a parent). We talked a lot about how life intervenes and throws changes at us that we’re not really prepared for.

We had some fruitful discussion about the legal powers that documents like a General Power of Attorney and Healthcare Power of Attorney bestow and how those legal powers don’t really help all that much when you’re standing around the bed of a loved one trying to figure out what to do. We spent a lot of time talking about talking. How having conversations, about our values and beliefs and the people we want around us when life intervenes, are so much more valuable to surrogate decision-makers than the possession of a piece of paper. Many were surprised to learn that documents are sometimes ignored in favor of people standing around the bed – whether they are the ones with the legal authority to make decisions or not.

There were some tears in the sessions when we talked about the guilt felt when placing mom or dad in a nursing home, or making some other decision with which adult children struggle. We talked about how difficult these conversations can be to start, but I assured everyone that once they get past the first conversation, the next ones seem to be easier. For some in the room, it seemed comforting to know that someone else (me, and the other family members) were going through similar things or have already walked the path of decision-making for a parent through the end of life.

Life intervenes in many ways. Sometimes good things happen (like putting me in my current job to help others my age deal with decision-making for their elderly parent); and sometimes bad (like a sinus infection, fender bender, or something much more traumatic).

Before life intervenes with a medical crisis, traumatic accident or terminal diagnosis, talk to people you love. Talk about what matters to you. What gives your life meaning and purpose? What kinds of symptoms are you willing to “live” with? What abilities can you not live without? Who do you want making decisions for you? Can they make the tough decisions? Can they advocate for you counter to physicians who may suggest a different path?

Caring Choices understands that these conversations are challenging, and making decisions for someone else can be difficult. But we also understand that fear and guilt from decision-making can be lessened when we’ve had conversations and prepared our loved ones with the knowledge and courage to do what we ask. We can help you start talking. It’s never too early, but it can be too late.

Dragged and Thrust

A few nights ago I was reminded how quickly a life can go off the rails. Someone I love is in the ICU after a relatively common and curable illness went on a rampage inside her. What was initially assumed to be a flare-up of a chronic issue became increasingly more problematic as additional symptoms followed. The symptoms compounded one another over a few weeks until a trip to the primary care doctor resulted in an unexpected trip to the ER, followed by several surgeries and now days in the ICU. She’s getting the best care, everything is being done to restore her, and we’re all praying that she recovers and recuperates fully.

Situations like this occur every day in our healthcare system. Patients undergo extensive surgeries, are attended in the ICU by teams of dedicated nurses and doctors who monitor every single bodily function for any change. In the meantime, adult children are scrambling. They are being dragged into the quagmire of complex healthcare decisions and procedures; some with very little understanding of the medical “lingo”. Some operate under the motto “Physician Knows Best” and don’t question anything. Others may consider the route of “do nothing” and elect hospice. Still others may be visited by palliative care personnel who will offer advice about pain management and symptom control. Some adult children may be afraid NOT to continue with surgeries/procedures; others may be afraid to agree to proceed with surgery.

While things are spinning out of control around them, they watch a loved one lying in an ICU bed surrounded by tubes and drains and machines and beeping. These adult children are being thrust into having to making decisions on behalf of their parents (or other loved ones) with little (if any) preparation to know what course of action is desired by the patient.

They’re thrust/dragged into this nightmare for many different reasons but typically for any combination of these three:

No healthcare power of attorney exists on paper or electronic record
They’re the next of kin
They’re the people standing around the bed or sleeping in the waiting room

Hearing my cousin’s exhaustion through the phone the other night after she spent the entire day in the hospital awaiting the outcome of another surgery, I wished I could save her from the anguish of the uncertainty of knowing what to do and when to do it.

Caring Choices intends to keep people from being dragged into healthcare quagmires or thrust into the service of a loved one without the knowledge, preparation and courage to make difficult decisions. We believe that talking with your family about healthcare choices can be a welcomed lifeline. Reach out and grab it.

Harsh Your Mellow

I’ll admit to being far removed from pop culture and the “scene” of 20-somethings, which won’t be a surprise to anyone who knows me well. I’m not sure I was part of the 20-something scene when I WAS 20-something myself. This week in the nursing home, I heard a 20-something nurse aide say the phrase “Harsh Your Mellow” and I admit I was intrigued by it! I’ve found that there are a couple of different definitions of this phrase, but the one I latched onto was that you ruin someone’s happiness with sad news or drama.

