» I went to the Moores Cancer Center today. In La Jolla ( luh 'HOY-uh ). I have actually driven by that road many times .. but never gave the name of the street much thought » Health Sciences Drive ..
Until now. Feel me? "So this is what's down here."
.. to catch an outdoor jazz concert while sitting beside the lovely marina there at Shelter Island.
I actually took the Bug's mom to a jazz concert there at Humphreys .. when he was still in her belly. I forget who we saw (because I have seen so many acts there over the years) but I remember having a great time. Hot summer night.
She said he was jumping around inside her belly with the music. Later we moved back to where the music wasnt so loud and he stopped kicking.
So the Bug has been to Humphreys .. even tho he doesnt know it.
But I am avoiding my subject. My uncomfortable subject.
I dont know where to start .. perhaps because I am a little overwhelmed.
Which is understandable, I guess .. considering.
I was definitely hyper-aware-conscious .. on the ride down there. A one-hour ride .. with good traffic.
I mean, the voice in my head is saying » "Dude, you're going to the Moores Cancer center. A little difficult to ignore that fact .. wouldnt you say? If you forget you can always ask the driver where he is taking you.
Did you notice the word 'cancer' in their name? How can you not? Cancer .. that's what they DO there at Moores. In fact, that is ALL they do. No, they dont make hamburgers. And the REASON that you are going there is because » cancer is what you have.
Just like your mom had. And her father, your grandfather. You know how that turned out. Not pretty. Scary-ugly. And you have the same genes. You look a lot like your mom, if you ask me."
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••• today's entry continues here below •••
The Dog Makes You Feel Like He is » There With You
Thank goodness that the Dog happened to call not long after my ride picked me up. I talked to him for much of the ride down.
.. and the way his Irish eyes sparkle like a leprechaun whenever he smiles at something that he finds particularly funny ..
» The Fellowship of [ Participation In ] His Sufferings
» "that I may know Him and the power of His resurrection and the fellowship of His sufferings ..."
Notice in particular the phrase » "fellowship of His sufferings".
Notice also that there is a footnote for the phrase "the fellowship of" .. which reads » Or participation in.
This is a good example of how I feel when I talk with the Dog. When he "fellowships with" me, I somehow feel as tho he is PARTICIPATING IN my sufferings .. even tho he is obviously not. By which I mean » he doesnt actually have cancer.
But clearly, some people are better than others at being able to fellowship with you and your sufferings, and to make you feel as tho they are participating in those sufferings WITH YOU. You know what I mean.
There is a bonding and a form of intimacy that comes with "fellowshipping with" and "participating in" the sufferings of another .. that transcends the typical friendship.
Consider, for example, the soldiers who experience the horrors (sufferings) of war together.
But it is uncanny how the Dog responds with just the right comment at just the right moment ..
.. to let you know that he is with you. That he is totally with you.
And sometimes he even shares a vignette that lets you know that he has already been there, and perhaps even to points beyond.
But of all the things that I adore about the Dog .. the #1 thing is when he points out things about you that you dont even notice about yourself.
When he says things like, "This is what makes you so cool. Because I could not do that. I wish I could. But I can't. And you can't even see it because you are up to your ass in alligators."
[[ As opposed to say, somebody like my dad, for example, who would say shit like, "Now, here is something about you, my son, that you don't see .. something that makes you fucked up. Let me help you see everything about yourself that is fucked up. This way I can focus all of my attention on you .. and not have to look at myself." ]]
» "Your friends really love you"
I once had an old girlfriend say » "Your friends really love you."
This was right after she had met the Dog .. at the Muldoon's Irish Pub there in Newport Beach .. right next to the Big Newport theaters ( "biggest screen in the West" ) .. which is right across the street from Fashion Island .. and mere walking distance from the PIMCO offices .. where Bill Gross (aka the "Bond King") used to work.
The Dog had driven all the way down from Hollywood ..
.. where he was living at the time (mere walking distance from the famous sign) ..
.. to have a bowl of Muldoon's world-famous Irish stew with us .. and a black-n-tan.
I picked that place to rendezvous because I wanted the Dog to feel at home. (He is an Irish boy.)
I love the Dog, too. (How can you not?) But this is not what I want to talk about right now. Again, I am avoiding my subject.
