Episode 6: Loss of Control
The sisters return to a more emotional topic this week with an exploration of the loss of control that accompanies a cancer diagnosis.
SHOW NOTES
Resources and Further Reading:
My Sister’s Keeper by Jodi Picoult
TRANSCRIPT
Kayla 0:09
You're listening to the My Sister's Cancer podcast. I'm Kayla Crum, registered nurse and writer.
Ella 0:15
And I'm Ella Beckett, social worker and cancer survivor.
Kayla 0:20
We're sisters on a mission to care for the cancer community through the sharing of real life stories, a sprinkle of sass, and lots of support.
Ella 0:28
Join us in a new kind of pity party. It's a pity so many of us carry the heavy burden of cancer alone, so let's make it a party and carry it together.
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Kayla 0:43
Welcome back to the My Sister's Cancer podcast. I'm one of your co-hosts, Kayla Crum, here, as always, with my sister Ella Beckett. Today we will be talking about loss of control, and you might hear in our voices a little nasal congestion. It's a bit ironic that on the day we're recording our episode about loss of control, we've both come down with a bit of a summer cold from being together over the weekend, we think. So hang with us. Hopefully, it's not too hard to listen to, but we will definitely be talking about how you can't always control your body and your health and how all of that relates back to getting diagnosed with cancer, and how most of us can relate to that on a small, small level from various illnesses that we all endure. So when we first talked about the concept for this episode, Ella mentioned the metaphor of cancer as a thief, which I just think is such a good way to look at it. It really does feel like it's stealing so many things from you. And one of those things is your control over your own life. So that might look different depending on how much control you had to begin with. For children, I'm sure they feel the loss of control, but their parents primarily control their life already. Same thing with the elderly, they probably have lost some control. And again, I'm not saying it's easy at those ages, but it's just a different experience than being an adult who's supposed to be functioning on your own and sort of in charge of your own destiny, as we like to say. I think most of us, at least in the United States, have a very independent mindset and we have a plan and a vision for how we want things to go. And we're told from a young age that's attainable and that if you put your mind to it, you can achieve your dreams. And suddenly when you get something like a cancer diagnosis, which most of the time you did nothing to bring on to yourself, that really tosses that idea out the window. And studies have shown, by interviewing different cancer patients and really looking at this from a psychological standpoint, that it really robs you of your perceived control of your health, how stable your emotions are, making plans, even just little plans, like, I'm going to get groceries today. All of that is just taken away from you kind of at the drop of a hat when you suddenly get that diagnosis and it's full steam ahead to eradicate the cancer.
Ella 3:16
Yeah, I think what you were saying about the independence piece really resonated with me. As we've talked about before on the podcast, I think I was at a very unique point of time in my life and so, at a time when I was really going to be the most independent and have the most autonomy over my decisions and my life and my day to day being… all of that was really just stripped away from me instantly. So I think that this loss of control was really exacerbated by the fact that I was just on the brink of independence and then really took five steps backward and really had very little control over my day to day life. And like you were saying, yes, then the goal was just, okay, let's get rid of this cancer. Let's figure this out. And so much of what I had planned for those months in my life were just completely gone. I actually was reading back in my journal and I found this little snippet that I thought played into this perfectly. I believe I wrote this - I don't remember if it was the day I was diagnosed or a few days after, but it really speaks to this loss of control in this new season of going off to college. So: “I had it all planned out in my head of how it was about to go. Now, the nearly perfect image of what I thought the next four years were going to look like has been stripped away. And a less than ideal image takes its place. While my friends adjust to heavy course loads, new friendships and late nights, I will have to adjust to endless doctor visits, intense treatments, and the devastating loss of my hair and strength.” And I really think that having so many friends who were starting this really exciting independent season of college made it that much harder for me to realize that I just had very little control over my life, if that makes sense.
Kayla 5:48
Yeah, it does. I'm impressed by how well spoken your journaling is and that you already had the presence of mind to call out and identify from your swirling thoughts the loss of control and how it compared to your friends. That's honestly kind of impressive that you even had coherent words to put down.
Ella 6:07
Yeah.
