Posts from May 2014

I cracked last night, and I mean that two senses: that of a structural crack, and a crack of the whip.  Over something admittedly important, yet still not immediately critical, I just lost it.  Angry lost it.  I yelled at my wife and child, at the top of my lungs, my voice cracking, venting frustration and rage.  I ended up leaving the house for a while, right in the middle of bedtime, because if I’d stayed I would have kept making things worse.

Part of me feels like I failed them and myself, because I was adding to the stress and upset of loved ones.  It radiated outward, a wave of anger passing from me to them and from them to others in the house.  We don’t need any more upset than we already have.  I shouldn’t have been the flashpoint.  I expect more of myself.

But more of me, maybe most of me, knows that strength always has its limits, and that last night, I reached mine.  There were too many weights from too many sources, and I broke.  It was, perhaps, understandable — the breaking, and maybe even the manner of breaking.

Whether you think the manner of breaking was okay probably depends a lot on the kind of household that raised you.  Some families think yelling in anger is merely a louder form of conversation.  Others think it’s a fundamental betrayal of respect, trust, and love.  The calculus often changes if children are involved, and how involved they were in whatever precipitated the anger.

I’m not here to ask for absolution, nor to be condemned.  Nobody else could do that anyway.  Only I know all the specific pressures involved, the mitigating factors, and the paths not taken.  I’m more than capable of judging myself and my actions (and inactions), and deciding whether I deserve harshness or leniency.  Or some combination of both.  I might err a little bit on the side of harshness; I always have, when it comes to me.  If anything, the past nine months have pushed me away from that.

Afterward, when the kids were (mostly) asleep and I had returned home, Kat and I talked, and I set a limit I didn’t want to set, but had to set.  I said exactly that to her, that this was not something I wanted, that I actually wanted the opposite, but it was something that I had to have, or else I would just keep breaking, day after day.  I asked forgiveness for what I was saying.  Asked us both for forgiveness, really.  She gave me hers.  I’m still working on fully getting mine, but I will.

Why am I even telling you this?

Because blogging is a heavily filtered view of reality, just like any other medium.  Here, I choose what to share, what to hold back, and what to lie about.  I do my best to avoid the lying, but to some extent it’s unavoidable, because I’m not going to record every conversation and every incident in precisely the way it happened.  Not even documentaries do that; every jump cut is a falsehood, by omission if nothing else.

It’s too easy to edit out the rough patches.

So many people keep telling us how strong we are, how amazing, how incredibly we’re coping with all this.  There’s a sort of imposed romanticism about it.  I’d always noticed, before we had cancer or even kids, that stories of people who discover they’re dying always get an aura of nobility applied to them.  In the shadow of death, the victim somehow always attains a special glow, one that spreads to those nearest them, bathed in a light of wisdom and clarity and rightness.

And I’ve fed it.  I’ve fed that aura in our own story, in what I’ve talked about and how I’ve presented it.  I didn’t consciously set out to do it, but it’s there.  I read back through the archives, and I can see it.  I shared the best parts, and skipped the bad parts; or, when sharing the bad news, did it in a way that made us, all of us, seem strong, amazing, incredible.

Maybe we are all those things, but we’re human.  Flawed, struggling humans, just like everyone else, just as prone to error, just as capable of hurting loved ones with our words and outbursts.  Inside the aura, there is no nobility.  We don’t get a special, knowing inner light.  There is no melancholy beauty, no surplus of grace.  We don’t get bonus abilities.  We have more help than anyone could ever dream likely, all the hundreds people who lend and have lent their hands, their ears, and their encouragement, and still we struggle imperfectly with ourselves and each other and the demands we must meet.

We’re human, with every drop of beauty and ugliness that label carries with it.  The angel and the demon, all rolled up together.

We cry and we crack, inside and outward.  We stumble and fall and fail and flail.  We simmer and seethe, and also we soothe.  We give and forgive.  We hold to each other and hold ourselves tight.  We do what we can, as best as we can, as long as we can.

And when we falter, we patch the cracks as best we can, make our apologies, and try again.  That’s what keeps our failings from making us failures.  We try again, one day at a time.

That’s not noble.  It’s not even all that remarkable.  It’s simply what has to be done, over and over.  Just like everyone else.