» Radiation Oncology
Anyway, sitting here on the bed beside me, I have an elegant blue folder-sized booklet (22-pages) with white lettering on the cover that says » Radiation Oncology Patient Handbook.
I read the first few pages while I was sitting in the waiting room. I would be proud to have been the author of this booklet. Very well written. Professional yet personal.
Not easy to pull that off. A delicate balance .. because 'professional' can come off as cold and heartless. Which this booklet is not.
While reading it I felt like crying .. repeatedly. I actually had to exert considerable effort to not cry ..
.. the voice in my head saying » "Dude, you definitely cannot cry here. This is not a good place to cry. Hold it together."
I saw a few ladies come in wearing the head-scarves over their bald heads.
And I heard a lady sitting a few chairs down say into her cell phone (as she started crying herself) » "I can only take so much of watching her suffer. They think it has spread to her spine. They are giving her morphine. She is coming in the ambulance. She should be here in ten minutes."
And ten minutes later, four or five paramedics wheeled in this lady. She did not look good. No. Very bad. Scary bad. Whoa. So let's change the subject.
» Learning Something New Every Day
Here is what I learned recently » Radiation Oncology and (plain ol') Oncology are two different things. With two different doctors. Two different appointments. At two different addresses. So you have two different things to deal with.
Oncology = Chemo-therapy. Whereas Radiation Oncology = .. uh, well, you get it. You learn something new everyday, it seems.
If you never saw a doctor at Moores, you would STILL be impressed .. by the buildings themselves. Modern industrial art. High ceilings. Lots of open space. Lots of big windows letting in lots of natural light.
Valet-parking. A concierge-like person there to greet you with a smile as you first enter and perhaps point you in the right direction. And not just one building either. No, sir. But rather many buildings. Many BIG buildings. All around you. Totally impressive .. even before you ever see a doctor.
Life has been such a rollercoaster ride these past few weeks.
With lots of sudden, steep plunges.
Sometimes I dont know which way is up.
Sometimes I just feel emotionally exhausted .. like I could sleep for a week.
Like I'm playing in the sixth quarter of a four-quarter game .. where I am taking a thumping. "Make it stop."
» He Reminds Me of My Brother
This doctor who I saw today .. I will share more later. But for now, I simply want to say that .. he reminded me of my brother. My brother is a surgeon. So I felt comfortable with him. With this doctor. A Radiation Oncologist. I could use the same communication set of skills that I use with my brother.
The only other person who ever reminded me of my brother .. was » Matt Damon.
For reasons that would take too long for me to articulate.
But the similarities fall along multiple lines. Some obvious. Others less so.
Matt Damon is a Harvard boy, so he is no dummy himself.
Anyway, I was totally impressed with this doctor. I mean, it would be hard (for anyone, for anybody) NOT to be impressed by him.
He gives you the feeling that he is so smart that .. if he were to stare at a piece of paper sitting on a chair-seat for more than a few seconds, it would burst into flames. From the prolonged focus of raw mental energy in one place.
» Truly Remarkable Skill Set
And he mind-melds with other super-smart doctors, who each have their own particular skill-set. Truly awesome shit. They have weekly "Tumor Boards" .. where all the minds come together (meld) to discuss your particular case and apply their particular area of expertise.
In other words, it is not a cookie-cutter operation. Each case is an individual case. That is much more difficult to do. (Than the cookie-cutter approach.)
And he employs the latest cutting-edge technology. While I was reading about their state-of-the-art intensity modulated and image-guided linear accelerator, I woulda totally had a techno-geek boner .. if I wasnt so freaked out by being there. (As a patient.)
» A Recruiter's Dream
I mean, I would be proud to work there. Given its location (there in La Jolla, a very desirable place to live) and the professional prestige associated with such an impressive place .. you would have to assume that they are able to attract the very best talent.
"Hi. I'm from Moores in La Jolla. We've heard about you and would like to know if you'd be interested in seeing if you think you might be a good fit for our team.
We appreciate talents such as yours. We appreciate them very much. Come visit us and let me show you what I mean.
Have you ever been to San Diego? Of course, we realize this job is not for everybody. It takes a certain type."
I told my son » "This doctor who I'm seeing next week .. he's down by Seaworld. Very close to Seaworld. You remember Seawold, right? And he has two boys .. close to your age. So I should be able to develop a good rapport with him .. thanks to you. Everybody says he's very good."
