Tis But A Flesh Wound

I've decided that my memoir should be titled "A Little Bit Bruised." I like it. Sounds like a Sheryl Crowe/Adele/Carrie Underwood song. Strong woman survives, even thrives, but there are marks on her. I'm not sure that this world is designed for unscathed women. In fact, if one gets to fifty years old without some kind of trauma, how much has she lived in this world? Come to think of it, who among us hasn't been beaten up, either literally or figuratively, by the end of freshman year of high school? 

Life is difficult. It's an obstacle course, a gauntlet, and only those who cheat, avoid it, or refuse to race escape without a few scrapes. I don't think it is truly possible to escape the obstacle course of life; it's always there. It's not a race against each other, or a goal of getting through unscathed. It's a mindset of "make it through the element, learn from it, become stronger, and go onto the next thing." Along the way there are cuts, bumps, and bruises. The wounds heal and we take the scars with us.

By the age of fifty-one, I definitely have the marks of a veteran soldier. The current wound I am working on healing is part of a larger scar from a big battle. Seven months ago my appendix burst and I had emergency surgery to remove the debris, part of my colon and intestine, and any infection. My surgeon tried to do the surgery laprascopically, but ended up needing to cut an eighteen inch incision in my belly-- from the middle of my front stomach to my right side.

I call my stomach Frankenbelly, as I was ready for Halloween on October 29 when they released me after nine days in the hospital. Those nine days involved:  

• seven days without solid food
• an injection of Narcan after a bad reaction to pain medication
• vomiting three times with staples across my abdomen after a premature attempt at liquids
• three days of an ng tube up my nose to pump out the contents of my stomach
• Covid-19 staffing and supply shortages, regulations, and visitor restrictions

I took home my Frankenbelly fully knowing I was in for a long recovery. I had old and new scars. Four and a half years earlier I had gone through a complete hysterectomy after a tumor burst on my left ovary. That surgeon couldn't do the simple, three-cut, laparoscopic surgery he would have preferred due to the size of the tumor. Instead the procedure he used was similar to a C-section, and I have a question mark shaped scar to commemorate my battle with cancer. Add to that as small, almost now indistinguishable scar above my right breast for a Port-A-Cath that was inserted for chemotherapy delivery. (I am glad to still have this technology, as it is still a big benefit.) Last fall, three more scars from the attempted laparoscopic appendectomy (one near the hysterectomy scar), a pea sized scar where my JP drain was inserted, and the eighteen inch monster were added. Add the purple, green, and yellow bruising, the swelling, and numbness, and my core was generally beat up inside. My organs had been shoved out of the way, rearranged, and reassembled.

Within 24 hours of my release I was back in the hospital. My incision had begun to ooze the fluid that comes with an internal infection. The nurse practitioner in my surgeon's office poked and squeezed out the gangrene they had missed when I was discharged. After surgery and the bad reaction to the pain medication, I never had a fever or needed pain medication other than the liquid extra strengthen Tylenol they piped into me. So this infection was difficult to catch until it forced itself out of me. I spent three more days in the hospital mainly to figure out how to manage my wound care at home. There was now a three inch or so section of that eighteen inch scar that was an open wound. It needed daily care that I couldn't do. Nor could I ask my husband or parents to try to do. I couldn't bring myself to look at the gaping eye of Frankenbelly. How could I ask my non-medically trained loved ones to do that?

Seven months later I am still working on healing the wound in my side. It's almost done. It doesn't hurt anymore, and is mainly an annoyance at this point. I'm trying to avoid a third silver nitrate treatment. It does drain some fluid, so it isn't closed up, but the tissue is healthy and not infected. It's just taken so long. (It's likely been drawn out by the blood thinner I've been on for six months to treat a blood clot that developed in my leg.

I've looked back on the challenges I've had to face these past seven months and come to the conclusion that I am one tough, badass woman. As things are about to close up, I am pushing myself not ask anymore "Why me, Lord?" I had spent most of this year's Lenten Season contemplating my wound. I asked Jesus, who has his own wound, "What about my wound, Lord?"

He came back with, "What about MY Wound, Dawn?" 