• Cracks Appear was published on Friday, May 30th, 2014.
• It was assigned to the Personal and Rants categories.
• There have been thirteen replies.

Rebecca’s spark has dimmed, and we don’t know why.

On days we go to Pittsburgh, she sleeps the whole way there, is pretty normal at the hospital, and then sleeps some or all the way back home.  When we get home around mid-day, she usually stumbles to the couch and takes a long nap.  She might have a few normal hours of wakefulness starting mid-afternoon, get energized around dinner and bedtime, and then go to sleep for a full night.  Or she might spend those hours not doing much of anything except lie awake.

On days Rebecca goes to kindergarten, she usually walks there and has a normal morning.  And then, right around lunch time, she usually runs out of steam.  We had to go pick her up the other day because she’d fallen asleep at her desk, deeply enough that normal attempts to rouse her got no response.  (Normal, as opposed to “THERE IS A FIRE WAKE UP NOW!”)  We got her home, and she stumbled to the couch and took a long nap.  Once that was done, she didn’t do much for the rest of the day.

Even when she’s awake, at least half the time she seems distant, disconnected.  Much of the time she’ll just lie on a couch or a lap, not moving much, not doing anything but staring off into space.  You can catch her attention and get a warm smile or an air kiss when you do, but that’s it.  She’s there, and yet not there.  At her most energetic now, she’s much more subdued than she has been in the past.

And we don’t know why.

We’ve ruled out seizures.  The EEG showed absolutely no trace of any seizure activity, even when she just sort of stopped and stared off into space, as she does so often these days.  Everything was completely normal, diagnostically.

We think we’ve ruled out pressure due to tumor growth, given the latest CT.  We’ve moved up her next MRI, and expanded it to most of her body, to see if there are tumors elsewhere, or if the CT somehow missed something.  Maybe a thalamic tumor.  Maybe not.

We can’t definitively rule out a virus of some kind.  Her viral panel was negative, but it’s a limited test.  Everyone in the family has had a virus that drained us, as have some of our friends, but most of us recovered in a few days and Rebecca’s been like this for two weeks now.  If it’s a virus, then something is keeping her from recovering from it.  But her blood work is normal, her immune system apparently fine.

We can’t rule out the possibility of side effects from the p28 treatment.  Rebecca is the 38th child ever to receive this treatment, and one of a very few who’ve gotten it at her dosage level.  Maybe this is all just a huge side effect.  Except it’s been almost a week since her most recent treatment, and there doesn’t seem to be much, if any, improvement.

In the absence of certainty, it’s hard not to descend into fear.  Maybe none of these things are what’s wrong, we try not to think.  Maybe she’s just dying.  It’s a little like being deep in the heart of an unknown forest at twilight (or is it sunrise?), unsure which way to turn and what’s really dangerous.  A snake could be in that log.  A rotten tree might fall.  There might be a bear.

I grew up in forests; Kat’s totally a city girl.  But even I can’t help feeling like Rebecca is leaving us slowly, a tiny little bit at a time.  Intellectually, I know that may not be so, but in my gut I feel it.  I look at her lying limply on the sofa, her eyes vaguely focused on something a thousand miles away, and my stomach twists icily.  I want to shake her fully to life, drag her back to us, scream until the spell is somehow broken.

Instead, I take her hand and smile at her.  I sign “I love you”, tapping it to my heart as we always have in our family, to see if she’ll do the same.  Usually, she speaks “I love you” back, because that takes less energy, less movement than signing.  Her eyes crinkle with warm affection when shes says it, looking into my eyes, holding my gaze for a few moments.  Until her gaze slides away and loses its focus on the here and now.

If Rebecca were cranky and irritable from exhaustion, that would actually be easier on us, because that would make sense.  That would be normal.  It’s the quiet inertia that really, deeply scares us.  Whatever our heads may derive from looking at all the maddeningly incomplete data, our hearts are filled with fear.  We’ve tried to push it away, and also tried to accept and acknowledge it, and neither approach seems to help.  The fear persists.  We’re afraid that her light is very slowly going out, that she’s fading from this world, that she’s leaving us.

And we don’t know why.