Kayla 6:10
Yeah I think something that stuck out to me… you ended that by saying the devastating loss of my hair and strength. And I think that that in particular is foreign to youth. So most young adults and young people take their health for granted, some of us more than others, but we all do to an extent. I've even heard studies that say - and I don't know how we can really prove this - that say, you can't even really wrap your head around death and what that actually means until your mid-20s. Like, your brain is just not quite formed enough for you to truly understand that you're going to die someday. And so youth just has this level of invincibility, and it's so strange then as a young person that have your body basically take control of your life and become your boss. Hijack all your plans, have everyone obsessing over your body and feeling almost powerless and trapped inside it, I'm sure. I just remember so much of my communication, especially with Mom, was like, what are the blood counts? How'd she react today? Like, you would show up and they'd take your blood, and then you had to wait for that to be processed before they could even decide if your body was going to accept the chemo today. So that's something that - I was in nursing school at the time, and I would later come to know this better, but I didn't think about that when I'd heard of people having cancer. That like, yes, we're giving you these toxic drugs to cure your cancer, but that means that a lot of days, your body isn't going to be up for it. So you're going to drive all the way here. Your whole day is going to be devoted to this. And you might get there, sit there for an hour while they draw your blood, process it, and then get turned away. Things like that happened all the time.
Ella 8:12
Totally. And having absolutely no control over any of those situations was, like, really hard for me. I think for Mom and I both. I think we both have a tendency to be - I don't want to label Mom, but I'm a self-proclaimed control freak. I will say that. And I think literally having absolutely no control over those situations was so hard and so humbling, because, like you were saying, your entire day is devoted to this. You obviously want to stay on track and on schedule. And then all of a sudden, it's like, no, it's not going to work out today. Sorry. You're going to have to come back in a few days. And we'll go from there. And it's like, so infuriating.
Kayla 9:07
I guess that for the people listening who haven't been intimately involved in treatment, that's something I just want you to know and understand, is that it changes a lot. The plans are always in flux, at least in our experience. I'm sure that different types of cancer vary, but the body is very temperamental. You're literally poisoning it, in most cases with cancer. And so, like, what you hear a week ago might not be the plan anymore the next time you see an update or hear from that person. And I think that's where it gets hard too. We've talked many times in these episodes about asking for help, and it's hard to ask for help when you don't even know what tomorrow is going to look like, really. Like, you have to constantly be changing your plans based on how many white blood cells you have. And so it's hard to even know how to schedule people or how to get help. So that's difficult.
Ella 10:00
Yeah, and I remember, too, with the scheduling piece of it, so many of my friends who were really present with me throughout all of this and were reaching out, wanting to do things with me and being really inclusive and kind with all of the college things. Like they wanted to invite me on a floor date with them or they wanted to have me swing by for lunch or whatever. And it's like, first of all, I never knew what I was going to feel up to. So, like what you were saying about my body becoming the boss? Absolutely. I also think in many ways I was really upset and angry at my body because I felt like my body had betrayed me and was preventing me from doing literally anything normal. Right? Like, there were these plans that people tried to make with me and so often they just didn't work out. I was either not feeling up to it or our treatment day ran three hours late. All these things that, again, are just completely outside of your control. And so I think even those little shreds of normalcy that we tried to incorporate into my life, and that a lot of really kind and wonderful people made a huge effort to maintain for me, even those were compromised many times.
Kayla 11:29
Yeah, you just saying that about treatment… I don't know why I forgot this until right now, but even if your blood counts come back adequate, then they start making the chemo. So they have the ingredients, but they don't mix it because it's thousands and thousands and thousands of dollars. So I get it, but that can take - it’s so much sitting and waiting. It blew my mind how much you sit there. But you really couldn't make any of those plans because… you just never knew how late it was going to go. I remember scheduling bridesmaid dress shopping for my wedding with you around your cycles, because you would go every so many weeks. So we tried to plan it for when you'd feel your best, kind of right before your next cycle. And I think that did end up working out, but it's like all those things are just up in the air all the time.
Ella 12:22
Yeah. And then one little change in that plan, which so often happened, then the whole schedule you tried to make is completely thrown off. Yeah.
Kayla 12:33
Even your transplant, I think it was supposed to be in October, like you relapsed in August. You were supposed to be transplanted already in October, but the chemo they had given you didn't get rid of enough of the disease. So then you ended up spending Christmas in the hospital for your transplant. So even, like, big picture stuff can often get really out of whack.
