Saturday, June 27, 2009

No Summer

Okay. I have been through hell and back over the past few days. It all started with physics. As in I dropped it. After 3 days of studying non-stop, I was not at all ready for the first exam. We were to have an exam every 3 days over 10 chapters each. Nope. Not happening. I decided it would be better to take the class during a traditional quarter instead of the 4 week long summer sessions. So.....
I went online to look at my account for UC to see what this would do tto my tuition. This is when I found out that I would not be getting my S.M.A.R.T. grant. Uh-oh. Furthermore, they did not kick-in my metropolitan tuition rate that I became eligible for when I changed majors then picked up the double major. Big Uh-oh. The grant left me about $1300 short, then I was assessed a $4800 surcharge for being out-of-state. The moral of the story is that I ended up owing UC over $2K. Lovely.
First they told me that it had to be paid this week or my classes not only for summer, but for fall as well, would be cancelled. I asked about what would happen if I just dropped the rest of the summer courses, and that was no good either. In stead of owing $2K, all of my loans would drop out because I would no longer be enrolled, so I would owe 50% of my tuition with no aid. About $7K. What to do? And regardless of what I do with UC, I cannot just transfer to Northern Kentucky University (with their much cheaper tuition, but much lower academic standards) because until I satisfy this debt, there will be a freeze on my transcripts. Grrrr.

So the plan is work. Work. Work. Work. And save. No more eating out or quick trips for coffee. No more of going to the video store and renting literally piles of movies. No more. Thanks to UC, my summer has turned into nothing more than work and school, school and work. Not that this is a change from previous quarters, but I was hoping to find some time for at least a little bonding with Evan while he is out of school for the summer. Instead I have to be content with just going to work. I did finally speak to someone in the collections department, and she said what the university did to me is ridiculous, and has set me up on a payment plan. 2 payments of $1000. Thank God I have the type of job with the type of pay that I can work about 3 extra shifts to make $1000. Well, maybe 4 or 5 if consider how my dear Uncle Sam rapes my overtime pay. I've already made a start. Instead of being off from Monday through Thursday this week, I have picked up shifts on Monday, Tuesday, and Wednesday. Which has the added benefit of putting me in overtime by the time I get to my scheduled shifts on the weekend. If you consider that The 4th of July is this coming weekend, and that will be holiday pay AND overtime, so double overtime for those 2 nights, I may be able to satisfy the first part of that $2K obligation this coming payday.

Wednesday, June 24, 2009

Sunday, June 21, 2009

Frailty of Life

So....I really want to blog about the experience I had this morning in a code. An experience so bad that it left me questioning if I want to stay in this world I have lived in for several years: The World of Medicine. A 36-year-old female with breast cancer suffering from complications from a lymphectomy. There were those of us on the ICU team that had been working on her for hours before one of us hit the blue button that would signal the hospital switchboard operator to make the overhead call of "Code Blue", then there was the general crowd that shows up when the code is called. Those of us that knew the story tried to resuscitate the young woman with faces that were streaked with tears. One of my colleagues came to check and see if I needed any help, and saw that I was crying, so he offered to relieve me. Her mother was already there, but we kept her alive until the "rest of her family" got there. When we realized our efforts were futile, the Nursing Supervisor went to get her family. Allowing the family at a resuscitation attempt is kind of controversial. Is it cruel? But studies have shown that families deal better when they see the effort we are putting in to save their loved one. So while I hate it because it does not always allow me the mental distance from the situation, if it helps them, so be it. But nothing prepared me for this. Her weeping husband. And her nine-year-old daughter who was wailing in pain and anguish. I tried to count the number of ceiling tiles in the room. I inspected my shoes. I didn't have to look. By now, my hands hold within them the rhythym of breathing and I can deliver breaths at a steady pulse while intentionally not looking. But this time that didn't stop the tears. This time it was my family I was seeing, no matter where my eyes tried to focus.
I could not get John's face out of my head. Or Evan's voice. My reasons for living. And undoubtably, the husband and daughter were hers. They were robbed by the intricacies and the mysteries of the human body. And like us, I am sure they had plans for their future. The husband had been out of town, and didn't know that he would never see his wife again. I still cannot get the image of his pained, tear-streaked face pressed to her cold, pale, lifeless one. The picture serving as a study in the contrast between death and life. And her death proved something to us all. She was in the MICU, the unit of the hospital to which I have been assigned for going on the past 2 months now. Our MICU is new. State-of-the-art facility and equipment. Staffed with the A-team of the medical world. Even we therapists are a select few. We are all oriented to the unit, but non-hackers weed themselves out. But this morning, nothing we had to offer could have been enough for her. Which is scarier than you could imagine, because it humbles all of us. It shows us that we cannot fix everything with almost unnecessary cruelty. And while we are all there, working our demanding schedules to pay for kids' tuitions or the new family minivan or the plasma tv that society tells us we need, we are forced to face the idea that we are away from the very ones we are doing it all for. That life is frail, and would it be better to be at home, snuggled in bed with our spouses or waking in the morning to sloppy kisses from our young children. Because as we were witnessing at that very moment, life could have other plans for us.