Perhaps posting this publicly will make all the symptoms go away, and I’ll wonder some day what I was so bothered about.  I hope so.  I’ll absolutely take feeling foolish in exchange for having her be herself again.  I’ll even accept never knowing why she’s been like this.  Just as long as we can put this forest behind us.

• Deep in the Forest of Fear was published on Thursday, May 29th, 2014.
• It was assigned to the Cancer and Rebecca categories.
• There have been thirteen replies.

As soon as the doctors came back into the room from looking at the just-completed CT images, I knew the news was not bad.  I didn’t know exactly how not-bad it was, but I could tell just from the way they walked into the room that the worst had not come to pass.  The expressions on their faces simply confirmed it.

And then their words: the primary tumor’s size is essentially unchanged since the MRI that was done three weeks ago.  There are no obvious solid tumors arising from the flare sites.

This is huge.  The rate of growth previous to starting the p28 study was frighteningly rapid.  If unchecked, it should have been at least a third bigger, maybe half again as big, maybe even twice as big, by now.  Instead, it’s basically the same size.  The flare sites have not produced tumors of any notable size, and may have produced none at all.

I can’t say if the primary tumor is exactly the same size, or a little bigger, or what, because today’s image was a CT scan (done in the Pirate Island imaging room, by the way).  As such, it can’t be directly compared to the last MRI.  We won’t get a more precise estimate until another MRI is done, and even then it won’t be ultra-precise.  Medical imaging can only get you so far, precision-wise.

The tumor isn’t being eliminated, because that’s not how this treatment works, but it is being held in check.  The p28 is buying us time — enough time, we can hope, to find a way to shrink or possibly even eliminate the tumor.  That’s where our energies will be directed in the next few weeks and months.

So after all my angst and worry about making a blind choice, there was no opportunity to make it.  In a sense, we had no choice, though of course we always had the option to refuse.  Given the situation, though, we ended up imaging earlier, and differently, than expected, for unexpected reasons.

The reasons were that, starting Friday afternoon, Rebecca became very tired, almost to the point of listlessness between daytime naps.  She hasn’t napped in years, and suddenly she was sleeping twice a day, going to bed early, waking up late, and still having low energy.  There were periods where she’d rally and be her usual self, but they got shorter and less frequent.  Yesterday, there really wasn’t a time where she had her usual energy levels.

Our instincts basically got whipsawed into pulp.  There were a few times over the weekend where I nearly tweeted that she was dying, because that’s how it felt to both me and Kat.  Then she’d rally, and we’d think that maybe it was just a virus.  And then she’d slide into a torpor that felt so much like the days before her seizure last August.

The thing was, it was only fatigue and lethargy.  There wasn’t vomiting, as we would expect with intracranial pressure, nor complaints of headaches.

Then, last night, there was an incident that seemed like a very small seizure.  We talked with the on-call nurses both here and in Pittsburgh, and both agreed that we should get her to Pittsburgh for her p28 infusion and further evaluation with the study doctors.

Kat and I were pretty well convinced that the CT would show a much larger tumor, not driving up pressure so much as disrupting the normal brain tissue and slowly killing her.  We were braced for the news that the drug wasn’t working and that she was out of the study.

As we waited for the CT machine to spin up, Kat broke from our embrace to look me in the eye.  She asked, “Are you ready for the results from this?”

“No, of course not,” I said.  “But whatever they are, we’ll deal with them.”

Less than an hour later, we were asking the doctors to repeat their findings.  No change.  Our intertwined fingers contracted, squeezing as one, disbelief translated into white-knuckle pressure.  We turned inward, fell into each other’s arms, and wept tears of relief and a kind of joy.  For the first time in months, our tears came from something other than fear and sorrow and pain.

Tonight, Rebecca is in yet another hospital bed, this time at the Cleveland Clinic.  She’s still deeply tired all the time, and if the tumor isn’t exerting pressure, then there has to be another cause.  We might have waited it out to see if it’s viral, but there are enough other signs — the incident last night, some subtle physical changes, behaviors that might not be behavioral — to tell us that she’s probably having micro-seizures, and having them pretty often.  The tumor would be the most likely culprit here, considering where it’s located.