Ella 12:58
Yeah. And that was really blood count dependent, too. I remember we would have to drive to the hospital on the weekends to check where my counts were at, to see if we were on track to do the stem cell harvest so that we were on track to do the transplant. And it's just like there's so many factors in the big picture.
Kayla 13:21
And I think going back to your friends and family and whoever… It's hard to communicate adequately… that you really just can't. Because I think sometimes people stop asking [you to hang out] if you've canceled on them so many times or said no so many times, because they're like, “Oh, clearly, I'm like, she's not up for this right now.” And it's hard. I guess we can't speak for every person going through it, but I would recommend you take that person at their word. Like, if they say, “Oh, I have to cancel again, but please ask me another time,” believe them, because it's just truly like they can't control their body. And I'm sure sometimes you just don't even feel mentally up to it and have every right to bow out of something. But I think repeated cancellations can make people feel like they should stop asking, but that's not necessarily the case.
Ella 14:18
For sure. Yeah, I would echo that too. Yeah, I always really appreciated the people that kept asking, even after I had to cancel multiple times. I think one of the things that I realized in the midst of all this - like I think, I don't know if I realized this as soon as when I was writing that entry in my journal, but as we've mentioned, we are believers in God. And it was around this time, really, that I was, I feel like, stepping into my own faith and really developing a relationship with God for myself. And I think one of the things that I really learned through all of this - and I think some of this too, is what you were saying about younger people and thinking that we're invincible and thinking that we can just manifest whatever we want. I think a lot of times we think that we're in the driver's seat of our life, right? That like, well, if you just put the right gas in and you just, you know tune up the brakes and whatever, it's like you can just drive wherever you want, whenever you want. It's your car. You do you. Like you can just make it happen. And it's like, at the end of the day, we're not the ones in the driver’s seat. I mean, I just really came to know and understand that God is the one driving the car. And I'm really just along for the ride, so to speak.
Kayla 16:01
Yeah. Jesus, take the wheel. Am I right? [laughter]
Ella 16:04
Quite literally, yes. [laughter]
Kayla 16:06
Like the Carrie Underwood song. I wrestled with that idea… From what you're saying, we might have even landed in slightly different places, but maybe we're in the same place. I had to accept that God is in control, not me. But it was more of admitting to myself that I am not a god - not that I truly thought I was divine, but that I didn't have god-like power - more than actually adjusting my view of God himself. I think I had, again, with that invincibility of youth, imagined myself to have a lot more power than I thought. And so I was stripped of any facade of me being godlike. But then at the same time, I was mad at God, because if he's the one driving, that's an easy thing to blame. It's like God driving the car. So I kind of settled on this. Free will has caused the chaos in the universe. But it's a gift worth bearing. And so He's driving the car, but He doesn't necessarily throw all the bad stuff at us. That's just from the fallen world, if you will. So I don't know if that resonates with you. Yeah, definitely.
Ella 17:29
Yeah, definitely.
Kayla 17:30
I struggled with my faith for sure, but that almost came a little bit later. I feel like I clung to God through most of it and then afterwards kind of looked back and was angry at God. But what I also struggled with was anxiety. I think the word anxiety is thrown around a lot, and I'm glad that anxiety and depression and mental health are getting more airtime and more accepted and less stigmatized. But for me it was several years after you had been transplanted and had been in remission for a while that I just found this anxiety on my chest where, like, I had this weight that I couldn't remove every day, and it just interfered with my daily life every day for over a year before I got help for it. And the tipping point for me was sitting on the beach on my birthday, which is, like, my perfect idea of a day, and still feeling that way. I had my family and friends around, and I was in this perfect spot, and it was perfect weather, and I was just like, if I can't feel relaxed right now, something's really wrong with me. And I went to therapy for a year and a half with a master's level social worker and unpacked a bunch of stuff. But I think at the root of a lot of my anxiety was my desire to control things that I can't control. And I'm not saying that in a way that I'm wagging my finger at my past self. It's not like I could have just “leveled up” and hacked my way into not wanting control. I think it's something you have to really work through, and hopefully with the help of therapist; it's difficult, but… especially being your sister, I wasn't your caregiver. I wasn't you, and yet I had all this knowledge from nursing school, so it felt like I had to do something with it. But really just having to watch what played out and be helpless to it, it just started to build up and get to me. And then after you were in remission, you'd have these scans, and they become less and less frequent, but those always took a toll, too, as I'm sure they do on you. And just, like, waiting for the other shoe to drop and just knowing that you're walking around living your life and there's nothing I can do to A) prevent your cancer from coming back or B) prevent some other terrible tragedy from befalling you. It's almost like in some weird “My Sister's Keeper” way from that Jodi Picoult book, like, I guess I won't spoil the ending of that. But sometimes people fight an illness. There's that battle language again. Fight an illness, endure an illness, get better, and then are killed some other random way. And so I remember one time you had talked about skydiving, and I'd like to say I was like, “Yes, girl, you conquered cancer. Like, jump off a plane.” But my instinct was to be like, how dare you? We spent millions of dollars and gallons of tears getting you better, and you're going to jump out of an airplane?! [laughter] If your shoot doesn't deploy, I'm going to be so mad at you. I don't know, just that control, I just want it. And that really did lead to generalized anxiety in my whole life, in all aspects of my life for over a year. So if you're struggling with that, anybody listening, I highly encourage you to get help. Your issue might not be control. Like, anxiety has a lot of different causes, and sometimes you can't pinpoint one cause. I wouldn't say that was the only reason I had anxiety, but that was a huge thing I had to unravel and work through as part of my therapy.