I'd not meditated on the meaning of the wound in His side. His Body sustained the wound when the Roman soldier thrust his lance into His side, and blood and water flowed forth filing the Holy Grail. Traditional belief says that like my wound, Jesus' wound was on his right side. When the Risen Jesus appeared to the doubting Thomas the Apostle, our Lord invited him to put his hand in His wound. Why? To prove that it was Him, that the Divine and Human Jesus Christ had risen from the dead. I believe that Jesus has conquered sin and death. I believed before I saw the wound. Perhaps I am not to know why for my wound.

Instead I am asking "What does this all mean? What have I learned?" I am way tougher than I ever thought I was. When I know that Christ is with me there is nothing that we can't handle. He gives me the grace and strength to navigate these elements of life. My past battle with cancer taught me that, and I've leaned on it again this past year. With God's help, I've managed to retain my spirit, my optimism, my youthful approach to life. I've learned to take things one day, one element, at a time. I've learned lessons in humility; using a walker for two weeks will do that. I've lost much of my pride and vanity; hospital gowns and going without a shower for a month (sponge baths only) are good for that. God provides what I need, including angels to lean on, help with healing, and show the way. Life is good, and it is up to me to choose joy. I count it all Joy. I will not let these elements on the obstacle course of life rob me of all the Good Stuff God has planned for me. I am a prayer warrior princess and I proudly wear my scars for the glory of God and His Kingdom.

Subject of the King

We are only half way through January 2021 and Christmas 2020 already seems like a distant memory. The Christmas season ended with The Baptism of Our Lord and we are now in Ordinary Time in the Catholic Church calendar, but there are important lessons from the Christmas Season that I need to engrave on my heart and soul, things I seemed to have missed. Earlier this month we celebrated the Feast of the Epiphany in the Church. It's a very important feast that I think was largely overlooked this year. The chaos of 2020 (not just Covid-19, but the whole smorgasbord of events that have been cooked together) have managed to accomplish what Christians of the modern age of consumerism have been crying out against for decades-- taking Christ out of Christmas. So little mention of Him. In scaling back our gift giving, feasting, traveling, gathering, and singing, we missed the whole point. Yes, the Star came this year in the conjunction of Saturn and Jupiter and we gawked at it with fascination, but have we earnestly pursued the infant King of the Jews?

"Where is the infant king of the Jews?"

Without the carols, the elaborate worship services, and participation the Eucharist, have we sought Him who the star proclaims? Have we heard the angels sing? 

I've been spiritually distracted by this world's nonsense-- and that is what it is- no sense. In letting my mind pay too much attention, my heart has been lured away. Oh, to have had the focus, the passion of the Wise Men and the Shepherds! They traveled long distances, stayed awake, overcame obstacles, endured hardships, to make it to the manger. What did I do? I got distracted by the mask issues, the social distancing, the protocols, the silence, the meal that didn't turn out, and one trip to the ER. The virus, social unrest, and the election confusion dominated the headlines and my thoughts. I missed hearing the angels bring glad tidings and the stars declaring the Glory of God. Fortunately my God is a patient and forgiving God, and the invitation to come worship and adore Him is 24/7/365. So my own epiphany came on the last day of the Christmas Season and is carrying me into Ordinary Liturgical Time during Pandemic Time.

When I taught seventh grade religion more than a decade ago, a whole life ago, I learned so much from and with my students. They were my inspiring muse in finding a deepening relationship with Jesus. One January, as we returned from Christmas Break we discussed the second chapter of the Gospel of Matthew. What makes a man a king? Three types of kings were present: Herod, the magi, and the Christ Child.

Herod the Great by all accounts was a vicious man. He enslaved his people to build huge and dangerous projects in his honor. He was suspicious of everyone around him and even had his own family members killed. He ruled with fear and when he learned a new king had been born, he had all the baby boys under two years old killed. The Slaughter of the Innocents is a horrific reminder that "absolute power corrupts absolutely."(Lord Acton) Herod's pursuit of the Christ Child was motivated by his fear and the selfish, idolatrous desire for power. Despite his words, he had no desire to worship Jesus.