So tonight a technician is gluing a couple dozen electrical leads to her scalp so the EEG monitor can tell us if we need to add an anti-seizure medication to her daily routine.  In one way, I hope that it does, because that would be a known, fairly easily-addressed problem.  We’ve done anti-seizure medication in the past, and have a good idea of what works for her.

Of course we don’t want her to be suffering seizures of any kind — she’s suffered enough as it is — but as Kat observed, we’ll take a seizure disorder over an unchecked brain tumor any day.

We’re not out of the woods yet.  Even if the p28 is preventing the tumor from growing, which is all we can realistically expect it to do, the tumor is still there.  We have to find a way to deal with it, because we can’t expect the p28 to be effective forever.  But if this initial effect holds up, we might have several months, possibly even a year or two, in which to search for a stronger, more permanent treatment.  We’re checking into a number of clinical trials, some you’ve heard about in the news and others that were unknown even to our neuro-oncology doctors.  (That’s not a knock on the doctors; there are a lot of studies happening at any one time, and always more being launched.)  We’ll use the time the p28 is giving us as best we can.

A long day, and a very emotional day, but a good day, one of the best in a long time.  Any day you end with more hope than you started with is a day worth celebrating.

• A Good Day was published on Monday, May 19th, 2014.
• It was assigned to the Cancer and Rebecca categories.
• There have been nineteen replies.

It’s the nature of cancer and its treatment that there are often incredibly difficult decisions to make on very little information with no real idea of the eventual outcome.

Once conventional treatments for cancer (or any other life-threatening illness) fail, you enter a realm with no landmarks, full of apparently identical paths, and you must choose one.  Or else refuse to choose any, and so wait for death to catch up.  Because past chemotherapy and radiation, there are experimental studies, alternative remedies, and so on.  One of them might be the path to long life and health, but there’s nothing to distinguish it from all the others.  And it’s entirely possible that none of the paths lead anywhere but a quick death, some more painful than others.  And there’s still nothing to distinguish one from another.

So many paths, all looking exactly alike.  Choose one.

We’re facing a particularly difficult decision soon.  Rebecca qualified for a Phase I clinical study of a novel treatment.  It isn’t chemotherapy, but a whole different class of drug.  To quote (with a minor edit) the Sloan-Kettering Cancer Center:

Many cancer cells have a protein called p53 that does not work properly. This protein normally puts the [brakes] on rampant cell growth, and when it does not function well, cells can continue to grow uncontrollably (as cancer cells do). The p28 drug is designed to find and kill cancer cells with dysfunctional p53.

The major advantage is that p28 isn’t anything like chemotherapy; thus, it doesn’t have the toxic side effects of chemotherapy drugs, though apparently some patients do get nauseous from the infusions.  It’s basically a genetic therapy, in the sense that the treatment is designed to address a particular genetic situation.  It doesn’t interfere with other systems, like the immune system or bone marrow.  Not so far as anyone knows, anyway.  It’s always possible the study could show otherwise.

We’re in this study because the genetic analysis of her tumor last fall indicated a “p53 deletion”.  Thus, drugs meant to address p53-related problems are a first choice.  In theory, p28 could completely halt the growth of her tumors.

In theory.  In practice, miracle drugs are never totally miraculous — every type of cancer is its own distinct thing, and every patient responds differently.  The upshot is that there’s no way to know if her tumors are being affected by the p28 drug without doing an MRI.  The doctors leading the study arm in Pittsburgh want to do an early MRI, six weeks into the study instead of 12, to see what’s going on.

If we do the MRI and the tumor is essentially unchanged from the start of the study, then it means the drug is working.  In that case, we continue the treatments while we try to figure out ways to cause the tumors to shrink, either through careful surgery or other experimental treatments.  Kat’s been researching options along those lines, since she’s the one with three advanced-practice medical degrees and a Doctorate of Nursing.

At the other end of the spectrum, if we do the MRI and it shows the tumor is growing just as fast as before, meaning the p28 isn’t working at all, we would withdraw from the study, because the time we spend going there and back for treatment is wasted time.

But if we do the MRI and it shows too much continued growth, even if it’s a reduced rate of growth, then she will no longer qualify for the study.  Some growth is acceptable under the study protocols, but too much — even if it’s less than would have been the case without the drug — is not.