In life, there will always be sad news and for many people, drama. I try to avoid drama at all costs. That may be my 50-something maturity, but I find that drama is usually overrated and typically unnecessary. I have noticed in my end-of-life work (hospice and long-term care) that there is often drama that could have been avoided or just lessened – if only people would have talked when they were healthy and able to do so.

Sadness is unavoidable in this life; drama, though, can sometimes be kept at bay. I’ve watched families wrestle with making decisions for a loved one who can no longer speak for themselves. I’ve seen adult siblings separated by hundreds of miles and a childhood of drama come together around a bedside to try to make decisions for a parent who was indifferent all their lives. Sometimes adult children gather to try to make amends as a last-chance effort to find togetherness. Others appear from a far distance (in time, miles and emotions) to make sure they get “their share” of whatever Mom or Dad may have left in worldly goods.

I’ve sat with patients as they received sad (bad) news from their oncologist. I’ve listened to long-married spouses ask us to help their partner “get stronger” even though their last station is on the near horizon. I’ve witnessed the caring of my Uncle Warren who visited his wife every day in the nursing home where she resided for 7 years even though she could no longer speak or acknowledge his presence. These situations could have been full of negative drama; they were certainly full of sadness.

When I speak with people facing their own illness or death or that of someone they love, I tend to be forthright in providing education and information. I can sometimes be blunt but I am always compassionate. Because of the reality of the subject, I may even “harsh your mellow.”

Caring Choices recognizes that by avoiding discussions about the harshness that chronic illness, terminal diagnosis or advanced aging brings, we may escape the sadness, but the drama may increase – both for us and for our families. We may need to be more willing to “harsh the mellow” when we’re healthy and able to rationally discuss healthcare options. Better to harsh our own mellow than the mellow of those we love.

Shrink Wrapped

Throughout my life I have absorbed wisdom, ideas, inspiration and hope from the world around me. Life is one experience after another; good or bad, welcomed or resisted, change occurs. Today during a breakfast meeting with a very good friend I was enlightened with today’s blog topic by a certain phrase he stated. After listening to me rattle on about the completion of my Key to Your Soul CD project and Elephant in the Room discussion guide he said. “Congratulations on your two shrink wrapped accomplishments.” I laughed and said something about my head getting shrink wrapped in reference to the invested risk, time, work, and cost of the projects. Later I realized the value in his statement in relationship to some views on death.

Even with the health care exposure in my life time (as patient, first aid class attendee, life guard, CNA, LPN, RN and 10 year experience with Hospice), it is still obvious to me that there are some people in this world who cannot, or will not, feel comfortable with discussions about death. Fear, I believe is the ultimate factor for most. For others it is more the fact that, as with birth, death is a private journey in which they are accurately aware but just not comfortable discussing it. No matter what the rationale, there are certain facts we know about our feelings, hopes, dreams, and wishes that would better serve us if others were to know them as well. Yet for the vast majority of us, our ideas about death are “shrink wrapped” inside us and we put trust in some vague hope that somehow we will have a “good” death. Good, as in peaceful, painless, regret free, quick, and while we sleep.

One of the major influences on my early education in the healthcare field was a class I took through Rio Salado College in Maricopa County, Arizona. The class text book was Albert Ellis’s A Guide to Rational Living. “Let’s face it,” Ellis writes “reality often stinks.” This particular statement produced an immediate sense of the tragic comedy of this life. We are given senses and a mind to explore and search the vast universal realms of heart and soul equipped with a vessel that weakens and deteriorates just at the time when our life experiences culminate into the realization of self and purpose. Now that’s funny! Yet it is sad all the same. For those of us fortunate enough to survive the experimental years of youth, wrath of war torn global politics, and accidental or intentional trauma, sickness or disease, we are left with aging bodies and dimming minds. Bless the industry of suspended youth that has cropped up in light of this insurmountable fact.

Caring Choices would like to encourage everyone to examine themselves in the mirror, and if necessary, break the shrink wrap around your hearts and minds. Discuss the love and hope for the future with your family, friends, and caregivers. Allow them the opportunity to serve you with the goal of hope for that peaceful, pain and regret-free moment when all intimacies are true and no fear, shame, or agony is invited.

Don’t Wait

I recently resigned my part-time hospice social worker gig. It was bittersweet, but necessary. I’m not as young as I used to be (no kidding; who is?). I came to recognize the signs that working a full-time job, plus doing my best for hospice patients and their families in my “moonlighting” flex time job, was taking its toll in more than one way. I wasn’t sleeping well. My stress level was escalating. My focus was segmented in too many directions. I was missing much needed down time to rejuvenate and renew myself. I needed more free time for the “little” things: spending time with Jim, staying in touch with my son, playing with our cats, reading a good book on a snowy weekend afternoon, having meals with friends, etc.