The magi or kings were from the east, probably Persia. We have no idea what kind of men they were in their daily life, nor what kind of power they wielded over others. They were motivated by intellectual curiosity for sure, and perhaps spiritual desire. They may have envisioned this new king as a kind of successor to themselves when they started out on their journey. If they did, that changed by the time they found the Child with Mary and Joseph. Their response to finding the Child was to do Him homage. they prostrated themselves before Him. As I explained this to my students, I realized then and now that we Americans are ignorant - for better or for worse-of what a national king is. For many years Elis and The King of Pop ruled over music and culture in many ways, but we Americans still don't grasp the concept of a royal family with a king. We obsess from an ocean's distance over England's royal family, but when it comes to kingly leadership and rule in this country, we reject it. Thankfully, George Washington wanted nothing to doe with a crown and we Americans bow to no one but God. (These days I don't think we bow to Him at all, if we ever did. We are more likely to take a knee to our own ideology.)

Since we have no king in America, we should take some time to really think about this action of paying homage, bowing, laying prostrate before another. Bow. Genuflect. Kneel. Prostrate. They are all different levels of homage. Each one puts us subject, literally "thrown under another's rule." The question becomes how much under? The bow puts a person under but still with dignity and freedom of movement and defense. When one genuflects one loses the ability to move about freely but can spring up in an instant. When one kneels on both knees one gives up to the ruler the ability to move. To prostrate one's self means to lay in the dirt face down in all humility and subjection. There is no ability to strike out, defend, or move. All power and glory is given to another. 

This is what the wise men, the magi, did upon meeting the Christ Child. After an arduous journey, with their wealth and power at another King's feet, they laid down in the stable before the God-Man. How moving and wondering a scene for Mary and Joseph! These men of Persia to laid down like the Persian rugs they once thoughtlessly waked on, and before a Baby? What a marvelous thing. Such devotion. Such faith. Such humility. The wise men were saying in the most powerful way, "You are our king. The King of all kings. We place ourselves under your feet, your rule."

To get closer to the effect of this my students and I practiced the experience of being prostrate. When was the last time I have laid faced down on the ground? We got out of our chairs and laid moved to lay with our noses to the tile floor of the classroom. It wasn't an easy thing to do as spoiled Americans in the 21st century. Before they were even flat on their well-fed bellies, my students were complaining. "Ow! my knees." "The floor is cold!" and "Ew, it's dirty." Non of use felt comfortable not being able to see everyone else. How long did we have to stay that way? Until the King says "You may rise." We are at the mercy of the King.

Several lessons later, while covering first meetings of Jesus and His disciples, we had a discussion about how we would respond to Jesus' invitation to "Come and See". What if Jesus walked into the classroom right now? How would we respond? Hands shot up, but I wanted them to act it out.

"Don't tell me; show me! Right now!"

A significant number of the boys and girls got out of their desk simultaneously. Immediately they lay prostrate on the floor. If the King of Kings came into the room, they pay Him homage. More than a decade later I still wonder at their faith. Unless I have the faith of a child I will not see the Kingdom of God.

The King of Kings has come into my world of 2021. Have I come to adore Him? I need to put everything-- all of my being and my life, my thoughts, my dreams, my fears, my riches-- all of it under His feet. This Ordinary Time before Lent is about me repositioning myself. It's about gaining the wisdom of the magi and the faith of my students. It's about humbling myself. Then He will lift me up.

A Day In the Chemo Life

I have one chemotherapy treatment left and I thought it would be good for me to recount what a day and week of chemo have been like for me. Chemotherapy affects everyone differently and, of course, not everyone is on the same course of drugs, doses, or frequency. Hence, my story is just my story, and does not reflect what it is like for others. Still, if I had read a complete account beforehand I would have had a better idea of what to expect. Maybe.

The basic schedule of my chemotherapy regime was eighteen weeks long. Six rounds. Each round began with carbo-platin and taxol given on Day 1, a Thursday. This first Thursday of the round involves more extensive blood tests and an office visit with my doctor or nurse practioner. The following two Thursdays, days 8 and 15, were days I only received the taxol.  I felt good on Thursdays and Fridays. I would go to work for half a day on Fridays.  Saturdays and Sundays are my low days that I need more rest on and don’t have the energy to focus on things. Mondays I come out of the chemo fog, so I put in a half day of work. Tuesdays and Wednesdays have been good days, so I often put in full days. Every Thursday for the past five months I have spent the mornings and early afternoons at the Esther Marie Hatton Cancer Center at St. Elizabeth receiving my treatments.

