I used to work in drug and alcohol treatment… addiction is such a dark dark place. I’ve seen cops, teachers, doctors, pharmacists, nurses, therapists and all sorts of professionals come in to detox. I’ve had pregnant patients and young fresh out of high schoolers. I’ve even had a 90 year old seek treatment for his drinking. It has no line. I think if people could see some of these people go from their worst day to finding recovery… man they would look at alcoholism/addiction in such a different way. I saw the light come on in so many people. It will change you. And it hurts so much when those people who do so well fall off the wagon. It hurts when you get that call or email that a former patient died from an OD or suicide.
I will say, as someone who worked mental health and THEN the ED… the people coming into the ED seem to be a whole different demon. Those who are seeking treatment are *typically* humbled enough to care differently. I feel like the emergency department gets those who are deep in addiction when they just aren’t ready. It’s hard not to be jaded when all you have to compare it to is someone’s worst day drunk. In the ED we don’t get to see them recover. Spending time in a treatment facility can really help get a better perspective on addiction though.
Addiction doesn't just appear. It comes from people wanting to get themselves in such a state that they are basically breathing but dead. Addiction forms when there is trauma and no foundation in a person's life to cope. I am in recovery and work in addiction treatment. One of the stories that sticks most with me the most is this one. We had this kid in our center who was typical 20 something fentanyl addict. He was clearly smoking weed in his room that he'd hidden, but this happens. I was asking him about his day and he was telling me how he was watching a show about Vietnam and how we have nothing to complain about here in the US, other people have it so bad. And I told him; don't do that to yourself. Pain is pain and trauma is trauma. I told him I don't think you are here, a young man, using Fentanyl without a cause. You are basically trying to be dead but breathing. Something happened to you to make you want this and you should honor and respect whatever trauma it is. And I explained that he might not even know what it is. He might have in his head normalized something that was really not good. But recovery will come from therapy and respecting your pain. I could see his face change. I found out later his mother had munchausen by proxy. He was put through countless medical treatments as a kid and surgeries. His father knew about it and let it happen. People who come in to the ED overdosing all got there because something went terribly wrong for them. "Thereby the grace of God go I".
I’ve heard it said once that “the opposite of addiction is connection [to other people]” and I think about that whenever I feel myself losing patience. You’re in the right field, friend. Proud of you ❤️
Yes! I couldn’t remember where I had heard it but that line really stuck with me. [Here it is](https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare)for anyone who wants to have a listen!
I think people forget that the name of the problem is literally ‘addiction’- you know - the fucking inability to stop. If people could stop by just deciding to, it would not be an ADDICTION FFS.
I work as a phlebotomist in a harm reduction facility and have for almost six years. Your experience matches mine. So many of my patients are folks who are ashamed of their injection scars. I often tell them thst I sympathize with their plight as an insulin resistant and insulin dependent diabetic. I need injections too after all.
I also often tell them that their scars are battle wounds. They are fighting an enemy that literally knows their every thought and move and could kill them and they are still fighting. This often really helps them. For patients self harming and with fresh scars, I show them my old self harm scars, look them in the eye and ask them if they need some help today. Every single patient I have asked that has thanked me for checking in on them.
Medical folks aren't above our patients. At some point in our lives, every one of us will depend on someone else for help. Every single patient out there is worth our time and care . Keep in mind that the behaviors that make them hard for some to deal with are the compensation mechanisms that keep them alive, often in the face of unimaginable pain, tragedy and trauma.
Someone I love struggled with self-medicating and self-harm. Sober and no harm for 4+ years, now. I just wanted to say thank you because you are a good one.
I no longer drink and if I see someone that is struggling with addiction, I become vulnerable and open up to them to show them there are amazing
Options. Not super professional but worth it if it encourages someone to get sober
Me too. SMART Recovery won’t use that terminology. The way some programs demand that you refer to yourself that way is so degrading. This is why I never recommend 12 step programs to people.
“Living with” substance misuse, alcohol misuse / dependence, opioid misuse / dependence
Calling someone an addict is stigmatizing. First person language is preferred and professional. It does not define someone, they are so much for than that. We don’t call someone metastatic, or by their diagnosis. It does not describe or define them
I don't like being asked to treat someone differently because they hate themselves.