We don’t know what the odds are for these outcomes.  Rebecca is part of the first p28 study ever done in children.  And there haven’t been that many p28 studies in adults.  There is nowhere near enough data to tell us what the odds of success are in general, let alone for her specific type of tumor, let alone for tumors of that type in patients with her age and gender and ethnic background.

If we scan sooner, at six weeks, two out of three outcomes will mean she exits the study and the tumor continues growing at its pre-study rate.  One of those two would mean exiting the study even though there was some benefit, simply because there wasn’t enough benefit.  The third outcome is the best case, the one where she stays in the study because it’s working.

If we wait to scan at twelve weeks, and the tumor is growing unchecked, it could very easily kill her before we get to the scan.  We would spend all those hours in the car for nothing.  Or she could have too much growth and be disqualified.  Or the growth could have stopped.

These are the blind gambles you take, the excruciatingly difficult dilemmas you face, as the parent of a dying child.  Do you find out what’s happening sooner, even though it could mean you hasten her death, when not finding out might have meant she’d live longer?  Do you wait to find out what’s happening, even though that could mean you waste six more weeks, and you could have used those six weeks to try to find another treatment, one that might actually help?

And even if you look sooner, and as a result you find out that another treatment is needed, you don’t know what other treatment will actually help.  Maybe none of them will.  The choice is real enough, but the implied promise — that the right choice, if you can somehow manage to find or luck into it, will lead to a cure — may be, almost certainly is, an illusion.

I don’t know what choice we’ll make.  I still haven’t worked out how to come to a place where I can live with whichever choice we end up making, should the worst outcome of that choice come to pass.  I can’t even take refuge in not choosing, since that is the same as choosing to scan later instead of sooner.

Events will not wait for me, of course.  Soon enough, the choice will have to be made, one way or the other, whether or not I’m ready, whether or not I’m prepared to live with the consequences.

The only thing I think I do know is that I wouldn’t be able to live with myself if I refused to make a choice.  Right or wrong, good or bad, this is part of what I volunteered for when I became a parent.  Taking that role meant taking responsibility for the lives and welfare of my children.  Now Kat and I must take direct responsibility for the life and death of our child, and if we must choose blindly, we will keep her firmly in our sight as we choose.

• Blind Choices was published on Thursday, May 15th, 2014.
• It was assigned to the Cancer and Parenting categories.
• There have been seventeen replies.

Half an hour after we left UPMC this morning, just as we were approaching the entrance ramp for I-76 West, Rebecca threw up with no warning.  She threw up a lot.  We pulled over and scrambled to get her out of the car so we could clean her off and check for any other symptoms.  She stood with her arms held away from her body in the classic “ick” pose, until I peeled her shirt off to get most of the vomit away from her.  “It’s all over my arms and legs!  Why do I have to be like this?” she wailed miserably.

I pulled her to me, wrapped her in my arms, and said over and over, “I know, honey.  I know.”  Keeping my voice as level and calm as I could.  I don’t think I did a very good job of it.

By the time we’d gotten her and her car seat mostly clean, she felt fine, except for the taste in her mouth, which she pronounced “disgusting”.  We found the nearest drug store, bought some wipes and paper towels, completed the cleanup, and got back on the road, a newly fresh set of fears riding with us.

It could be the experimental treatment she’s taking, which is known to induce nausea in some kids, though she’s never been sick from it before.  It could be an aftershock from the GI ailment that went through the house the past few days, which had every single one of us dealing with unpleasant symptoms at one point or another.  It could be that she choked on her juice and triggered the gag reflex.  Or it could be the tumor, finally grown large enough to kill her.

I don’t know.  But the last time Kat and I were cleaning her off by the side of a Pennsylvania highway, she had four days to live.

• Afraid was published on Wednesday, May 14th, 2014.
• It was assigned to the Cancer and Rebecca categories.
• There have been eleven replies.

We lay snuggled together in her bed, the stories read and books put away, the lights turned low, listening to her nighttime music.

“Rebecca, can I tell you a secret?”

“Sure.”

“I love you super a lot.”

“I already knew you were going to say that, Daddy.”

“Oh, so it’s not a secret?”

“Nope.”

“Well then, can I tell you something that’s NOT a secret?”