Thursdays are days I’ve gotten to sleep in a bit. Usually my appointment would be at 8:30 am (sometimes as early as 8:00 am or late as 9:30 am . I get up at 7:00 am to give myself my blood thinner shot. I get ready, making sure to choose a top that makes it easy for the nurse to access my port. (The port-a-cell was inserted in early June for easy access for blood draws and administering medicines and chemotherapy.) I also put a bit of lidocaine on the port and cover it with plastic wrap so that it has an hour to work its magic. I use this to avoid a bit of annoying pain. When the nurse attaches my port to the drip line there is a decent pinch. The lidocaine masks that. It’s not a big deal, and I have forgotten to apply it once or twice so I endured the pain. But I figure any pain that doesn’t have to be felt shouldn’t. It helps save my strength for bearing other things. Plus, it has helped me to not fear that approach the nurse has when she comes at me with that contraption with the stick and tubes because I know it won’t hurt me.

Mom and Dad have gone with me to almost all of my treatments (they have selflessly given me their Thursdays and their time, home, and love throughout the past five months. They are my heroes.) We pile in Dad’s car with my bag of supplies. Fortunately for me, the cancer care center is about fifteen minutes from their house and in an area very familiar to all three of us. Some of the patients there have to travel a much longer distance to a place that doesn’t feel like home.

A warm welcome is always waiting for me at the front desk when I check in. After 18 weeks, they know me on sight.

Gina, the receptionist at the front desk, checks me in as soon as she sees. Mom and Dad scope out their seats in the waiting room by the coffee machine and the cookies. I like the soft chocolate chip cookies, so I take a few for the back room. Either Mom or Dad will go back with me, as there is space for only one person to accompany me to the actual treatment room.

My nurse for the day comes to get me, asking the now frequent question of my name and birthdate. The treatment room has actually two areas, a kind of figure eight with the nurses’ station and desk in the middle. One side is larger than the other. The outer edge of the room is rimmed with reasonably comfortable lounge chairs for the cancer patients. I usually choose one away from the television on the wall. While I get myself organized and Mom or Dad finds a chair next to mine, my nurse gathers her supplies to get me hooked up.

The treatment chairs at the cancer care center.

There is a tray that I pull over my lap for my supplies and later my meal. It might look a bit like a little old lady’s bingo table with all of her trinkets and lucky charms, but really it’s all my artillery. The chair is my battle station, and I need to keep my head in the right space. So I pull out of my bag several items. My Comfort Cross. My cell phone. A Pooh Bear. Coloring pens or pencils. An inspirational picture to color, often with scripture on it. A Sprite Zero, cup of ice, and two cranberry juice cups to make my “spritzer”. In my lap is a prayer blanket my cousin Jenni gave me. These items keep me from thinking dark thoughts, combining comfort from my faith, childhood, creative side, and my network of people who love me.

My nurse cleans up the port site, which is located above my right breast for easy and comfortable access, and prepares to hook me up. I don’t know the technical term for the stick and the line that she attaches to me. She feels around for the solid lump that is just below the surface of my skin. It’s about the size of a quarter and 75 cents thick. When she gets a good sense of where the placement is she counts to three and sticks it in. I don’t feel anything but pressure. A protective bandage goes over the area. First she pulls out the preservative liquid (I forget the name) that they put in at the end of my last one. Next she draws blood out. It’s weird to see my blood coming out of my chest into tubes but not feel it—I feel disconnected and can only briefly ponder what is happening. Then it rushes upon me and I have to look away from the connection and the flow.

Here I am with my line attached to my port. Trust me, it doesn't hurt.

After the blood draw is done (anywhere from one to four tubes depending on the week), she flushes out the line so that it is ready to receive next. I like this step. It puzzles my nurses, but no one else has my memories. The sense of smell triggers strong memories. When she flushes out the line she uses a sodium chloride solution that we patients can either taste or smell. I smell it, and happy memories of playing in the chemistry labs at Thomas More College rush upon me. In an instant I am spinning on the stools with Jeff or sporting Mom or Dad’s lab coat while we wash beakers and flasks. Happy family memories. It’s one of the best parts of my chemo day and the nurses think I’m nuts because no one else likes it.

A few of my coloring projects that have kept me focused on the right things.

