Saturday, 10 March 2012

Saving Lives and Trying Not To Get Shot

It's been a really long time since I posted anything here.  I'd like to attribute it to ungodly hours at the hospital but most of the time I'm just really tired and couldn't be bothered. Gotta say though I did not expect to ever reach 12,000 visits , although to be fair 8,000 of those were people looking for pictures of  Yousra naked and/or Demon picture searching. Read my post on my Psych ward days. It's somewhere in the archives and I'm too lazy to actually get a link.

So I'm finally a resident in our local Pediatric government hospital. It's been a month now and the things I have witnessed, ranging from bitchy nurses to crazed parents, I suspect, have taken their toll on my psyche. But not to worry folks, that just means more stories for you, ESPECIALLY if I know you in person. Now a lot of things have happened in the one month so it's tough to choose a particular story, but seeing as how I haven't updated in a while, let me tell you about the time I almost got shot.

It was like any other day in the emergency department. The flow of patients was unbelievably horrible and we were trying everything we could to stay on top of things. Among those patients, were 2 neonates (less than 28 days old) who were ridiculously sick. They both needed to be admitted into incubators (of which we had none available) and so we told them to go out and call as many hospitals as they could in hopes that one hospital would have an incubator available to move them into. Before you start wondering why we leave the patients' families to call hospitals and label us assholes, it's simply due to the fact that staying on the phone takes a long time and when you have a dozen patients at any given moment, you tend to use every given moment to good use on the patients you can actually help.

Anyways it was all well and good, until suddenly one of the mothers lost her shit. She started shouting at us and called us 'fucking corrupt assholes'. Apparently, what had happened was that there was another patient that needed an incubator too but because those people had 'connections' with the hospital staff they were able to free up an incubator for them. When mother of sick baby number 1 asked mother of baby going to incubator what was happening, she literally told her, "It's because we know a certain doctor here"


Ouch.


Needless to say, it didn't take too long for both families to descend on our asses with full force. Not only were we outnumbered but there were other patients that needed management and they were just getting in the way of that. So I decided to go outside and talk to about 10 maniacally angry family members, who saw me as the devil's bastard son that never lived up to the devil's expectations. Like Peter The Pied Piper, I lured them all outside with my white coat, that they thought needed a little bloodying.

Keep in mind I did not see this 'fabled doctor' that brought a patient upstairs. So I operated on the basis that this did not happen, and that the mother was full of shit.

I went outside, and decided to talk to the two fathers; one very calm and one very VERY angry. Very angry dad shouted obscenities at me and kept threatening to destroy the hospital and everyone in it (normal fluffy stuff for doctors who have been to the Emergency department) and I tried to summon every ounce of my being to appear sympathetic. Its not that I wasn't. It's just that it's very hard to be sympathetic to a man who's constantly slurring at you with violent obscenities and things he'd like to do with your anus. After successfully calming him down (by promising to show him that we really don't have any incubators available) calm father decided to interject.

"Doc, listen. I work as hospital security for another hospital, and I know and you know, that if I want to secure a place for my son, I'm going to go ahead and do so."

Very normal, albeit a little bit irrational, statement from calm father. Now the thing is, he was saying this to me as he was pulling a gun out of his jacket.

Puts a whole new spin on that last sentence now doesn't it?

So there I was, not quite at gun point because he never pulled it out entirely, but still very much stressed out by a man with a gun who just threatened to kill me.

I did what anyone would do at said moment.

I smiled and laughed.

Okay maybe not anyone.

I asked him "Are you threatening me?"
"Not at all, I'm just showing you what I'm capable of."
"So you are threatening me then. Well let me ease this for you. If you kill me right now, that still won't free up an incubator for your son. The only way you can free an incubator is for me to direct you upstairs and have you kill one of the babies inside one."

That totally caught him off guard thank God.

"What the fuck are you saying? Of course I'm not going to kill a baby."
"So you're going to kill me? A man trying to stay awake for 24 hours and at the same time trying to help as many sick kids as physically possible."

That shut him up.

He put the gun back in his pocket and started crying.

I took everyone outside and gave every cigarette I had to everyone and we all shared a smoke and calmed our nerves down. That was it. Just as easily as the situation escalated, it was easily defused again.

There is a happy ending and there is a sad ending to this story. Angry father's baby managed to stay stable enough for them to find an incubator the next morning. Calm father's baby didn't.