I want him to associate this with good/positive things .. as much as possible.
» The Desirable La Jolla Mailing Address
When I first arrived in California, many years ago .. it was with the Navy .. stationed aboard a nuclear submarine as a reactor operator. We were there for two months during the summer (in San Diego).
I called mom from a pay-phone, "Mom, I'm in California. Surprise!"
She said, "Oh, you should call cousin Karen. She lives there in San Diego. You've never met her, but she is very nice. Let me give you her number. Tell her I said hi."
[ People used to ask me, "Are you from California? You're so laid-back. So easy-going." ]
"Hi," I say, "Is this cousin Karen?"
"This is Karen."
Long story short .. she comes to the Navy-base at Point Loma, where we are tied up, and picks me up. Takes me to a fancy Mexican restaurant ..
.. and then to a party with a gathering of all her artsy art friends. (Graphic designers.) Totally groovy. Very interesting people. And they found me interesting, too. "You do what?"
We even went out dancing a few times. And running the beach together. (She was a serious runner.) Lots of fun that girl was. Mom's side of the family. Two other sisters. No brothers. Good stories. Good family stories. On the drive over to meet one of her other sisters, she turns off the music and says, "You can't tell my parents that I brought you here."
.. which meant absolutely nothing to me (at the time). She lived right on the very edge of La Jolla. If you cross the street, you left La Jolla.
[ The Dog once told me » "I live right across the street from Harlem. In a shoebox. Sometimes I have to step over dead people to get out of the building in the morning." This was when he was going to Columbia. ]
I did enjoy myself very much at that party, tho. I remember thinking » "I like this place. I like these people. I like this weather." (in San Diego)
When I first met her, bro was one of the first things that she told me about. Because I had been away from home for so long (.. five or six years). Away in the military. She told me things I found very interesting.
But I am avoiding my subject again. I'm sure you understand. This is not easy. Any reason to detour will do. A detour from otherwise unpleasant things.
» Seeing Things Differently
When you have cancer, and when Mr. Death approaches you and introduces himself to you .. and when he starts calling out your name, saying » "Your ass is mine, bitch. It's just a matter of time now." ..
.. uh, you see things differently. You think about things differently. Without even trying. (Trust me.)
Your gaze includes glimpses of eternity that you did not see before.
» The Most Thorough Examination
Let me just say here, before I get too carried away .. that when this doctor examines you .. you know you have been examined.
Besides running the scope-cable up your sinuses and recording the inside of your body ..
.. he also crawls his fingers over pretty much every inch of your body from your chest up .. looking for lumps and other abnormalities.
He got near my tumor (which is a tender area, due to the tumor pressing relentlessly on nerves) .. but never hurt me. You could FEEL the skill in his hands.
At one point near the very end, he had his arm pretty much down inside my throat, elbow deep. Yes, I exaggerate .. but not as much as you might think.
But yes, this is what you want. You want somebody digging deep .. looking for bad shit. I shit you not when I say he made me gag three or four times.
But he DID spray a lot of that cocaine up my nose .. just like the other doctor did. Actually, I do not know for a fact that it is cocaine .. but it numbs you, so I think of it as cocaine.
They also spray a drying agent, which has speed-like qualities. So imagine somebody spraying pharmaceutical-grade cocaine and speed up your nose .. and you get a rough idea of how I felt. (I have always been sensitive to drugs.)
I mean, you are already in an altered state .. because of WHERE you are .. and WHY you are there.
Then they spray things up your nose and stick their arms down your throat elbow-deep and make you gag. Can the Twilight Zone be very far off?
I find it telling that this doctor did not simply rely on the findings of other (obviously capable) doctors .. but rather he performed HIS OWN (very thorough) examination. He looked for himself.
My experience has been .. as you proceed up the ladder of specialists .. the examinations become progressively more thorough.
At first, they just look at the bulge on the side of your neck, shake their heads and say, "Oh, this is not good." And I say, "Don't you want to look in my throat?"
» Your Life in His Hands .. to a Large Degree
This doctor .. who I saw today .. at Moores .. he definitely gives you the feeling that he is always a step or two ahead of you. And yes, this is what you would expect, sure. But the consistency of the clarity of this impression is really what stood out for me.