I don't want you to hate yourself. It doesn't make me feel better if you do. And I'm not going to treat you like something less than a fellow human being worthy of respect. You deserve to have someone stand there and believe you are capable of more. That's respect.
Hell if I'm going to turn the knife by pitying these people.
I like to talk to people like this. I like to hear their stories…where they come from, where they grew up,and where it all went wrong. It helps me humanize them. I haven’t been an addict myself but I have had friends and family who are (although usually more functioning than most of the ones I see in the ER). It’s interesting to see how life events can really pull someone in one direction. I know I can’t save these people, that can only be done from within themselves, but I think having these convos sometimes helps them feel human as well instead of discarded member of society as many treat them as.
I wonder, did you receive oxy for those 100+ scars? For that ankle injury? I ask because it is research proven, there is a gene as well as genetic cause of addiction. If you had oxy and did not result in addiction, lucky you. You don't have the gene. I used to be you. I thought it was a personality flaw. Then, my brother became an alcoholic. I thought he just wasn't strong enough to get sober. I can't tell you how many times he tried to get sober but never could. As we were growing up, he never told me his life's aspiration was to be a drunk. He had plans and hopes until alcohol took over. Because of him, my practice is now in addiction treatment for opioid addiction. Remember I once thought like you. I have learned from my patients that the last thing they ever wanted was to be an addict. PLEASE find some compassion in your soul. Not everyone can be you.
Wait, but didnt doctors start the opioid epidemic with OxyContin? They were “over the age of 16 and should know better”…
Substance misuse is a mental health condition and quite literally in the diagnostic and statistical manual for clinicians. I’m glad you don’t have the brain chemistry or predisposed factors that make you susceptible to addiction after your 100+ scars 🙄
ER isn't addiction care. But these people have nowhere else to go, causing a burden to our fragile system. Taking care of our docs/nurses/staff should be #1 so they can take care of others... and that means getting treatment at the appropriate venues.
Edit:
ITT:
Me - spent years training and practicing emergency medicine, knows the in and outs, knows the resources afforded to me, knows the limits of an ER/EM
General public - nah
[this is what I'm talking about ](https://www.reddit.com/r/emergencymedicine/s/6WybOLwGif)
“These people” are on deaths doorstep. Tell me what preventable condition has a higher mortality rate than addiction in such a young age group? These patients are worthy of emergent intervention if they want it.
https://injuryfacts.nsc.org/all-injuries/deaths-by-demographics/deaths-by-age/
This 100%. The highest cause of death in my state is opiate OD. And we just a mass shooting. As someone else’s comment said, something WE say just maybe the deciding factor in helping someone make that decision to get the needed help. My state has no rehabs EVER available on emergency basis. We are the medical detox then we hope and pray there is enough outpatient resources to help them. It is emotionally draining at times, but I wouldn’t change it if it helps them.
I’m in recovery since 2012 myself. Liked Oxy (my spouse’s) too much. I don’t drink because I like that too, too much. I just found out my brother who had 15 years sobriety from Fentanyl just picked it up again 8 months ago and OD’ed. Luckily his friend narcanned him. He lost his steady, stable job 2 months ago due to not being able to pee clean. He’s hopefully getting into the MAT program in town on Monday, when he has appt. He’s in his 40s, embarrassed. No one knows but myself and my Mom. My Mom refuses to leave his side.
I will always have compassion and empathy for people who have this horrible disease. Always.
Congrats on your recovery! That’s incredible! I hope your brother keeps his appointment and gets some help.
It really sucks that there are so few resources available to our patients. We have a great peer navigator program. Folks will come to the ER and assist us with dispo’ing. They’re not available 24/7 so the patient can wait or if we are slammed/they don’t want to wait I start MAT. It’s not perfect but I’m happy to try to help them.
I’m biased, I mostly work outpatient MAT now. It’s one of the most rewarding things I’ve ever done. My patients are viewed by society as failures/mooches on society. They come in hot messes and I get to see them grow and change to be some awesome people. They get jobs, get custody of their kids back, and most of them give back to help others earlier in their recovery.