There is no point to this story. I am not angry at the man who pulled the gun out on me. He was a father and didn't know what to do. I'm not sad at the kid that died. He was young yes, but there was alot wrong with him so he's definitely in a more comfortable place right now. I'm also not angry at the hospital due to their surprising lack of incubators (one might argue they have the money and they're not spending it correctly or one might argue that we don't get enough funds but that is neither here or there)

I guess I'm angry at the fact that it's never enough maybe. I don't know. This story was supposed to be surreal and funny, and to my friends that I've told this story to in person, they can vouch that it was.  I think it's because writing it down makes it seem a whole lot more real that it actually felt. A man resorted to something he probably thought he'd never do in his life to save his son.

It's so sad, stupid and brave all at the same time. 



Sunday, 4 December 2011

What Nobody Tells You About the Free Services We Provide

For all sakes and purposes, the hospital I work in, is truly a free hospital. That means that, technically speaking, the patient doesn't have to pay for anything at all ranging from investigations, medication or necessary surgeries to actually staying in an ICU ward. There is, however, a catch to all of this. Several catches, actually. Let me shed some light on them, and go into detail on one of them that particularly bothers me.


  • First of all, we will run all the necessary investigations to help reach a diagnosis, so long as our shit works. If you frequent this blog, you'll know we have an especially troublesome CT machine that tends to 'stop working' quite often. That's not all. Certain blood tests too, aren't readily available either. By readily available, I mean immediate. Let me give an example. In the Emergency ward in Pediatrics, it's a 24 hour shift. Now in the morning the main labs are open and stay open until about 2 pm. Now, if the main lab is open and you submit a sample at 8 am in the morning, they will not hand you the results until 2 pm in the afternoon. Protocol and beauracracy at its best. That means if a patient comes in at 8 am with severe anemia and you want to find the hemoglobin level not just to confirm the anemia, but to order a blood bag, they're going to have to wait until 2 pm. It's unfair too because if a patient comes in after 2 pm, then the emergency labs are open, and that only takes an hour for the results to yield. So if you ever need to go to the emergency department in a free hospital, fucking come late because coming early isn't worth the effort. Keep in mind that this isn't what bothers me.

  • We will give the medication for free, only if we have it. Some medication is simply not available in our hospital or requires a special order (that must be filled in only in the morning). Either way, if we don't got it, your best bet is to go buy the stuff outside. This is normally okay because even in the worst case scenario, most medication isn't that expensive. However, sometimes it can truly be heartbreaking. We had a patient that needed cyclosporine (a drug we did not have) and it cost them 1,200 Egyptian pounds to go buy. That's alot of money for the type of people we get in our hospital. It also becomes even more annoying when they end up spending money for investigations outside(to speed things up) and find themselves spending more money for medication. Alot of departments thankfully do get around the money issue by giving out donations courtesy of the older professors in each department. Sadly, not all departments have a heart. As sad as this is, it's also not what gets to me.

  • ICUs are readily available too, but only if they're empty obviously, and the problem with ICUs is well, patients tend to stay there for a while. So having to tell parents that they need to bust their asses looking for an ICU for their very sick child can suck at times but again, this is one of those things that is out of our hands. Again, as much as this sucks, this is not what gets to me.