Ella 21:43
What do you feel like your relationship with control is now? Like, how do you feel therapy helped you in your relationship with control?
Kayla 21:59
I think that one of the biggest things of therapy is that it helps you become more self-aware. So even though they don't necessarily give you a magic cure or silver bullet, the biggest step is becoming aware of when thoughts creep in or feelings get out of control. A phrase I learned in therapy is thought-stopping, which has been huge for me. So if I start to have a spiraling thought about well, if this, then that, then that, then that. I just can replace it with a different thought. Or like, we're not going there today. And it's kind of like working out in the gym. You need to exercise your brain to be good at thought-stopping. And it actually carves new neural pathways. So you're literally retraining your brain to not go down that road that lights up between those two neurons of worry, worry, worry, worry. You're like, no, we're going over here. We're going over here. And so it's less… I think that my instinct will always be a base level of wanting to control. And I think that's kind of human nature to an extent. But it's what I do with those urges when they come up and identifying them. Because I think before it was a lot of it happening in the background subconsciously and I wouldn't catch myself until I just felt really bad. Even now, I've been meeting with a spiritual director which, maybe on another episode we can talk more about, but to kind of unpack more of my anger at God and things like that. And so they're kind of like more of a life coach than a counselor. They're not really there to help you with mental illness per se, but be a safe and reflective listening space on a spiritual journey of any sort. And I was going on and on about something and then he just, like, nods and he goes, I hear control. I was like, dang it. I thought I conquered this with my therapist a couple of years ago. And here I am down the road, different practitioner in front of me, still having control as one of my issues. So I wouldn't say I'm recovered. I'm a recovering control freak. And like I said, that number one tool is seeing it for what it is and thought-stopping it. And also having to let go or choosing to let go of things you don't have to know. So, like, if you don't tell me, I don't ask you anymore when your scans are. Like, if it comes up and I find out, that's fine. But before I was very much like, okay, so when's your next one? What have they done to you? Are they doing blood? Like, I wanted to know everything. And I think in the past we've talked about these, like, detailed people - that is, for me, from a need to control. And it's like, me knowing exactly what tests you're getting done and what date isn't going to help you not have cancer, and it's just going to make me feel worse for weeks leading up to it. And so it's like, of course I always want to be here for you if you want to share that with me, if you're having a particularly anxious cycle or something. But more importantly, I'll be there, whatever the result is, because then that's just the fact of the matter and we have to move forward. But it's like, “Yeah, Kayla, you don't need to know every little thing she's going to the doctor to do because that literally does nothing for her body or her health.” Like, I had to let go of that. So choosing, “Oh, me knowing this actually doesn't really help at all.” I don't know how that feels to you.