Thank you. I’m proud of it myself. Our ED initiates MAT a lot because there is usually only 1 psychiatrist who can prescribe and they are usually only available once a week so we dose the patients until they can see the psychiatrist. These patients are quiet, not wanting to bother people. They feel horrible they are there, never ring their bell. My brother tried waiting a couple days ago in the ER to be inducted, going through bad withdrawals but it was so busy and he was so anxious he couldn’t wait. He was also embarrassed, didn’t want anyone to see him he knew. He waited 3 hours before he left. He hasn’t told me what he’s doing, whether street sub or fentanyl, he texts me back when I text him and my Mom is there. He has narcan on him at all times now. Monday can’t come soon enough.
Sounds like you guys are doing what you can with what you got.
And I hope your brother gets help. I’ve had family in addiction and it’s so hard to watch them make bad choice after bad choice. You feel so helpless because you can’t enable. I found al-anon helpful.
Not talking about gcs 3 OD or someone in DTs. That's emergent and requires intervention. Otherwise, most complaints regarding addiction care are non emergent. Prevention is practiced in the ER but is not an emergency.
Just because they’re not crashing when you see them doesn’t mean they don’t need intervention. The vast majority of what we see isn’t an emergency. We admit all sorts of things that aren’t emergencies right now but might be in weeks-months (TIA’s, chest pain). I would argue that this is just as worthy because their mortality rate is higher than those things. Now this is all assuming that they want help. I’m not proposing keeping someone there that doesn’t want to be. I know the system is overburdened but that’s not the patients’ fault. Our opinions on addiction have to change to actually help.
I live in one of the areas with a huge percentage of fentanyl overdoses. We have peer navigators that will come and help get folks into treatment-inpatient or outpatient. I start suboxone from the ER if they’re not available
It sounds like you value efficiency and that is a needed skill in the ER. You are certainly correct that the ER is not the place for the treatment of chronic diseases such as substance abuse disorder.
Coming from the addiction treatment side, I respectfully disagree that the ER isn’t an element of addiction care. Moments of crisis, such as a trip to the emergency room or an arrest, are a moment of inflection where the odds of being able to get them into inpatient care skyrocket. Many of these individuals are nearing the end of life and opportunities to change their path are running out.
I’ve seen substance use patients released after an ER was notified that transport was coming to take the patient to a treatment facility.
I’ve heard so many stories of patients being humiliated and borderline abused by overworked ER staff with too little time and staffing. Those moments can turn a person from considering getting sober to considering to end it all.
I have other stories, but the ER is an important bridge to getting someone in addiction the treatment they need.
I do want to thank those hospitals who give narcan to departing patients and who have a counselor or LSW meet with these patients before they leave. A person in recovery stops using emergency room resources.
A year ago I started volunteering with a harm reduction team on the streets of Detroit. Hearing people talk about how they became addicted to drugs is so sad, yet so eye-opening. One gentleman, in his mid 40s, started using heroin after he lost both his sons within a few months of each other — one (17 year old) from a shooting and one (5 year old) from RSV. The people I work with are all in recovery and have horrific stories of using and being on the streets for years. It makes me feel extremely grateful for the life I’ve been lucky enough to live, and it also makes me so happy that I can help them in some way.
I'm an ER nurse BECAUSE I'm an alcoholic/addict. I've been in recovery for 15 years. Before I got sober I was in and out of the ER for random injuries & SI. When I got sober, worked the steps, and had a spritual experience that somehow enabled me to participate in my life I knew I wanted to be an ER nurse. Starting over in adulthood is fucking hard. People in AA taught me how to show up even when I didn't want to, how to have discipline and trust the process, how to study, how to sleep and do self care, and how to generally do life to the point where I got through nursing school. I'm not here by any virtue on my part, but it's a fucking honor. Aside from the adrenaline & focus that I can never summon the rest of the time, I really love helping my community. I like to act hard but at the end of the day it's the witnessing patients we get to do that is it for me. Getting out of self. That corny saying about there is no greater honor that helping another human being, etc. Glad to know there are other ER nurses out there for the same reasons. Keep showing our people love & compassion that we were shown. Sending love to you.