  • Above all else, our hospital, is a teaching hospital. We have students readily coming in and patients regularly get examined by these students. Exams and classes with patients are prepared by the residents when the need arises and so on and so forth. It can genuinely be a bitch to find certain patients too. For example, neurology week would need different neurological cases. Cases we might not have, so we go around bargaining with other departments to give us their patients just for a while until the class ends. By bargaining, I literally mean bargaining. Usually, other departments also want other patients so we switch for a few hours until the classes are over. Just a few days ago, I had to go to the other Pediatric hospital across the street (we have two) and bring a patient for a class. It was especially difficult, because the mother was being difficult. Her kid had just had 7 samples taken out of her; she was tired and she wasn't ready for a class full of students palpating/groping her child. The mother had a point obviously, but she didn't have the right however. All patients admitted to our hospital sign an admissions form explicitly stating that we can do whatever we want and we have the right to use them for tests, classes etc. Now, I felt for this mother. Her kid was especially in high demand because the manifestations of her disease were easily shown to students. So this was her 5th day in a row. I managed to coax and convince her and she tagged along.  Now this may not sound so bad, but it gets much much worse when it comes to exams, especially Masters or PhD level exams. Higher level exams require complicated patients that fulfill very specific criteria according to the examiner (our professors) and they can be ridiculously anal on what they want. Our professors also will not take no for an answer. Again, let me clarify with a better example. We had a kid (who I'm going to call Adam) with Rheumatic Fever in our department. He was a really nice 7 year old with a great and understanding mother. He got on the medication, got better and we told his mother that come Saturday they'd be going home and continuing their evaluation at a clinic. They were ecstatic because let's face it, a hospital is not a cheery place. The Friday before, a few professors came in and asked us what our cases were and we told them. They looked at Adam and heard his heart (he had Mitral Regurge, a complication of the disease that reveals a certain sound on the stethescope known as a murmur). They came back to us and told us, "Keep Adam for a week. He's going to be in one of the exams." We argued back and told them that we told the mother he was leaving. Their response was simply, "Doesn't matter. Make something up and keep them for a week."

    Let me clarify what "Make something up" means. Make something up means going to the mother and telling her that we just need to make SUPER sure Adam's okay so we'll run a few more tests on him, JUST to be on the safe side. It's all bullshit of course just to keep him there. THIS IS WHAT I HAVE A PROBLEM WITH. Thankfully, the specific scenario of Adam ended on a happy note with one of the more senior professors deciding he wasn't fit for an exam (not because of his health, but because his case was too easy for Masters students)

    This sort of shit is what ticks me off. It gets much worse as well. A few professors had entrusted me to find cases for a PhD exam in a few hospitals, one of them being our own version of a Cancer Hospital. Their criteria was simply, "Try to find a super difficult case so that more people fail than pass." So not only did I have to go about finding patients with rare fucking findings, I had to do it so that other fellow doctors would fail their PhD. This story got much worse because when I got to the Cancer Hospital and spoke to my contact there (Yes, a fucking contact established through the professors) she showed me an especially hard case (that had cancer and rare findings) and then she told me to let her know if they'd want her because if they did, she wouldn't have to start the next dose of chemotherapy on time and delay it for a few days until after the exam (because the findings would subside after a dose of chemo)

    Not only was I dealing in patients but I was sometimes prolonging treatment. Now, to be fair, we're not monsters either. I mean, the 'delay' isn't going to harm the patient and everything is looked after so as not to deteriorate the patient's health.

    But goddamnit if it doesn't make you feel like an asshole.


So the next time people talk about how free hospitals really are free, always realize that nothing in this world is for free. There are consequences and repercussions to everything no matter how great it sounds on the outside.





Friday, 25 November 2011

G6PD aka Favism aka What do you mean he can't eat Ful (mashed beans)


I'm about to get scientific on all your asses right now so please bear with me.

There's a disorder out there called G6PD deficiency. Now G6PD is an enzyme called Glucose 6 Phosphate Dehydrogenase. It's an enzyme that protects the Red Blood Cells against oxidative damage. Now you might not know what oxidative damage means but all you need to know is that there are certain food items and medications that have molecules within them that can essentially destroy a red blood cell. G6PD is an enzyme that protects the red blood cell from this destruction.

The deficiency is pretty common especially here in Egypt, and it can be quite disastrous for the parents. Why is that you might ask? 

Well, remember when I said certain food items. By certain food items I mean Ful (http://en.wikipedia.org/wiki/Ful_medames).

Looks appetizing no?


Ful is the commonest and cheapest dish prepared here in Egypt. It's basically mashed beans along with some olive oil and garnish. Suffice to say, many people of a lower socioeconomic class have designated Ful to be their prime nourishment throughout their life. It's cheap and it's satisfies the hunger more so than any other meal I've heard of. 

Having a deficiency in G6PD means you cannot eat Ful, forever.

If a person with a deficiency eats the beans, his or her red blood cells start getting destroyed (hemolysis) and the person presents with a case of acute severe anemia that cannot be corrected except with a blood transfusion. The destruction can be so severe that it can cause death in some cases. 

There is no cure or anything like that. The only cure is to stay the fuck away from all food items, including Ful, that may induce hemolysis.