Thursday, June 18, 2009

Guilt and Sadness

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Before I know it, Summer will be gone. Evan will be back in school. And starting tomorrow night, I am back to the grind. By the time I get off of work on Monday, it ill be time to head to another quarter of classes. And at the end of the Summer, this baby of mine will be 8 years old. I know I will not be getting a break until we are both off for Christmas.

I look at those brown eyes and I miss it all: the sloppy kisses and macaroni and cheese faces after dinner. The cuddling and giggling. Getting his bubble bath ready at night. Making sure he learns math. And I look at the stretch of time ahead of us and I realize that by the time I finish medical school, this little boy will be 13 years old. Is it worth it?

I had a talk with Evan just now, asking him if he wanted Mommy to go to school to be a doctor, even though it is going to take a long time. He looked at me with those big brown eyes and said yes, very emphatically. When I asked him if he would still think I was a good Mommy if I continued to be away, he said yes again. I asked him why he wanted Mommy to be a doctor, and he told me that he has the smartest mommy in the world, and he knows I can do it. So now I am sitting here at my desk typing this, amidst the crepe paper flowers and finger-painted rainbows he has given me from art class in school, and I have found out the truth.

I am so very blessed. For some reason, whatever higher power is out there has decided that I am deserving of this amazing little person in my life. How lucky could I be?

I Did A Good Job

We went to the grocery store as a family, which is usually a mistake. For the first time in a long time, little Evan was very well-behaved. When I told him no to the sugary crap because it wasn't "good for our bodies" he replied with an "Oh, okay". He helped me keep track of what we needed here at the house. Overall it was a nice experience. When we get to the checkout, he asked for a candy bar. I thought it over and said he could. Hershey bars were 2 for $1. He got 2.

Later we get home, and I have finished putting the groceries away. He comes up to me with this huge smile on his face and hands me one of the candy bars. I ask if he is sure he doesn't want to save it for another time. He shakes his little head and says, "No, Mom. This is for you because you did such a good job picking out groceries."

Wednesday, June 17, 2009

Endless Downloads, Cracker Crumbs, and More


I hadn't been into my office in days. I have instead been vegging out with the laptop on the sofa, which is infinitely cooler than the office in the absence of AC.

So today, I walk into my office only to discover that my desktop on the big computer is covered with icons for those free game trials you can download online. I have spent all day getting those off of there and making the computer like Fort Knox so I won't ever have to do that again.

And Chhez-Its. All over. The carpet beneath my feet looks like a pale shade of orange because they are ground into the carpet. They are between the keys of the keyboard, in the mouse, everywhere.

The kid is now banned from the office.