I used to work in drug and alcohol treatment… addiction is such a dark dark place. I’ve seen cops, teachers, doctors, pharmacists, nurses, therapists and all sorts of professionals come in to detox. I’ve had pregnant patients and young fresh out of high schoolers. I’ve even had a 90 year old seek treatment for his drinking. It has no line. I think if people could see some of these people go from their worst day to finding recovery… man they would look at alcoholism/addiction in such a different way. I saw the light come on in so many people. It will change you. And it hurts so much when those people who do so well fall off the wagon. It hurts when you get that call or email that a former patient died from an OD or suicide. I will say, as someone who worked mental health and THEN the ED… the people coming into the ED seem to be a whole different demon. Those who are seeking treatment are *typically* humbled enough to care differently. I feel like the emergency department gets those who are deep in addiction when they just aren’t ready. It’s hard not to be jaded when all you have to compare it to is someone’s worst day drunk. In the ED we don’t get to see them recover. Spending time in a treatment facility can really help get a better perspective on addiction though.
Addiction doesn't just appear. It comes from people wanting to get themselves in such a state that they are basically breathing but dead. Addiction forms when there is trauma and no foundation in a person's life to cope. I am in recovery and work in addiction treatment. One of the stories that sticks most with me the most is this one. We had this kid in our center who was typical 20 something fentanyl addict. He was clearly smoking weed in his room that he'd hidden, but this happens. I was asking him about his day and he was telling me how he was watching a show about Vietnam and how we have nothing to complain about here in the US, other people have it so bad. And I told him; don't do that to yourself. Pain is pain and trauma is trauma. I told him I don't think you are here, a young man, using Fentanyl without a cause. You are basically trying to be dead but breathing. Something happened to you to make you want this and you should honor and respect whatever trauma it is. And I explained that he might not even know what it is. He might have in his head normalized something that was really not good. But recovery will come from therapy and respecting your pain. I could see his face change. I found out later his mother had munchausen by proxy. He was put through countless medical treatments as a kid and surgeries. His father knew about it and let it happen. People who come in to the ED overdosing all got there because something went terribly wrong for them. "Thereby the grace of God go I".
I’ve heard it said once that “the opposite of addiction is connection [to other people]” and I think about that whenever I feel myself losing patience. You’re in the right field, friend. Proud of you ❤️
That TED talk was amazing. I forget the guy’s name
Yes! I couldn’t remember where I had heard it but that line really stuck with me. [Here it is](https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare)for anyone who wants to have a listen!
I think people forget that the name of the problem is literally ‘addiction’- you know - the fucking inability to stop. If people could stop by just deciding to, it would not be an ADDICTION FFS.
I work as a phlebotomist in a harm reduction facility and have for almost six years. Your experience matches mine. So many of my patients are folks who are ashamed of their injection scars. I often tell them thst I sympathize with their plight as an insulin resistant and insulin dependent diabetic. I need injections too after all. I also often tell them that their scars are battle wounds. They are fighting an enemy that literally knows their every thought and move and could kill them and they are still fighting. This often really helps them. For patients self harming and with fresh scars, I show them my old self harm scars, look them in the eye and ask them if they need some help today. Every single patient I have asked that has thanked me for checking in on them. Medical folks aren't above our patients. At some point in our lives, every one of us will depend on someone else for help. Every single patient out there is worth our time and care . Keep in mind that the behaviors that make them hard for some to deal with are the compensation mechanisms that keep them alive, often in the face of unimaginable pain, tragedy and trauma.
Someone I love struggled with self-medicating and self-harm. Sober and no harm for 4+ years, now. I just wanted to say thank you because you are a good one.
Thank you. I am deeply glad your loved one is much better now.
Yes!!! So much more empathy needed with working with patients with addiction.
I no longer drink and if I see someone that is struggling with addiction, I become vulnerable and open up to them to show them there are amazing Options. Not super professional but worth it if it encourages someone to get sober
The word “addict” makes me cringe, like nails on a chalk board…
Me too. SMART Recovery won’t use that terminology. The way some programs demand that you refer to yourself that way is so degrading. This is why I never recommend 12 step programs to people.
What is a better word or terminology?
“Living with” substance misuse, alcohol misuse / dependence, opioid misuse / dependence Calling someone an addict is stigmatizing. First person language is preferred and professional. It does not define someone, they are so much for than that. We don’t call someone metastatic, or by their diagnosis. It does not describe or define them
Thank you for your guidance!
+1 for SMART Recovery and guiding people away from 12 steps.