Now as far as enzyme deficiencies go, this one is awesome. Most enzyme deficiencies are fatal and severely affect a person's lifespan because they're involved in vital functions of the human body. G6PD is just a 'protective' enzyme and so all it does is protect the cells. So, whenever a kid comes with this condition I usually tell the parents that it could've been alot worse.

Problem is, parents don't quite see how it could be alot worse. 

As I said, people of a lower socioeconomic level depend on Ful for sustenance. They can have it for breakfast, lunch and/or dinner. And in a country where more than 50% of Egyptians are on the poverty line, they try to be as economically wary as possible. 

To them, it's a death sentence. Reactions I've had from parents who were told their kids had the deficiency have ranged from sheer disbelief to just mental breakdowns and tears. I remember laughing a little on the inside when a certain family just broke down into tears about the subject. I thought they were being dramatic. After all, they came to us in the ER and there were kids dying everywhere, so just needing a blood transfusion and staying away from the stuff, to me, was a win. After going back home and talking to my friends about it, we realised they were crying because they literally had no idea where or how they were going to get enough money to feed their kid something that doesn't contain beans. 

We've had parents come in over and over again, because their answer was "We have to feed him something! He's going to die anyways if he doesn't eat, so we get him to eat the Ful then take him to the hospital for a blood transfusion." 

These are parents who are willing to take the risk of their child dying because they can't substitute Ful with anything else.  

Fucking crazy.

All in all, it's a sad disorder to have if you're living here in Egypt. Ful has seeped its way into culture even and many (myself included) are not considered full blown Egyptian if they don't eat Ful at least daily. 

I'll end this post on the funniest line I've heard from a patient's dad when I told him his son couldn't eat Ful forever, if only to document the mindset and to alleviate the sad tone of the post.

"Is this some sort of conspiracy? Is there going to be a Ful shortage so you're being forced to tell me that my son can't eat it? No, its impossible! God would not do this to the Egyptians. He can't! He knows how much we need Ful!"

It's funny, but also sort of sad.




Thursday, 17 November 2011

Stupid Things I've Heard Mothers and Fathers Say (Part 1)

Here's a list:


  • "NO! You will not take another sample from my son's precious blood! You're draining him away!" -Scared woman who was pissed off at us for taking a few samples for reports. I think she also said something about selling her baby's blood in the black market. 

  • "I don't know why I didn't bring him sooner Doc. I just thought that his head growing faster than his body and that's where the brain is right? So he'd be getting smarter too!" - Mother who brought in her hydrocephalic child after months of leaving his head to grow in size. (Google hydrocephalus if you want, but I must warn you, it's pretty disturbing.)

  • "Listen Doc, I know he had a seizure and he needs to be under observation for a few hours, but I have work in the morning and his mother's tired. Can't we just leave him here and come back to pick him up in the morning?"  -Father after realizing he was going to have stay 5 extra hours with his child that had a convulsion.

  • "Can't I just give him my blood Doc? Yeah I understand it has to be a match but I'm his daddy and I know MY blood will specifically save him." - Father upon hearing it's not like the movies and that it  actually takes an hour for a kid to receive blood from the hospital.

  • "I'm worried about his poop Doc! It's brown and it smells nastier than usual. What do you think it could be?" - Mother discovering that poop is actually brown and smells pretty bad.

  • "So.... You're saying we SHOULDN'T feed him to the point of vomiting? But that's what my mom did and look at me! I'm fine!" -Mother reveals her wonderful technique for feeding her baby that is also, a family trade secret

Wednesday, 16 November 2011

A New Start.

So it's been a long time since I've posted (4 months and then some) so I figure I should update you on what's been going on.

Country's in shambles. Islamophilia and Islamophobia are on the rise all at once, and it's not looking good for anyone who's living here. However something monumentally life altering has happened:

I've finished my internship.

Now this might mean that the blog is done and dead. No more wacky stories from the intern who gave you a peek at an Egyptian Government hospital. Don't fret! For I have bigger news:

I start my Residency in a month (hopefully less), and it's going to be in Pediatrics, but for now I'm volunteering every now and then at the hospital so that I'll know my way around when it all becomes official.

Now, I know what I said before about me not being able to post that many stories when I was interning at the Pediatrics hospital, but, after much thought and exposure to both stupidity and mind altering moments of clarity, I've decided to keep posting about the stuff I'll be seeing. Keep in mind it might not be funny all the time, and sometimes, it's going to get a little dark and depressing. Anyways, let's get started.