Sunday, June 14, 2009


Sometimes I have the autonomy to override a doctor's orders. Sometimes I do not. This weekend was an example of a time when I did not. It was also an example of the concept that just because we can do something to prolong a life doesn't always translate to we should. A lesson in medical futility and ethics. I have been assigned to the MICU for the past 6 days. The sickest patients in the hospital were once again in my care, as is happening even more frequently now.
A patient was admitted on Wednesday night, and by Thursday, it was well-known that there was nothing we could do for him. The name was familiar to all of us, but none of us could place his face. Disease had ravaged his body until there was little with which to work. I am not going into detail about the disease process or any other fact that can be used to identify this patient because I want to protect him as I am legally obligated to. But he was very, very ill. I watched as a parade of specialists for just about every body system in a human organism came and went from his room, speaking with his family.
I'm sorry. There is nothing more we can do.
We will provide him with comfort while he makes this final journey.
We will allow him to die with dignity.
I made sure he had enough oxygen, then went on to other patients of mine. Patients who were not breathing on their own, hooked to my ventilators. Not much time passed before another specialist came to see the patient. The patient, on top of everything else, had a raging infection. Sepsis. He wanted me to suction the patient, something we don't usually do for the dying patient because it is so uncomfortable for them. I asked him to explain why. His follow-up was that we were going to suction him, and then intubate. Within 15 minutes, the family wants to do everything. Put him through the medical gauntlet. The doctor seeing the patient for his infection bypassed the cardiologists, nephrologist, pulmonologists, neurologist, and oncologist. Told the family we could fix him.
My experiences with family members facing the loss of a loved one have taught me something. You must be very careful when you walk into the room of a dying patient. Because any tiny word you utter can be misconstrued as hope. Hope where there is none. And they grab onto to that like a life preserver, and hang on to it. To the layperson, this would seem like a gift to them. Instead it makes it worse. The patient passes away anyhow, after they have thought it was not going to happen. From the minute we know that death is looming, our care shifts from the patient to the ones left to live. Every action becomes about them. Making it easier for them. Never more difficult. The have enough difficulty to face.
We failed that family. We didn't do what we should have done for the patient.
We intubated. I hooked him up to the machine that would breathe for him. I stood at the bedside and cleared mucus from his chin and smoothed down his hair while the ventilator hissed and puffed behind me. In that instant, I realized who he was. One of our regulars, I would always save his breathing treatment for last because we would always end up talking about his military service and kids. Through all of his admissions, he never forgot that my son's name is Evan. He would always light up and ask me if my Evan was still driving me crazy. He always called me his "Breathing Angel" because he said I always seemed to show up in the same instant he was thinking about calling for a PRN treatment. I tried on several occasions to explain to him that it was probably due to the fact that he was due for his medication and less about me. "In fact," I would tell him, "I'm actually really mean in real life." He would always giggle and shake his head, telling me he couldn't believe it.
I almost didn't recognize him through all of the tubes and lines.
Within 5 minutes of intubating him, he tried to go into cardiac arrest. We brought him back. I heard his ribs crack during CPR.
By the time I had reported for the next day, he was on continuous dialysis. We had given him the maximum amout of medication allowed to maintain his blood pressure. Dopamine. Levophed. Vasopressin. I was no longer able to maintain any sort of oxygen saturation on him. We had to insert an arterial line in his femoral artery, in his groin. His body temperatre was 88 degrees. We had him wrapped in heated blankets and a warming system so that only his face was visible. He had a rectal tube inserted that was draining blood. 10 IV pumps going. About the only drug category we didn't have covered was sedation. Through all of it, he didn't need any.
The family still was clinging to the hope that we could fix him. Despite the fact that we told them repeatedly that it was gettting worse. They held fast to that life preserver. I left my shift praying for his death.
By the time I reported for my shift the next day, he had died on his own. It took 6 nurses and me to remove all of the lines and tubes. His body released every fluid in it. There was a piece of tissue that I assumed to be a part of his trachea that came out when I removed the endotracheal tube.
I didn't cry. Instead I hated my job. I was upset that I didn't put my foot down for him and advocate for him. I realize that even if I had, and refused to participate, they would have just called another of the therapists. This was one of those that I could not override.
I still feel like I failed my patient. I wasn't his Breathing Angel anymore.

Tuesday, June 9, 2009

What if Atlas Shrugged?

Considering what is going on in our world, I have been pondering this question. In Atlas Shrugged, Ayn Rand tells the story of the "Producers" of society, and the world that saps the life out of them.

Who are the producers? We are. The people who go to work every day and perform a function from which society can derive some benefit. This could be in the form of a beautiful opus that we all enjoy, a knowledge of medicine and the power to heal that comes with it, or a delicious meal that we can cook for others. Whatever the contribution, we make one. What is our thanks? We get taxed. We pay through the nose. If we put our foot down, we are "selfish". Don't we want to help our fellow man? When is enough enough?

I want to put my foot down. I want to say "No more!". I am sorry that the Jones' next door do not have health coverage. I truly am. But since when is it my responsibility to pay their bills? Did they lose their job do to the collapse of out auto industry? Well, I tried to help. They were selling their ability to make cars and I contributed to their cause by purchasing a new vehicle.