There is something here I am trying to convey, but I am having trouble zero'ing in on exactly what it is that I am trying to say.
Maybe later it will come to me in a way that I can better describe.
It surprises me that he does not intimidate me. I mean, I could not respect him more. Him or his craft. Particularly for the very tangible difference he is able to make in the lives of certain people .. people who have been bitten by the fiery serpent of cancer.
And let's be frank .. this man has your life in his hands .. to a large degree .. to an uncomfortably large degree.
To be honest, I do not like to depend on anybody for anything .. especially not for important stuff .. because humans are fallible creatures and too often they let you down. This has been my experience, anyway.
Not Intimidated » But Awe'ed
So I sorta feel like I should be intimidated. But I'm not. I feel comfortable with him. A testimony, I'm sure, to his skills.
So I dont feel intimidated, but how DO I feel?
The word that came to mind is » awe'ed. I try to reserve that word for diety. But you catch my drift. I obviously think very highly of them. These doctors and their skill sets. I am just trying to be honest with my feelings and my choice of words.
When you get up close and personal to the skill set that they wield .. it is hard not to feel awe'ed .. to a degree.
I have also used the word 'awe' to describe the sense of responsibility that comes with parenthood. Because you are responsibile for another human being .. who totally depends on you for pretty much everything.
Maybe later I will go find the link to where I wrote that. Where I use the word 'awe' to describe the sense of responsibility that comes with parenthood. But sometimes I write things in places you might not ordinarily expect.
Barbara Tuchman uses the word 'awe' in the opening sentence of her Pulitzer Prize winning » The Guns of August (1963) to describe the common folk in 1910 who were witnessing all the various kings in attendance at the funeral of Edward VII of England.
I'm sure they indeed felt awe'ed.
» Establishing Parallel Rapport
If a man has my life in his hands .. something in me tries to establish a rapport with him. This seems natural, no?
And there are a few nice points where I tried to establish parallel rapport. But he was focused. I know that look. "Let's take care of serious business first, and we'll do the touchy-feely later."
That is how I am myself in a professional setting. You dont want to let the personal distract you from your focus on the matter at hand.
He is there to deal with your cancer, not to take you out for a beer and play shrink. The professional knows where the professional / personal lines fall. But I confess that he interests me. And I'm sure that I'm not the only one.
Just before he walked into the room, I caught myself wondering how he would deal with the personal vs the professional .. which, in his line of work, is a much more prominent line .. because we are talking about matters of life-and-death.
My surgeon, for example, delivers it to you in a manner surprisingly straightforward. He does not let you squirm off into denial. Thank-you very much.
I told this doctor, this Radiation Oncologist, the story of how bro was planning to go into Oncology, because our mother had died of cancer while he was mid-way thru Yale .. before med school.
But another doctor in the family (who had married a cousin of ours), told him » "It's a depressing field. All your patients die." So bro went into Orthopedics instead.
This doctor today looked me in the eye and said (quite convincingly) » "Well, I like Oncology."
I was thinking » "Well, I for one am grateful. And I'm sure there are others. Many others."
» Humor as a Form of Stress-Relief
I made the nurse today laugh. They come into the room first, before the doctor, to check you out and ask a lot of questions.
She asked if I drink and I said, "No," but added after a pause » "But dont think I havent earned my Jose Cuervo merit badge. I've just never had the staying power of the true devotee."
I could tell she liked that. "Jose Cuervo merit badge .. you're funny."
I said, "When I am feeling stressed, I use humor as a form of stress-relief."
She asked about my anxiety level.
I said, "Severe." And no, I did not have to think about that answer. "Especially after I got the call from the results of needle-biopsy results." [ while pointing at the bulge in my neck ].
The fact that I am sitting there seems proof that I want to live. Death is the thing that I am trying to GET AWAY FROM. Trying to avoid. And you nice people have been kind enough to help formulate a plan of escape.
She also asked about my energy level. "I seem to fatigue much more quickly," I said. "It feels like something is sapping my energy." Sometimes I get so worn out that I feel shaky. Your staying-power is kaput.
Like you cant get enough rest .. no matter how much rest you get. Like you are tired beyond mere physical fatigue. Like your nerves are tired. Like you are emotionally exhausted .. from having to deal with one thing after another. In rapid succession.
» "They're small, so I brought you two."