A few days ago, in the Pediatric ER department we had a patient that went into shock.We stabilized her but she needed to get into the ICU. Luckily, the resident at the ICU department said there was a free space available (a rarity in its own self) but we'd have to wait a while until the patient using the bed previously actually got discharged i.e: her parents would come and pick her up. So we comforted the mother and told her, and needless to say, she was ecstatic (she knew about the difficulty in actually finding a free bed available) After a few hours and dozens of patients we'd realized that the resident in the ICU hadn't called us back to tell us to bring her in. So I went to go talk to him about it.

"What happened? I thought you said it was a done deal and your patient would get discharged."
"Yeah, about that, the patient's parents aren't picking up their phone."
"What do you mean they're not picking up their phone?"
"I mean they're not here in the hospital and I can't just kick her out into the street now can I?"
(Keep in mind the soon to be discharged patient was 4 months old)
"Well, keep calling them. They'll have to pick up eventually right?"


4 hours later.....
"What the fuck man? It's been 4 hours. Did they not pick up?"
"They did but we have a bigger problem.They don't want her."


"What?"

"Like I said, they don't want her. It turns out they weren't the ones that brought her to the hospital. That was her uncle. Her parents don't want to have anything to do with her."
"I don't understand. What do you mean they don't want her?"
" I mean they don't want her. They said something about worrying she was going to die if she left the ICU but from what I gathered, they just don't seem to want her back."
"Did you tell them we're not a fucking orphanage and that bed's needed."
"Yeah yeah, all that, they still don't seem to give a shit though."
"What am I going to tell the girl's mother upstairs? We practically promised her the bed."
"Well, she's going to have to leave eventually. When she eventually leaves the bed's still guaranteed to your patient upstairs."


So yeah.. 

Now, it's not relatively uncommon for parents to not give a shit about their kids. If I keep posting, you'll soon realize how frustratingly apparent and common it's become.  What ticked me off, was that there was a bed that was available that could have really helped another patient, and it was being wasted on someone who didn't need critical care. 

And that. Fucking. Sucked.

I went upstairs and told the mother. She was amazingly decent about it. She kept asking me one thing though:

"What sort of mother would do that to her own child?"



Saturday, 9 July 2011

My first OB/GYN shift, in which, surprisingly, I don't see any lady parts.

Okay so maybe I hyped up OB/GYN a bit more than I'd hoped for. 
It's actually not as hilariously insane as I might have expected it to be. 

I mean, sure I had to carry a bunch of samples, which included urine and tissue from an ectopic pregnancy (or a wannabe fetus as I like to call them) in a carton that was once a carton used to store a crap ton of eggs (there was no other medium of transportation).

Sure the sample with the fetal tissue was exposed and there was a big gaping hole in the bottle, which was ultimately worrying because I kept envisioning myself being drenched in, ummm, 'embryonic tissue'.  

Which , BY THE WAY, totally DIDN'T happen thank God, much as it would have been entertaining I'm sure.

Yes, my first day was disappointing. 

But then something awesome happened near the end of the shift. The resident, who I'd known from my previous stint in the resuscitation room (he was serving time there as well) came up to me and asked me who was covering the mid shift (I was in the morning shift).
"A reliable guy, don't sweat it."
"You don't understand, I need a man's man to get something done for me. Do you mind doing it and staying a bit later?"
"Sure, no problem."

Little did I know, that he wanted me to do something totally and utterly illegal..............

There was a patient that was due for a C-section the week after and she had mentioned a heart problem that she had when she was 6 years old. She didn't know the specifics but she remembered having had an operation. Now, the resident, ordered an echocardiography but it came up inconclusive. The problem was that no cardiologist would see her unless she had a chest X-ray. 

So the resident wanted me to get a Chest X-Ray done, on a very pregnant lady, in a hospital that has a protocol of not doing X-Rays on pregnant women. Not only that, but he wanted me to do it in the ER (because any other way would take forever)

Now a few notes I have to mention here, just in case people reading this think I'm some sort of reckless doctor with absolutely no ethical background whatsoever. 
  • It's alright for a woman to get an X-ray during her pregnancy. It's not routine, but if it's necessary then it needs to be done.The few rads of radiation won't hurt anyone. The problem lies in multiple x-rays and so, just as a precaution the hospital banned all sorts of x-rays on pregnant women.