But my heart will always be with hospice and fortunately (yes, fortunately) I can continue my hospice social work with residents and families in long term care. Hospice care is a blessing for many families. This PBS article helps explain why. Please take a few minutes to read it.

The gist of the article is the point of my blog. We’ve seen it all too often with our own family members, our patients and my residents & their families. Those of us who work in hospice hear it all the time: “I wish we’d started hospice sooner for Mom.” I have never heard anyone say “Dad was on hospice too long.” Part of the problem, I think, is that the word hospice still connotes “immediate death” for some people. The PBS article states: “People often wait too long before seeking hospice care. In the United States, the average length of hospice care is less than 60 days with 30 percent of those who elect hospice care dying in seven days or fewer.”

It’s difficult for some to embrace the hospice concept and so they wait to enroll their loved one. Or they wait to have a conversation with a healthcare provider about hospice (or the healthcare provider waits too long to initiate). When my Mom’s doctor told us – “There’s nothing more we can do. Your disease is end stage. It’s time for hospice.” – neither she nor I had ever heard of hospice. There has been much more about hospice in mainstream media since Mom died in 1998 (on her 7^th day of hospice care). I often say I wish we’d known about it sooner. And not just for my Mom’s sake, but for mine and that of my then-13-year-old son.

There was so much support that we did not have time to fully engage. Now I know that there was a social worker and a chaplain available to us for resource, emotional and spiritual support. There were volunteers who could have come into our house to sit with Mom while I took my son to his baseball games (instead of me leaving her alone and then sitting anxiously by my bag phone – it was 1998 – awaiting it’s ring telling me she needed help.) There were people who could help other family members come to terms with the situation. The nurses we met were great; the aides were invaluable to me since I was uncomfortable with bathing my Mom.

Let me stop there to drive home a point: I recognized that there was something I just could NOT bring myself to do. With hospice, there was someone I could call to help us. She didn’t mind that I couldn’t bathe her and she was grateful for the aide who could. And I wasn’t then (nor am I now) ashamed to admit that I could not do this one thing for my dying mother. I could empty/clean her bedside commode. I could clean up other bodily fluids that she would expel given her COPD. I could feed her, wash her clothes, reposition her in the bed, entertain her, listen to her, and spend time with her. But there are reasons that certain people are CNAs and others are social workers (or plumbers, or policemen, or truck drivers, etc.). Each job has demands that the other may not be comfortable doing. My mom knew I wasn’t able to bathe her because we talked about it before we knew her disease had become “end stage”. And I didn’t have any guilt about not bathing Mom because we’d talked about it and there were others who could help us with that.

And there’s the point. We talked. Even before the doctor’s proclamation that there was nothing more to be done, we had talked. We didn’t wait. We continued to talk throughout the next 9 nine days until the morning Mom died. And there was a lot more to be done. Our final conversation, just hours before her last breath, was about her funeral scriptures and songs. Until the very end, Mom wanted to be sure I knew what she wanted.

So, don’t wait. Start a conversation with people you love. It doesn’t have to be a lengthy discussion initially. Just ask your kids who would be comfortable giving you a bath in your last days. You’ll be amazed what conversations follow that!

Caring Choices understands that each of us is designed to do certain things more comfortably then others. Recognize your strengths and abilities and then lend them to care for someone you love. Don’t wait too long. Better yet, don’t wait at all. Talk. Share. Love.

Strength

Recent contemplation of the meaning of this word had prompted me in choosing it to represent my New Year 2015. I had no idea how immediate the consequence of this decision would be upon me.

As early as New Year’s Eve I had already been fighting a lingering headache all day at work; on the 1^st day of this year I woke with additional symptoms of a slight sore throat and a dry painful cough. The next day I called and requested what past experiences had shown effective treatment of Bronchitis. Following the physician’s advice, I started a new medication for treatment of the flu called Tamiflu. By Sunday my whole chest cavity was raked with severe pain at every frequent cough along with a colorful array of drainage from sinus and lungs. After evaluation at the Walk-In Clinic, I was started on a short course antibiotic, steroid taper, and powerful cough suppressant/pain reliever liquid to promote sleep which, by this time, I had only maybe 10 hours since the New Year began. I would not be back to work until at least the 7^th.