Ella 25:47
I think at first I was just like, a little surprised by that because I know you and I know that you tend to like the details, but I can really see how sometimes, yeah. Ignorance is bliss. I think we said that on an earlier podcast too. And it's like I felt that way… like what you were saying a few minutes ago really resonated with me. In a lot of the unknowns that we were facing, I would say, especially when we were suspicious of the relapse, like, living in that awful, just, time of unknown before you know what it is… like for me, I'm the kind of person that I can do just about anything, but I need to know what it is we're dealing with. Right? It almost felt better to me to just have the news of the relapse and run with it, because living in that space where the doctors were kind of… questioning my instincts, and then I started questioning my self-awareness of my body, and then it was test after test, and it's like, well, we can do this if it would make you feel better. I think that made me feel like a total loss of control. But then once I had the actual okay, yeah, unfortunately, it's back. In some weird way, it's like, that was better for me because I was like, okay, now I know what to do. I know what comes next. Does that make sense?
Kayla 27:24
It does. And that reminds me of another important point. I don't want anyone to hear from our conversation that you should be passive or not advocate for yourself once you're in that seat of being the cancer patient. I don't think that's how it's coming across, but I just want to be super clear. And we'll do a whole episode on this, but when you did relapse, you suspected in your body that it was back, and multiple times the doctors reassured you that it was very unlikely. And your persistence is why we found the relapse when we did, and we'll never know if that saved your life. Right? That's hard to think about. So Ella did take control in that scenario and insist multiple times that something was wrong, but… So I think it is important to acknowledge what you cannot control and try to thought-stop and let that go. But hang on to what you can. And don't be afraid to white-knuckle what you can control especially. When it comes to being the expert on your own body. I think that a lot of people, at least a lot of patients I worked with, experienced hopelessness, or because so much control had been taken from them they almost became… I've heard the phrase “learned helplessness.” Especially if you've been walking this journey for years. Your whole life feels like it's all up to the doctors and your body. And you're just trapped here. Doing what everyone says… they kind of became depressed and just didn't make any choices for themselves or couldn't control anything anymore. And so that's the other end of the spectrum. It's like, yeah, you need to learn to let go of some stuff, but swinging all the way that way isn't healthy either.
Ella 29:28
Yeah, I think from the patient's perspective, like, having gone through this, I just really think focusing on the things that you do have control over… I mean, I think this is a somewhat talked about thing on social media and just like in society today, focusing on the things that you do have control of versus the things that you don't. I think a lot of people really brought this to their awareness during the COVID pandemic when, honestly, most of society, all of society, was living in a similar situation to what our family went through and what a lot of people navigating a cancer journey go through. When you are just thrust into something that you did not ask for, that you have little control over and that dictates your daily life so much. And I think especially in those first weeks and months when we were all stuck in our homes and really not doing much, I think a lot of people went to a really dark place mentally. And I think what you were saying about hopelessness and helplessness, I think people were just not in a good spot and feeling like they had absolutely no control over anything. And I feel like that was around the time when I started seeing these really helpful visuals. Often you'll see, like, a Venn diagram or a smaller circle inside of a larger circle really highlighting the things that you can control versus the things that you can't. So for example, some of the things that you do still have control of is your attitude. Right? And I definitely had times where I did not have a good attitude at all and I think that is totally okay too. But it's like, you have control over your attitude and what you're thinking. Like you were saying with the thought-stopping, Kayla, you have control of what your brain is doing and what thoughts you're ruminating on all day. And it's like there comes a point where if you are just down in the dumps negative all the time, that's just not going to serve you very well, even in a cancer journey. Like, trust me, I'm not the person to be like, “everything's awesome,” like, thumbs up, like toxic positivity. But I really do think, like, your attitude and your thoughts and how you speak to yourself really matters. And it's like there's all these things that you just absolutely can't control, but we do have control over a lot. One thing that I found a lot of joy in was that I really wanted something that gave my day's purpose, because I think that was one of the things that I struggled a lot with, was, like, with the loss of control. It's like, I was supposed to be a college student, right? And that kind of just got stripped away from me. So then I was like, well, shoot, now what am I, right? I definitely didn't feel like my identity was what I thought it was going to be, if that makes sense. And so my days were just, like, super long and pretty sad a lot of the time. And I just really wanted to find something to give my energy to that was positive and I actually turned to art, and it became really therapeutic to me. And I began creating a lot of different things. People were ordering custom pieces, and just creating was really therapeutic for me. And it was like a reminder that I did have control over how I spent the time that I felt good enough to do things. And it just felt really good to be productive when I could be, but also in a way that really filled my cup.