  • Now, there is a way to get around this, ahem, legally. You get a radiologist to sign in on the request, and he sets up an appointment for her to have her x-ray. That's a totally doable situation but there's a problem with this scenario. It takes fucking ages. As I mentioned in a previous post, the bureaucracy in our hospital is maddening, and shit tends to take a while. Time was not something we had.

  • She really did need an X-ray. A C-section is , for all means and purposes, an operation, and having an operation with undetected heart problems could lead to disaster for both her, and her unborn child.

I was up for the task and told him I'd do it. So I went to her and explained the situation clearly to her. After she agreed, I told her to get dressed in her normal clothes and we were on our way to the ER. Now the only way we'd get the technician to do said X-ray was if we lied our asses off. So for 20 minutes, I had a brand new cousin who needed a Chest X-Ray. I told her that if anyone asks about her ridiculously swollen belly, she'd tell them she had ascites ( fluid in the peritoneal cavity). After getting our stories straight we arrived at the X-ray room. 

I'd love to say that I had to convince the guy to do this one favor for me. I'd love to say that it took me ages to persuade the technician to perform the X-ray. 

In reality, it took me all of 5 seconds. It went a little something like this:
"Hi, I'm an intern here and my cousin wants to get this chest X-ray done because the doctor at the clinic said she needed it done."
"So she's a relative, sure man no problem. Consider it your machine!"

God bless favoritism. 
God bless corruption.
God bless Egypt.


PS: In case you were wondering, the X-ray revealed ridiculous cardiomegaly, which did in fact mean that there was something wrong with her. She's now being treated by the cardiologists and she's on the proper medication and hopefully, everything will work out fine.


Saturday, 2 July 2011

Obstetrics and Gynecology. Fuck Yeah!

That's right folks.

For the next 2 months, I'm going to be talking about pregnant ladies and vaginas.

Now before you perverts start thinking,
"You lucky sonofabitch, women will strip down and show you their lady parts for free for 61 days"
let me just illuminate your perspective.

You're absolutely right. Women will strip down and show me their lady parts for free...

Let me just add a few more words to that last sentence to show you why you're wrong.

EMOTIONAL, HORMONE PACKED Women....OF ALL AGES.....will strip down to show me their SICK lady parts for free.
Here's a list of bullet points ( because you all know how much I love bullet points ) to illustrate my dismay:




  • SICK lady parts: Women, don't get me wrong. You're beautiful in every way. All of you. And I'm sure that your lady parts are perfect just the way you are. But like all other organs and body parts, when you get sick, they start looking less, how you say, perfect. I won't get into specifics, but fucking trust me on this one perverts, no vag is better than sick vag



  • EMOTIONAL HORMONAL women:  Now hormones are a double edged sword. With them come all the wonderful things that make women women. Compassion, understanding, affection, love and all that. But when the hormones start working in overdrive you get all those other traits: Bugfuck Insanity, Absurdity, Illogicality ( I know its not a word but stay with me here) This becomes especially evident when a woman is pregnant, because according to her, EVERYTHING THE DOCTOR DOES is harmful to her baby, like say, take her god damn history and do an ultrasound.


Now the non-perverts (or perverts in hiding) are probably thinking , 
"But Dr. A, you're going to see the wondrous miracle that is child birth. It'll change your life every single time you witness it."

....................WRONG AGAIN!

Now don't get me wrong. I'm sure child birth is a beautiful process that brings a brand new human being into this wonderful happy planet (I hope to God you're realising the subtle undertones of sarcasm here)  but let me explain why it's not as 'life changing' as one would hope.

I once saw a doctor go in....with BOTH HIS ARMS.....to properly position a baby. 


That image is seared onto my brain, and is just a precursor to what sometimes happens in the 'Birth Kiosk' . Yes that's right, it's officially called a Birth Kiosk.

Now I'm sure its a beautiful process and all but witnessing this:


coming out of a uterus that was once the size of your goddamn FIST



can be quite disconcerting for many.  (The pictures aren't to scale I realize, but I'm too lazy to look for more appropriate pictures)

All in all, I'm sure they're going to be an entertaining 2 months, more for you than for me. So sit back, relax and enjoy the endless, and hopefully hilarious torment, that I'm going to have to endure.