Now Obama is wanting to tax our health benefits. My gut reaction, in the face of even more taxes, is to quit. I obviously will not be doing that, but I want to. If we all did, the powers that be would have to find another way other than taking it out on the hard-working people who break their backs to make this world go round.

I think I need to revisit my old dog-eared copy.


Obama is thinking of taxing our insurance!

Seriously? I worked 142 hours on my last paycheck, instead of the 72 hours to which I am obligated. I went without sleep for days, worked until my feet were screaming with pain. I did this to gain a little financial edge in light of the upcoming new quarter at school (in other words, new tuition bill and new set of text books to buy). Of that, Uncle Sam took over $1900. One thousand, nine hundred dollars. There are certainly people who live on less than that per month, but that is what I paid out in ONE PAYCHECK! If my insurance is taxed in addition to this, I will not be able to stand it!

Monday, June 8, 2009


So how was the trip back to Madisonville? Short. I stopped on the way and splurged on something I have wanted for a while now: A Nikon Coolpix camera. I would never spend the money on one because I tend to lose and/or break digital cameras. I tend to stick with the cheap ones (under $100). But I have coveted this camera for a while, and now it is mine. I love it. The pics from this weekend were all taken with it. The blur of the shot above is because I was playing with different settings on it on the ride home from the boonies.
This was also the first trip we have taken in the new car. I must say it was much more comfortable. The 120 outlet in the console came in handy: I plugged in my laptop, stopped and bought Evan a few dvd's he has been wanting, gave the kid a set of headphones, and the rest is history. It was kind of like that infomercial with the rotisserie: Set it and forget it! He was entertained the whole way, and there were several points in the 4-hour trip where we thought he was asleep because the backseat was too quiet.
We managed to get time in with both John's mom and dad. The boys spent the day Saturday playing with water in the 85 degree weather. Grandma made a run to Walmart for a Slip-and-Slide and some Super Soakers, and I sat on a nice shaded country porch and studied while the boys had a blast. Saturday night was all about some good ol' country cookin'. John's mom made my fave: her fried chicken with homemade mashed potatoes and gravy, cornbread, fresh corn-on-the-cob. For dessert.....homemade banana pudding, baked with the meringue on top like I had never seen done until I maried into this family.

Sunday morning, we met John's dad and his girlfriend Annie for breakfast, then followed him to his house. This is when the redneck came out of my husband and he spent hours fishing for catfish in his dad's pond. Evan got to drive the 1969 model Harley Davidson golf cart with his grandpa helping him, then the guys all loaded onto quads and the cart and chased each other at high speeds around the property. I got the brilliant idea of perching in the sun and studying while they had fun. Bad idea. See the pics in the post entitled "A Weekend in Pictures" to get a glimpse of the sunburn from Hell. To break of the monotony of studying plant diversity and evolution of land plants, John would get me onto the quad and take me zooming around the property. I screamed in his ear everytime he turned to sharply or went up or down steep hills, making me feel as if I were going to fall off of the back. It was just simple fun, but for that brief amount of time, we were just John and Andrea again. The country boy showing the city girl how to unwind, throw caution to the wind, and have fun. At that point, there was no such thing as bills or parenthood, pre-med or code blue, MCAT or 80-hour workweeks. I needed that, and more importantly, without my saying a single word, John knew I needed that.
The ride home Sunday night seemed to go on forever. We stopped at about the midway point, and I picked up some cd's I have been wanting for a little while, and we jammed the entire second half of the trip. I finally realized just how red I had gotten in the sun (it got worse as the night went on) when we stopped at Walmart to get me some aloe gel for my first official sunburn of the year, and other shoppers were stopping and staring at me with mouths agape.

Now I am back home. The plan is to get my finals done. I finished Bio this morning, have another exam this afternoon, and a paper to write. I have three more days off of work, which I am going to spend giving the house a nice and thorough cleaning, and studying ahead a bit for my summer physics course, which is sure to be a nightmare if the textbook is any indication.

When it MUST be Destroyed Overnight....

My father-in-law found this somewhere in Kansas or something and bought it for John. When we met them for breakfast Sunday morning, he slapped it on my car. Notice how road dust shows up really well on Dodge Sunburst Orange paint??? (Note to self: Make John wash the car!)