Now we wait for the blood results. This can take anywhere from a half hour to two hours, depending on how busy the lab is. Last week’s took two hours because they have a new system in place with more checks. It’s during this time that Mom and I work on a daily word puzzle we found we like to do together. If Dad is with me he reads and I color. I really like the prayerful, therapeutic nature of coloring. It’s peaceful, creative, productive, and cheerful. It’s time for me to just be with Jesus while in the cancer center. And He is definitely there. Sometimes I forget He is with me, and I see Him sitting with someone else who has a situation much more dire than mine. He is there lending strength and reassurance in the family and friends sitting next to them and in the nurses who offer their wisdom and soothing touch.

Once the blood tests reveal that my counts are good and I am cleared for treatment, the nurse puts in the orders with the pharmacy. My pre-meds are delivered. These are anti-nausea medicines that help me to handle the chemo. Thankfully they have done their job well. Zofran and decadron take the first twenty minutes to drip through my port. Then the next twenty minutes are busy. Pepsid and Benadryl are the last pre-meds. By this time with all these new fluids, I have needed to make at least one trip to the restroom. I unplug the pump machine from the wall and take the IV pole with me.  It’s on a battery pack, so it continues to do it’s job. I try to go the closest restroom as Benadryl makes me very loopy and sleepy. I really shouldn’t have a license to drive the IV pole! Before Benadryl has finished dripping into me, lunch comes. I get a hot meal each time I am there. The fried chicken, mashed potatoes, mac n cheese and green beans hit the spot when chemo is up ahead.

I can usually tell when the Pepsid-Benadryl mix is done, as my eyelids are very heavy. Sometimes I miss when my nurse administers the chemo because I am in dreamland. But usually I am aware of her showing up in her plastic protective gown and mask. She protects herself from exposure to the chemo, hangs a bag labeled with the cautionary icons for chemotherapy, and hooks it up to my line. She sets the pump for one hour titration, and I drift off. An hour later I hear the loud beeping from the pump that signals we are done. Aside from still feeling sleepy I don’t feel any different.

The nurses' station in the cancer care center with a few mobile computers. They have individual computers on carts that they pull up to the patients to do the chart work. It is a busy but very organized place.

My nurse turns off the beeping and disconnects the line from my port. She disposes of the whole contraption of tubing in the sharps bio-hazard container. She prints out a report for me that summarizes the medicines and procedures done that day and the upcoming appointments. I’ve been tracking my numbers, so I like to take the report with me. Plus, it helps me to keep track of my appointments.

When I get home I lay low for the rest of the day. I will usually sleep for another hour or two. Once the Benadryl wears off, I feel good. I find it difficult to sleep on Thursday nights because one of the pre-meds is a steroid that keeps me up. For this reason I usually only work a half day on Fridays. I feel fine, but I need to catch up on my sleep. I’ve never really felt sick to the point that I might vomit. There were a few times that I felt nauseated, but I took some of the anti-nausea medicine and it backed off. Generally, I just don’t have the energy. But that will come back, as will my hair, eyebrows, and eyelashes.

My last treatment is scheduled for this Thursday. I’m excited. It’s like the finish line of a marathon is in my sight. Crossing it doesn’t mean running is over. It just means that this leg, this race is complete. There is more to do—CAT scan and doctor’s appointment about the follow up that I will have to do for the rest of my life, both of which are the following week. I am by no means done dealing with this topic of my cancer, but I should be done with the chemo.

Hiccups, Bumps and Bruises

“We have some unexpected developments, huh? You doing okay?” he asked.

I instinctively smiled; it’s not hard to smile at my straight-shooting, young doctor with a sparkle of the boy still left in him. In any other career he probably would not have already lost so much of that fun-loving nature, but I am sure that being a cancer doctor takes a toll and matures a man beyond his years.

It was unusual for Dr. Pavelka, my remarkable gynecological oncologist, to be in the cancer treatment area Thursday, August 24. I don’t think he popped in on “our” side of things just to see me, but he did have reason to stop and reassure me. I greeted him, hoping to get some answers from him. Like most doctors who specialize in certain cancers, I imagine he has way more patients than he should or wants. That alone accounts for him having two wonderful nurse practioners who help handle his appointments. I don’t get to see him for all of my doctors’ appointments, which happen on the first of three cycles in each round of chemo. I see him about every third one of those. (That means six scheduled doctors’ appointments, but only two or three with him. They do work well as a team- the whole place does.)

“We have hiccups,” I replied, with a smile. 