Over the next few days my symptoms began to lessen in some areas and worsen or appear in others. My cough improved by becoming less frequent and painful, but on Tuesday morning I awoke with the back of my throat red, swollen, and very painful. One other time, in recent months, I had had this experience with the research indicating it could possibly have resulted from very loud prolonged snoring. Guilty as charged! So after another day of more awkward than problematic swallowing effort I noticed the swelling had been replaced by white irregular patches on the two main areas of involvement. This prompted another call to the doctor in request of medication for thrush. After antibiotics, inhaled and oral steroids and the stress of days with no sleep my request made enough sense to everyone for me to get a one-time dose of Fluconazole. So with the rest of the week off from work and a new medication, on Thursday one day and one week after my story began I felt like things were finally taking a turn for the better.

Saturday the 10^th I returned to the Walk-In clinic once more due to the increasing painful nature of the unresolved white patches in my throat and a feeling of intense fatigue with the effort to attempt anything beyond walking from here to there. Initial swab test confirmed as negative with cultures pending a call today. Another new medication added with little relief from its numbing anti-inflammatory coating intent. My excuse from work states that I am to return tomorrow.

Presenting the factual symptomatic history above has not accurately informed my readers of the interwoven emotional, psychological, and financial implications this has had on my wife and me. Pain during and currently is almost constant; the loss of sleep has been taxing and considering the assumed viral nature of this malady has likely prolonged its tenacity. Under other circumstances, what would have been a welcome respite from the routine of work responsibility had, in fact, now become a hurdle that must be overcome with no real reasonable “downtime” with which to recover from this attack on my immune system.

Finding the “Strength” to get out of bed every day, facing the known and unknown pain, hardships and challenges of everyday life is often sometimes more than anyone of us can bear. In the past nearly two weeks I have been through a multitude of changes in my physical endurance and emotional state of mind. I have researched all of the possible fantastical and nonsensical considerations for why I have been feeling like this. I have also realized that I have also been surrounded with a nurturing and loving atmosphere of which there would be no hope in life without. I have been able to show my weakness, express my deepest fears and grandest emotions. No matter what the outcome. I had someone to listen.

Caring Choices exists for the very reason this blog topic does. We are not standing apart from life but walking with you. We are facing the same demands of responsibility for ownership of our destiny as everyone else. We see moral courage in action around us every day in our lives, at home, at work, and in our communities. We witness these acts of strength of will to face the pitfalls of daily life despite disease and injury. We share in the unified attempts to relieve suffering at every opportunity. We encourage everyone to openly discuss your fears, concerns and hopes with your loved ones so that they too may aide you when you might find yourself at times without strength.

Overwhelming Choices

I’m not a shopper. In fact, I always joke with my friends and say I’d almost rather have a sharp stick inserted in my eye than to spend a day shopping. However, yesterday, I had errands to run and things to buy so I set foot into both a major department store and the grocery store in the same day. I had very specific lists for both places and I didn’t veer from those lists. I went into the aisles where the goods we needed could be found. But, as I walked through both stores, I couldn’t help but become a bit overwhelmed by the amount of choices we have available to us. (I usually feel this way in stores but since I knew I would be blogging today, it seemed to strike me more vividly than usual.)

My husband and I have become accustomed to certain brands and we pretty much stick to those brands. As I approached the toothpaste aisle to purchase our preferred tube, I noticed that there were about 10 other brands available. Within those 10 other brands, there are different aspects or features to choose from: cavity-fighting, whitening, enamel-protecting, organic, dye-free, gel, paste, etc. This variety of choice seems to be available in just about every aisle of the grocery store. There are as many different brands and types of soup, pasta, ice cream, bread, milk, etc. And the same is true in department stores where you can purchase bath towels, sheets or underwear in 20 different colors. Or choose from a dozen different kinds of light bulbs or Christmas ornaments or pet food.

I remember when I first went grocery shopping for my widowed uncle who didn’t like to cook for himself. He reached a point where he didn’t like driving in winter weather so I took over his grocery shopping while I did ours. His list was usually pretty simple: frozen (microwaveable) meals, some fresh fruit, milk, eggs, bread, ice cream. Because we had a close relationship, we both assumed that I’d return with things that he’d like. I carefully looked at labels because he had congestive heart failure and was supposed to limit his sodium and cholesterol intake. I probably spent an extra hour in the grocery store making what I thought were sound, healthy choices for my uncle’s health and well-being.