A Weekend in Pictures

Friday, June 5, 2009

If It Were an Old Clunker, I Wouldn't Care

My car, that is. But it isn't, so I do care...
We are preparing for our trip to see John's family today. So yesterday, John wanted to stop and get the oil changed. (He is obsessed with oil changes, and starts to freak a bit when it goes from 3K miles to 3001 miles between changes.) So the car is due for one, and we are also going to be driving it for 4 hours today, so I agree. What I do not agree with is where he wants to take it. I said dealer. He said no, that we should take it to this discount store chain, who shall remain nameless, as they are cheaper. Not really cheaper, but more convenient because you can do all of your shopping while you wait on your car. I go along with the plan.
So we get the oil changed, and we head back home. I am cleaning the car a little to make it more comfortable for the trip, and John is helping me, when he sees it. A nice fat oil stain in the distinct shape of a handprint. On the headliner by the door. The pale, pale, bone-colored headliner. Of the 2009 car.
I don't even care that I smell like Armor-All at this point. We load back in the car, and John goes in and comes out about 3 minutes later with the store manager. I am standing there, leaning against my car, when they emerge from the store. The store manager lets out a low whistle and tells us how he loves the car and asks if it drives as good as it looks. Are you serious? "Yes it does", I say. "It's brand new." He gets my point and sits in the driver side seat and looks at the stain, telling me how it is better for me that I brought it back right away. All I can think is that these people maimed my car, and that they are not doing me any favors.
The first attempt at a solution is to try to get the guy back at the oil change place to clean it. I watch nervously as he takes a red shop towel to the light fabric. It doesn't come out all of the way. Instead of a handprint, we have a gray smudge there now. He stops, telling me that it is fraying the fabric, and it is going to have to go to a professional, and how the guy who changed my oil has done this countless times, and he isn't even sure how the guy still has a job. (!) Back in the store we go, where the manager tells us they will take care of the damages, that I need to get an estimate and bring it back to him. When I ask if there is any place in particular I should take it, he says he would recommend I take it to the dealer being that it is new.
So now I am in a nightmare. John calls the dealer and speaks to some woman who says she will call back, that they contract all cleaning issues out to this guy in the area. She calls back and talks to me this time, and gives me the number. I must have said something in the conversation that triggered a reaction in her. Apparently John was not clear on the extent of the problem. She didn't know it was a new car, and she didn't realize it was on almost-white fabric. She tells me to call the guy anyway, and then also gives me the number to their body shop, just in case.
Of course the guy tells me that he wouldn't even fool with cleaning it, that I need to take it straight to the body shop or consider dying the headliner. I call the body shop and they are saying that I may have to completley replace the headliner, or I can have the strip of fabric replaced, which would be less of a hassle, but would be just as unsightly as the stain.
All of this is making me wish for the days when I had a junky used car. I wouldn't have cared then.

Wednesday, June 3, 2009

Ummm That Was Quick

GM declared bankruptcy, what, like Monday? Already, I have seen this commercial too many times to count.

Tuesday, June 2, 2009

Flip-Flop Weather and a Dreaded Trip

I love this weather. It is 90 degrees out there. Perfect flip-flop weather, and don't think I haven't been rocking the plastic and rubber shoes everywhere I go. I have this massive laundry basket full of them, stuffed in the back corner of the closet, and I have been dying to pull them out.

What else is going on in my world?
School is winding down. Next week is finals week, which I am not exactly excited over. But after burning the candle at both ends for some time now, I finally took a few days off of work. Keeping in mind that I am only obligated to 3 twelves a week, my cashing in some paid-time-off managed to get me off of work for almost 2 weeks. It still isn't a massive vacay. I still have this week left of class, then come back Monday and Tuesday of next week for those dreaded exams. All I know is that for the next 2 weeks, I do not have to do both school and work. Following that, I am off of school for 2 and a half weeks while we switch from Spring to Summer quarters, so then I will only have to do work and not school. Count 'em up! 4 1/2 weeks of one and not the other!