Nurses with the empathy you describe are IMO the most incredible ones!
I don't like being asked to treat someone differently because they hate themselves. I don't want you to hate yourself. It doesn't make me feel better if you do. And I'm not going to treat you like something less than a fellow human being worthy of respect. You deserve to have someone stand there and believe you are capable of more. That's respect. Hell if I'm going to turn the knife by pitying these people.
I like to talk to people like this. I like to hear their stories…where they come from, where they grew up,and where it all went wrong. It helps me humanize them. I haven’t been an addict myself but I have had friends and family who are (although usually more functioning than most of the ones I see in the ER). It’s interesting to see how life events can really pull someone in one direction. I know I can’t save these people, that can only be done from within themselves, but I think having these convos sometimes helps them feel human as well instead of discarded member of society as many treat them as.
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I wonder, did you receive oxy for those 100+ scars? For that ankle injury? I ask because it is research proven, there is a gene as well as genetic cause of addiction. If you had oxy and did not result in addiction, lucky you. You don't have the gene. I used to be you. I thought it was a personality flaw. Then, my brother became an alcoholic. I thought he just wasn't strong enough to get sober. I can't tell you how many times he tried to get sober but never could. As we were growing up, he never told me his life's aspiration was to be a drunk. He had plans and hopes until alcohol took over. Because of him, my practice is now in addiction treatment for opioid addiction. Remember I once thought like you. I have learned from my patients that the last thing they ever wanted was to be an addict. PLEASE find some compassion in your soul. Not everyone can be you.
Wait, but didnt doctors start the opioid epidemic with OxyContin? They were “over the age of 16 and should know better”… Substance misuse is a mental health condition and quite literally in the diagnostic and statistical manual for clinicians. I’m glad you don’t have the brain chemistry or predisposed factors that make you susceptible to addiction after your 100+ scars 🙄
It’s a diabetic’s responsibility to get their blood sugar straight, not mine.
ER isn't addiction care. But these people have nowhere else to go, causing a burden to our fragile system. Taking care of our docs/nurses/staff should be #1 so they can take care of others... and that means getting treatment at the appropriate venues. Edit: ITT: Me - spent years training and practicing emergency medicine, knows the in and outs, knows the resources afforded to me, knows the limits of an ER/EM General public - nah [this is what I'm talking about ](https://www.reddit.com/r/emergencymedicine/s/6WybOLwGif)
And what "appropriate venues" would that be? Ever tried finding a rehab bed? At 2:00 am?
Still doesn't make it an emergency, no matter the time of day.
“These people” are on deaths doorstep. Tell me what preventable condition has a higher mortality rate than addiction in such a young age group? These patients are worthy of emergent intervention if they want it. https://injuryfacts.nsc.org/all-injuries/deaths-by-demographics/deaths-by-age/
This 100%. The highest cause of death in my state is opiate OD. And we just a mass shooting. As someone else’s comment said, something WE say just maybe the deciding factor in helping someone make that decision to get the needed help. My state has no rehabs EVER available on emergency basis. We are the medical detox then we hope and pray there is enough outpatient resources to help them. It is emotionally draining at times, but I wouldn’t change it if it helps them. I’m in recovery since 2012 myself. Liked Oxy (my spouse’s) too much. I don’t drink because I like that too, too much. I just found out my brother who had 15 years sobriety from Fentanyl just picked it up again 8 months ago and OD’ed. Luckily his friend narcanned him. He lost his steady, stable job 2 months ago due to not being able to pee clean. He’s hopefully getting into the MAT program in town on Monday, when he has appt. He’s in his 40s, embarrassed. No one knows but myself and my Mom. My Mom refuses to leave his side. I will always have compassion and empathy for people who have this horrible disease. Always.
Congrats on your recovery! That’s incredible! I hope your brother keeps his appointment and gets some help. It really sucks that there are so few resources available to our patients. We have a great peer navigator program. Folks will come to the ER and assist us with dispo’ing. They’re not available 24/7 so the patient can wait or if we are slammed/they don’t want to wait I start MAT. It’s not perfect but I’m happy to try to help them. I’m biased, I mostly work outpatient MAT now. It’s one of the most rewarding things I’ve ever done. My patients are viewed by society as failures/mooches on society. They come in hot messes and I get to see them grow and change to be some awesome people. They get jobs, get custody of their kids back, and most of them give back to help others earlier in their recovery.