But the first trip to the store proved a learning experience for each of us. I purchased everything on his list, but not all the brands that he liked. I purchased several of the healthier frozen meals (they are few and far between) only to learn that he’d tried them before and HATED them. After we sifted through the bags of groceries I brought to him, we ended up with two bags of items to be returned for the brands that he preferred. Back to the store I went … but this time, equipped with the knowledge of his preferences.

No matter how well we know someone, we can’t know everything about them. We may not always know that they’ve tried something before and didn’t like it (and would not want to have it again). We may not know that they prefer a brand name item over a generic item. Like my first grocery shopping trip for my uncle, we won’t know likes/dislikes unless we have a conversation before jumping into the task. Even when we try to make sound “healthy” choices, we may be choosing something that isn’t desired.

Caring Choices believes that having multiple and frequent conversations is the only way to fully understand what someone else wants/needs related to healthcare choices. Just like within a grocery or department store, we will each be faced with overwhelming healthcare choices for treatments, procedures, medications, etc. Don’t make someone you love try to figure out which “brand” you want. Give them the power of knowledge. You CAN talk about this.

Stress Tsunami

By definition, depending on the resource used, a tsunami is also called a tidal wave or seismic sea wave. No matter how you define it, history has taught us again and again of the enormous devastation and loss these events can bring to coastal regions across the world. Millions of dollars have been spent on ongoing research into early warning systems and evacuation planning to help eliminate the costly destruction to lives and property from this and other natural forces of nature.

Preparation is the key to success in most every situation we can encounter in our lives. Musicians and actors rehearse for shows, politicians delegate supporters to plan rallies and take polls, spiritual leaders pray and meditate to appear before groups to deliver their messages, athletes exercise and study opposition gameplay of archived footage, all in hopes of having that critical edge to deliver the perfect performance on stage, platform, pulpit or field. As well as soldiers, doctors, volunteers, and students across the world, the idea is of a similar nature. We have a better chance to win, survive or learn if we take the time to prepare.

Would the same benefit from ongoing preparation not also help to lessen the possible stress of death for us as well? In fact, death is the one event in our lives we all have a front row seat for. We don’t all have an equal amount of time for planning as one would for a game, speech, lecture or appointment. And disasters do not always have equal warning. Yet we spend countless hours planning for these things. Very few people really plan for their death. Unless we are diagnosed with a chronic or slow progression of disease, most of us go along day to day with no regard to the eventual deadline we are given. Satisfied to concern ourselves with letting others deal with things after we cannot. For myself, I would not want my wife, sons or family to needlessly struggle with the wave of stress of making choices for me that I can make now.

Caring Choices supports and encourages conversations for like-minded people who also feel the burden of care may fall unwanted onto family, friends, or others in situations where gradual or sudden loss of independence necessitates. If you have ever known someone or directly been affected by the inevitable responsibilities that befall the recipient of a “Stress Tsunami” than possibly you may understand the importance of advanced planning. If you have not, but would like to better prepare for the future to decrease the stress of decision making on your family and loved ones, please contact us.

A Box of Chocolates

While enjoying wings and pizza with good friends last night, the movie Forrest Gump was on television in the background. In that movie, Forrest often says his mother always told him life was like a box of chocolates and you never know what you’re going to get. I think we can dig down a little deeper and say that in getting older and in dying, we also never know what we’re going to get.

Anyone who’s ever received a box of chocolates knows that there is usually (not always) an illustrated guide included to tell you what is inside the chocolates. You can then more easily choose which pieces to eat, rather than poking your finger in each piece to figure out what it’s like inside. For me, those thick, creamy fruit-flavored centers simply ruin the chocolate and biting into one of them without the guide is a little, well, frustrating. In that respect, I think healthcare decision-making can also be like a box of chocolates.

We don’t know exactly what’s ahead for our health, or how/when changes to our physical and mental states will impair our abilities to care for ourselves or to speak for ourselves. But I suspect that many of us know a few things that we don’t want as the ravages of time and declining health overtake us. As well, there may be a number of things we want to accomplish before time and health run out.

Talking about the kind of care you want (or don’t want) and writing down your preferences can give your loved ones the “illustrated guide” to advocate for your choices, prepare themselves to make decisions on your behalf, and to relieve the burden of decision-making from their hearts and minds. It gives them the tools to see what’s “inside the chocolate” without “poking their fingers” at multiple options and hoping they find something you would like.

Caring Choices can help you prepare the guide for your loved ones so they don’t have to make guesses about what you like (want) or don’t like (want). Each of us has our own preferences, but without sharing them we may end up with the cream-filled centers that we don’t like (want).