His eyebrow danced up. “Hiccups, too?”

“No, silly. Not literally.” I nodded to my right leg which was propped up in the chemo treatment chair.

Dr. Pavelka chuckled and then turned serious. “Don’t worry about this. These things happen with chemo patients. We’ve got a plan and the nurse is talking with your insurance right now. It’s all just a bump in the road.”

The main wall of the vascular area of St. Elizabeth. Something to think about...

On that Monday I had noticed a tightness in my left leg that resembled the after effects of the charlie horses I used to get. I didn’t remember getting one, but I thought maybe a cramp just had to work itself out. On Thursday it was still around and I mentioned it to my chemotherapy nurse. She said she didn’t think it was a cramp, but that she would bring it to the attention of my doctor. She reported back that my doctor had ordered a sonogram of my leg to rule out a blood clot. A visit with one of the nurse practioners calmed my nerves and I was taken to the vascular area of the hospital. The sonographer explained things to me as she took sonograms of both of my legs from the ankle to groin. She wouldn’t tell me what she saw, but she did tell my nurse who wheeled me back to the cancer care center for my scheduled chemotherapy.

The word was that two blood clots had developed in my right leg, one in my calf (where had I felt the tightness) and behind my knee. Back at the cancer care center, my dear friend Amy was sitting in my chair visiting with my dad. She had come to experience my chemo treatment with me and support me. Her presence gave me more peace. After a hug, I took back my chair, and the nurses resumed my chemo routine. I was surprised by this, but glad we were going ahead with the long day. Visiting with Amy kept my mind off things and I'm glad we could bond over this. I had thought I would be leaving by 2pm and Amy would take me home, but all these developments meant it would be more like 4pm. Amy stayed as long as she could and Dad would see that I got home. I was assured that Dr. Pavelka had a plan to address the clots and the nurse was already coordinating with my pharmacy and insurance the best course of action. I took the fact they were going to proceed with my chemo treatment to mean that things were going to be okay. 

The support and love of friends like Amy mean so much!

That’s when Dr. Pavelka. came in. It turns out that it was more difficult to get my insurance to cover the life-saving treatment than to diagnosis and prescribe the treatment. Finally all parties agreed upon a blood thinning regime of subcutaneous injections twice daily for six months. Seems like a long time to me, but it’s what needs to be done. So for the next six months I am injecting a blood thinner in the fatty area of my stomach (that’s about anywhere on my stomach) twice a day. I get a reminder on my phone at 7:00 am and 7:00 pm to the tune of “Ode to Joy.” Good thing bikini season is over; I’m covered in tiny bruises in various states of healing and will be for awhile. 

Two weeks later Dr. Pavelka and I were discussing bumps in the road again during a scheduled visit with him before the start of my second last round of treatment. (I receive weekly treatment every Thursday. Six rounds with three treatments each. I am about to begin round five.) I had visited the cancer care center briefly the day before for my blood draw. Evidently two of my counts were low, my white cell count and hemoglobin. I had noticed that things were trending that way, so I wasn’t completely surprised by this news.

Dr. Pavelka wasn’t surprised either. He says that the effect of chemo is cumulative and that I should expect it to be harder now than in the beginning. I had noticed that I was getting more lethargic and my resting pulse was higher. He says that both are directly tied to these lower counts brought on by my chemo therapy. His treatment plan was to postpone the start of round five one week to give my bone morrow a chance to recover and to put me on an iron supplement.

Despite the blood clots and the lower counts I am doing well. I get very tired quickly, but I donn't experience the sickness we imagine with chemotherapy. I am taking anti-nausea medicines that really work. Still I don't like these hiccups and bumps. Dr. Pavelka admonished me, “You can’t expect everything to go smoothly all the time.” 

Yes, I can, and I do. But I am learning to nod my head and be flexible. I’m adjusting my brain around these developments. I’m disappointed that I’ll have to postpone some vacation plans Dan and I had discussed. I’m trying to be kind to myself, but not be lazy. I’m working part-time (24-30 hours a week), working on some creative projects when my brain is working, and trying to be more helpful around the house. I am still largely staying with Mom and Dad, for which I am greatly thankful. They are a great reason for my peace of mind, and the fact that I get fed and have clean clothes to wear.

“These are just bumps in the road. We are on the right course,” assures Dr. Pavelka.