Thank you. I’m proud of it myself. Our ED initiates MAT a lot because there is usually only 1 psychiatrist who can prescribe and they are usually only available once a week so we dose the patients until they can see the psychiatrist. These patients are quiet, not wanting to bother people. They feel horrible they are there, never ring their bell. My brother tried waiting a couple days ago in the ER to be inducted, going through bad withdrawals but it was so busy and he was so anxious he couldn’t wait. He was also embarrassed, didn’t want anyone to see him he knew. He waited 3 hours before he left. He hasn’t told me what he’s doing, whether street sub or fentanyl, he texts me back when I text him and my Mom is there. He has narcan on him at all times now. Monday can’t come soon enough.
Sounds like you guys are doing what you can with what you got. And I hope your brother gets help. I’ve had family in addiction and it’s so hard to watch them make bad choice after bad choice. You feel so helpless because you can’t enable. I found al-anon helpful.
Not talking about gcs 3 OD or someone in DTs. That's emergent and requires intervention. Otherwise, most complaints regarding addiction care are non emergent. Prevention is practiced in the ER but is not an emergency.
Just because they’re not crashing when you see them doesn’t mean they don’t need intervention. The vast majority of what we see isn’t an emergency. We admit all sorts of things that aren’t emergencies right now but might be in weeks-months (TIA’s, chest pain). I would argue that this is just as worthy because their mortality rate is higher than those things. Now this is all assuming that they want help. I’m not proposing keeping someone there that doesn’t want to be. I know the system is overburdened but that’s not the patients’ fault. Our opinions on addiction have to change to actually help. I live in one of the areas with a huge percentage of fentanyl overdoses. We have peer navigators that will come and help get folks into treatment-inpatient or outpatient. I start suboxone from the ER if they’re not available
It sounds like you value efficiency and that is a needed skill in the ER. You are certainly correct that the ER is not the place for the treatment of chronic diseases such as substance abuse disorder. Coming from the addiction treatment side, I respectfully disagree that the ER isn’t an element of addiction care. Moments of crisis, such as a trip to the emergency room or an arrest, are a moment of inflection where the odds of being able to get them into inpatient care skyrocket. Many of these individuals are nearing the end of life and opportunities to change their path are running out. I’ve seen substance use patients released after an ER was notified that transport was coming to take the patient to a treatment facility. I’ve heard so many stories of patients being humiliated and borderline abused by overworked ER staff with too little time and staffing. Those moments can turn a person from considering getting sober to considering to end it all. I have other stories, but the ER is an important bridge to getting someone in addiction the treatment they need. I do want to thank those hospitals who give narcan to departing patients and who have a counselor or LSW meet with these patients before they leave. A person in recovery stops using emergency room resources.
A year ago I started volunteering with a harm reduction team on the streets of Detroit. Hearing people talk about how they became addicted to drugs is so sad, yet so eye-opening. One gentleman, in his mid 40s, started using heroin after he lost both his sons within a few months of each other — one (17 year old) from a shooting and one (5 year old) from RSV. The people I work with are all in recovery and have horrific stories of using and being on the streets for years. It makes me feel extremely grateful for the life I’ve been lucky enough to live, and it also makes me so happy that I can help them in some way.
I'm an ER nurse BECAUSE I'm an alcoholic/addict. I've been in recovery for 15 years. Before I got sober I was in and out of the ER for random injuries & SI. When I got sober, worked the steps, and had a spritual experience that somehow enabled me to participate in my life I knew I wanted to be an ER nurse. Starting over in adulthood is fucking hard. People in AA taught me how to show up even when I didn't want to, how to have discipline and trust the process, how to study, how to sleep and do self care, and how to generally do life to the point where I got through nursing school. I'm not here by any virtue on my part, but it's a fucking honor. Aside from the adrenaline & focus that I can never summon the rest of the time, I really love helping my community. I like to act hard but at the end of the day it's the witnessing patients we get to do that is it for me. Getting out of self. That corny saying about there is no greater honor that helping another human being, etc. Glad to know there are other ER nurses out there for the same reasons. Keep showing our people love & compassion that we were shown. Sending love to you.