Actually, before the nurse comes in .. another girl comes in and says » "Can I get you anythng? How about some juice? We have apple, orange and cranberry."
"I would *love* some apple juice," I say.
A minute later she returns, saying, "Here ya go. They're small, so I got you two."
I know this is a little thing, but it made me feel a LOT better. These unexpected small thoughtful kindnesses seem to have an unexpectedly BIG effect .. when you are in my situation.
"Thank-you so much," I said as she was leaving. And I genuinely meant it.
» A Rad Revelation
I will tell you a little secret that nobody knows » I waited a month after the lymph node swelled before I went to see the dentist .. because I knew I would be getting my son on the 4th of July (.. my favorite holiday of the year).
Sure, I knew I wasnt feeling so hot .. that fatigue was coming more quickly.
So I knew there was a possibility of bad things.
But I said nothing to nobody. Not even to the Dog. I pretended like everything was hunky dory.
Like I said, you feel like you are standing on a long escalator that is pitched downward at a slight angle.
You can feel where it it taking you, and you know your ancestor's health history.
It wasnt until the day after he went back to his mom that I called the dentist and made the appointment. And that was when denial became more difficult. "This is not a tooth problem. You need to have a doctor look at this. Today."
[ "Your sore tooth," the doctor said that day, "may turn out to be a serendipitous thing." And yes, I knew what that word meant. I could see what he was saying. ]
.. where we had the BEST TIME EVER .. even tho she had tumors in her lung and in her brain (.. that nobody yet knew about). I understand all too clearly.
It was the Saturday after the Monday they left .. when the phone rang at 6:30. Nobody calls you at 6:30 on Saturday morning. You know those calls are gonna be trouble.
"Are you sitting down?" Nana asked. "I'm still in bed," I said.
In other words » you know when something is not right .. even when you would rather not. The power of denial is truly remarkable .. for a while anyway.
My surgeon told me earlier this month » "You've probably been growing this thing [ the tumor ] for at least a year .. maybe 18 months."
» "You look exhausted."
Update October 31, 2014 » What a month this has been. I went to see my dentist today .. to get impressions taken of my teeth .. which is another story.
His assistant said » "Wow, you look exhausted." [ This was at 10 AM. ]
"Does it show?" I asked.
I do feel exhausted, both physically and emotionally.
Which is not totally unexpected, considering all I have been thru this month.
I have been sleeping better, but still feel wiped out .. like I cannot get enough rest .. no matter how much rest I get.
I actually napped both yesterday and today (for two hours). I didnt plan to nap .. I just laid down because I felt tired (wiped out) .. and woke two hours later .. after passing out cold, soon as my head hit the pillow.
The (severe) anxiety gives you (nervous) energy that you dont really have. And when that nervous energy wears off .. you are tired. Way deep inside.
Going down to Moores made denial impossible. It was an emotional trip for me.
I do feel a little more rested, especially after the chunks-of-flesh biopsies, which definitely took a physical toll .. because I lost a fair amount of blood.
Indeed, this is what the surgeon told me going into the surgery » "You will be coughing up blood for a while." But a feeling of being rested is slow in coming.
She (the dental assistant) suggested that I talk to my doctor about anti-depressants, which actually made me chuckle. She said they helped her a lot getting her thru her divorce.
My dentist said » "I have seen this before. The radiation cooks your salivary gland and your mouth dries up. A year or two later, all your teeth rot out at the gum-line. Then you need 28 root canals which never heal because the radiation has damaged your jaw. Then you have open sores in your mouth. You should have all your teeth pulled now, before radiation, so at least they heal properly. And get full dentures, both uppers and lowers. It's a no-brainer. Sure it sucks, but it's better than the alternative. I am going to call your doctors and talk to them. Because you are going to want to eat after radiation / chemo."
I mean, he did not bat an eye when he said all this. I was freaked out leaving his office. I was literally shaking in the car on the ride home. The voice in my head saying » "You are going to die a horrible death .. but first we are going to pull out all your teeth .. with a rusty pair of pliers."
» Results Review
The following is a synoposis of the various tests I've had and their results.