I can honestly say I need the break. For the past month, I have been working all night, then going straight to class the following morning, doing class all day then going straight into work all night. Then I---- you guessed it----head back to campus for a day of class. Finally on the third night, I get a little shut-eye. This is no exaggeration. This is my life. I was actually discussing this with one of the residents at work. He was commenting on my level of tiredness, knowing full well that I intend on heading to med school in a year or so, and said "Just wait until you get into med school!" When I told him I wasn't scared of a med school schedule and explained what I have been doing, his reply was this: "You are INSANE!"

Maybe so. Or maybe it is just determination. More and more people are rallying behind me. To them, I am the one who will make it to the other side. The politics of healthcare dictate that we are the grunts and doctors are the privileged. While I am in no way the poster child, to them I represent the notion that those of us without MD behind our name are still capable individuals. They can say, "Look! She was one of us and she was smart enough to become a doctor, so we can be too." This by no means represents everyone. I still encounter some crap-dishing from some coworkers who think my efforts are directed at proving I am better than they are. The fact that I want more out of my life is a personal assault on their choice of career. Of course this couldn't be farther from the truth. But for the most part, I pass people in the hall, and they will ask me how school is going. When I tell them it is going well, the statement is met with a pat on the back and a hearty "You Go, Girl!".

Part of the plan for my time off is to take John and Evan down to southern Kentucky to visit his family. I am a little nervous about going back there. I am not met by the same resistance I used to face. I've been around for the better part of a decade, and they have realized I am here to stay. But the time we spent living down there is now what I realize to be a different chapter of my life. A chapter full of welfare and stereotypes and North vs. South. I wasn't docile enough. To them, I was the Yankee wife John brought home, the one with the smart mouth who didn't realize a woman's place. While I never played along, I wasn't as out-there with my intentions of higher education and my drive for a career. Now, John and I have returned to my turf where I have adjusted to being myself again. Here, there is nothing wrong with a woman seeking achievement. But to make matters worse, John's sister is having a baby shower, full of church women, and I know it will provoke the inevitable questions about our intent for our family. To them, it will incomprehensible that I want to forgo having other children in order to pursue my education, that I focus on my career instead of perfecting my recipe for the perfect fried chicken. They will never understand that one child, my perfect little Evan, is more than I could ever want, and now that he is in grade school, it is time for me. They will look at me as if I have two heads, and whisper amongst themselves of the brazen woman who thinks she can have it all.

And John. They will, as always, compare John to his brother-in-law. The greatest thing one can aspire to be is an employee at the local electric company. It is not that there is anything wrong with the job.More like what is wrong with John that he wants to skip out on punching a clock in order to support his wife's ambitions? What kind of failure allows his wife to be the breadwinner? We deal with it everytime, and I know they mean well, but I cannot tolerate anyone criticizing my husband because he is helping me to realize my dream.

But nevertheless, we are going. And rude or not, I am taking my study materials and will have my nose in books the entire time. This will evoke the dreaded question: Didn't you already finish one degree? And I will tell them that I am back in school to be a doctor. God help me.

Anyhow...I am wasting too much time here on a computer. It is now time to take the kiddo out and let him get some sunshine while I study with my flip-flopped feet propped up, complete with the hot-pink polish on my toes that I whipped out especially for flip-flop season.

A Few Tidbits From Today's Lecture in Women's History

Equal Rights Amendment
Equality of rights under the law shall not be denied or abridged by the United
States or by any State on account of sex.
The Congress shall have the power to enforce, by appropriate legislation, the
provisions of this article
This amendment shall take effect two years after the date of ratification.

States that did not ratify the Equal Rights Amendment
North Carolina
South Carolina

1980: Jerry Falwell Condemns the ERA
"The Equal Rights Amendment strikes at the foundation of our entire social structure. If
passed, this amendment would accomplish exactly the opposite of its outward claims. By
mandating an absolute equality under the law, it will actually take away many of the
special rights women now enjoy. ERA is not merely a political issue, but a moral issue as
well. A definite violation of holy Scripture, ERA defies the mandate that 'the husband is
the head of the wife, even as Christ is the head of the church' (Ep. 5:23). "

Is Jerry Falwell even alive now?? He can come stay at my house, then look me in the face and tell me that "the husband is the head of the wife". Are we morally corrupt because I want to be treated the same as a man? ( Yes, the same!) Put women in the draft. Make us register for selective service. I'll wield an M-16. Put us in office. We'll get things done. This whole issue sickens me, and I have to write a paper over why the ERA was never ratified. Great!