Kayla 33:48
My writing, I think, has almost scratched that itch for me. It's interesting that I did that delayed. It almost seems to me like all of my processing of this was delayed. Like, I was angry at God after the fact. I had anxiety after the fact. I worked through it creatively, through writing in poems, after the fact. Now we're doing this podcast, like, five years out, and I wonder - I'm just thinking about one thing that I couldn't control really, at the time, was my stage of life either. So I was a senior in college when you were first diagnosed. I had to really realize consciously in my head, I had this conversation with myself, like, quitting college isn't going to help her. I had this wild urge to just drop out and live at home with you and… and it's like I lived an hour away. I ended up spending a lot of nights at home and a lot of time with you. But like, me quitting my degree when I was three years in, when a lot of days you were sleeping or like, spending time at the clinic wasn't going to help anybody. And I just had to face that and be like, I shouldn't… you know, me canceling this part of my life or whatever… that's something I could control. Like, I could have dropped out, but, like, realizing that kind of would be pointless. Now, I'm not saying that's always the answer. There are people in 100 different scenarios where that would be the right answer. But you had two loving parents who were happy to have you live with them, to pay for you and house you and cart you around. And it's like they really didn't need a third person with nothing to do other than care for you; that probably actually would have ended up bad. But then the second time. I didn't have the option. I had graduated, gotten married, and had a full time night shift nursing job on a cancer floor. And my husband was finishing college, so half of my paycheck every two weeks went to his school, and we rented an apartment out of the other half. And that was just it. We had signed up for that, knowing we would power through that first year and a half of, as they say, living on a shoestring budget. But at that time, you were in remission. And so it never crossed my mind that during this weird in-between time of my life where I was working nights and not making much money, that you would be needing more support or whatever. And so it's like I felt trapped in that job and in that situation, like I had made those choices, kind of giving a year and a half of my life or whatever, because we wanted to be married and move forward with our relationship. And we were just like, you know what? We'll just tough it out together. We'll be broke for a while, but we never thought that that would coincide with your cancer returning. I saw that I had made those choices, and then I felt trapped by them. And looking back, I had started my job the day before you relapsed. So, like, I was still doing orientation with Human Resources, and I was a new grad nurse. So I'm sure that if I had reached out to the hospital where I worked, I probably could have found a job not on a cancer floor. But we were just so shocked, or at least I was, by your relapse that I didn't even think of that until, like, years after the fact, that maybe I did have some agency there. I mean, I had signed up for the job in April, and you didn't relapse till August. That was contingent on me graduating and passing my licensing exam. So it felt like I had been committed to this job forever. But now that I've been an adult for a longer time, that was really my first “real job.” I realized, oh, I still could have pulled out of that, and I'm sure our parents could have patched us through a few weeks until I started on a different floor. But at the time I felt like I had no control over that. I don't really know what my point is. But it can be hard when you're in certain life situations that make you feel like you don't have control. You obviously much more so with your cancer, but then that can be compounded by life situations. What if I was the one with cancer? Right? People are in all kinds of scenarios where this happens and yeah, that's just hard to think about. Well, we want to leave you with a resource… like Ella mentioned, a lot of times, you'll see Venn diagrams or circles, and so the one resource we found for you relating to control is a circle. It's got three rings and the outer ring is no control. The middle ring is some control, and the middle circle is most control. And it's a worksheet with questions and it helps you kind of work through what you can and can't control. And you do it once, and then you sort of reflect, and then you do it again and be like, maybe some of the stuff I had said I had no control over, I have a little and here's what I could change. And maybe some of the stuff I said I could control, maybe that's not totally true, and I need to let that one go. So we'll link to that in the show notes. Like we said, it's not a magic cure, it's not a silver bullet, but it can help to just clarify if you're getting stuck in a rut, and if you feel like lack of control is beating you down every day, it can be helpful to just acknowledge those different categories. So hopefully by next week, we will be over our colds and sound back to normal. But as we've said, you can't really control your health in a lot of ways. So we'll hope for the best. And next week we will cover the fact that Mom was right, life isn't fair, and delve into that idea, especially as two sisters who grew up hearing that a lot. Thanks for being here, as always, we'd love to hear from you in the comments on Instagram or over at our website, mysisterscancer.co, and look forward to hearing about your experience and any tips and tricks you might have for letting go of a little bit of control at a time. See you next week.