- CT scan of throat and chest with and without dye-contrast » lungs look good
- 4 Needle-biopsies of swollen lymph-node » positive for squamous-cell carcinoma (during which I passed out like a big wuss)
- ENT surgeon's exam (scope up sinus) » negative (except for lymph node tumor)
- PET scan (following injection of glucose radio-marker) » negative (except for lymph node tumor)
- Chunks-of-flesh biopsies » negative
- Oncologist's exam » negative (except for lymph node tumor)
- Re-biopsy of the lymph node to verify the pathology » positive for squamous cell carcinoma
- Positive for » HPV-16.
Like I said, the Oncologist's exam was very thorough. And the chunks-of-flesh biopsies .. leave little to guesswork. "You're gonna do what?"
So they may decide to forgo the radiation/chemo and just have a surgeon cut it out. The Oncologist wants me to talk to his surgeon. Serious surgery. We will see. He is going to bring it up at next week's Tumor Board.
He said, "And then we watch you to make sure momma-cancer doesnt come back."
And I thought how nice it would be to keep my teeth. I could have kissed him when he said that. (But I thought better of it.)
He needs to get ahold of the PET scan to make sure all the bad stuff is isolated to that single (encapsulated) lymph node. And that no others have been affected.
Here is something that I just learned » a "Head and Neck surgeon" is different from an "ENT surgeon". (ENT = Ears, Nose & Throat)
An Australian friend, who is a doctor [ Internal medicine ] wrote » "You probably need a Head and Neck surgeon rather than an ENT surgeon, so that's probably what he means. Even within a specialty, one person can be better than his peers at certain things."
Radiation & Chemo vs Surgery
In that blue Radiation Oncology Patient handbook that I was reading down at Moores, I learned that the three pillars of Oncology are:
Tho not necessarily in that order.
Radiation & Chemo for Me » No Knife, No Surgery, No Cutting Open My Neck
[[ Update Nov 12, 2014 » My Radiation Oncologist called today and said that they are leaning toward » radiation/chemo. He called the chemo doctor a "Medical Oncologist". A new term for me. Yes, I felt somewhat dejected .. as you just want this whole thing to be over with. But I told him, "You guys are the experts. Whatever you feel is the right way to proceed, I'm totally with you." I went for a walk afterwards where I called some friends. They all said, "You sound good." <end Nov 12 update> ]]
Radiation Has the Greatest Effect on » Rapidly Reproducing Cells
Did you know that radiation has the greatest effect on » rapidly-reproducing cells? And that two of the most rapidly-reproducing cells are found in:
- the human fetus
That is why, in the nuclear industry, whenever a girl declares pregnancy ..
.. you ban her from working in any radiation areas. You give her a desk to fly.
Remind me to tell you about how I sometimes think of cancer as a vampire .. the living dead.
The undead .. which should be dead. But is not.
It lives and it sucks your energy. And at other times it just plain sucks.
Can you tell I've been thinking about this?
» The Long-Term Effect of Multiple Stresses on the Human Body
Perhaps I should also mention the effect of long-term stress on physical health. I mean, you can FEEL its effect. It works you. It eats at you. Who does not know what I am talking about?
For example, just a few days ago, I received an automated call saying » "You have not made a payment in more than 30 days. Please make a payment right away or else."
And I said to this automated message » "As soon as I get some money, I will. Thank-you for calling."
But I could FEEL the stress that came with that call. (Tho I said nothing to anybody.)
And the voice in my head said » "They dont care whether you live or die. They care only » about the money." Or so it seems.
In addition to financial stresses, their are legal stresses. And parenting stresses. I could go on, but my point is that these stresses gang up to take a toll on you.
One of the first doctors who I talked to about this swollen lymph node asked about my stress-level and afterwards said » "Long-term stress is not good."
Perhaps you have heard the adage » "Cancer is not caused by what you EAT; rather, cancer is caused by what's EATING YOU."
I am good at concealing stress. I try not to be a whiney complainer to friends about the circumstances arrayed to induce this stress. So people tend to be oblivious.
But it begs the question » How much stress can one man take?
And just when you think it cant possibly get any worse...
The end. ■
The theme of today's entry continues here (NEXT) » Verifying the Pathology (Nov 13, 2014)
The PREVIOUS entry in this topic is here » Existential No Man's Land Part Deux » The Chunks-of-Flesh Biopsy (Oct 15, 2014)
This topic BEGAN at the beginning of this month .. see here » The Existential No Man's Land Between Biopsy & Diagnosis (Oct 1, 2014)
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