“Sure.”

“I love you super a lot.”

(exasperated sigh)

I answered with a small chuckle, which earned me an affectionate glare.  Five minutes later, she was asleep, her breath quiet and even and calm and as normal as it had ever been, in the years before the tumors and the months after.

---

We were at the local playground, Rebecca and her sister Carolyn and brother Joshua and some friends and me.  At no apparent prompting, Rebecca came running toward me, then slowed to a walk and beckoned me to lean down closer to her.

“Daddy, I need to tell you something.”

“What?”

“I love you.”

“I love you too.”

“I love you more! I love you to infinity… and BEYOND! No really, I do.”

And she was already headed back to the slides, smiling at me over her shoulder, her eyes squinted in a knowing amusement, before she turned away and rejoined the other kids at play.

---

We lay snuggled together in her bed, the lights turned low, listening to her nighttime music and admiring the rainbow arc projected onto the ceiling by a bedside light.  It fell across the ceiling fan and some of the get-well stars strung in a line from one side of the room to the other.

“Daddy, did someone put a rainbow on that star?”

“No, it’s from the rainbow light, sweetie.”

“Oh.”

“What do you think when you look at your stars?”

“I think that my friends are always cheering for me.  Always.”

“You bet they are.  Always.”

“I love you, Daddy.”

“I love you too.”

“I will love you forever.”

“I will love you forever and ever.”

“Daddy, why are you copying me?”

“Well, because your words are beautiful, and they’re all true.”

“Oh.  Okay.”

“I love you to the moon and the stars and back again.  I love you to infinity and beyond.”

“Okay, okay, Daddy, we get it already.”

“Good.”

She smiled at me like we shared a gentle secret, as normal as ever.  I kissed her forehead, and within two minutes, she had fallen asleep.  I listened to her slow, steady breathing, my arm still curled around her — not to protect her, but just to hold her close — and looked up at the stars and watched the rainbow until its timer reached zero and it faded away.

• Three Interludes was published on Monday, May 5th, 2014.
• It was assigned to the Parenting and Rebecca categories.
• There have been seven replies.

This morning, I walked Rebecca and her best friend to kindergarten, all of us enjoying the crisp spring sunshine after the long, cold winter.  The girls ran ahead of me to see if the playground had been re-flooded by last night’s rains (it hadn’t) and then balance-walked a low retaining wall.  Once inside the school doors, I hugged and kissed Rebecca and told her to have a good day, collecting a hug and kiss and a “Love you, Daddy“ in return.  I watched as she tromped down the hallway in her sparkly new Bella Ballerina shoes and pajamas (today is a special Pajama Day at school) and rounded the corner out of sight.  And then I handed her principal a Do Not Resuscitate order.

She’s still so alive, so very vital, but we know that could change at any moment.  We’ve lived through it once already, last August, when she went from playing on the beach to the literal brink of death in just three days.

We carry DNR cards with us, and have given the school a DNR form sealed into a manila envelope with our names and phone numbers written on the outside, because if she suddenly seizes, our overriding goal is to make her as comfortable as possible while she dies.  The EMTs or hospice or we ourselves will give her medication to take away the pain and, if at all possible, the fear.  As much as she needs.

Because we know what will happen if the tumor induces seizure and she’s forced back to life.  We know that once it’s reached that stage, there are mere hours left, even if we permit life-prolonging measures.  Heroic measures, they’re called.  Hours, possibly days, spent in misery and pain and fear.

We can’t do that to her.  If there were a reasonable chance of her suffering leading to a cure, yes.  We did that last August, submitting her to multiple surgeries and the difficult recovery afterward, because there was reason to think that doing so would save her life.

Now we know better.  We know that when the cancer overwhelms her, there is nothing that can stop it.  We know that the best we can do is make what’s left of her life as normal and happy and full of love as possible, and minimize any horrors as it ends.

We’ve thought about pulling her from school entirely.  That would ensure that if she does have a sudden seizure, she’ll do so with one of us.  By sending her to school, we risk it happening when she’s not with us, and inflicting that experience on her schoolmates instead.

We send her to school because she loves it there, however much she may complain about having to get up in the morning and get dressed and put on a coat to walk to school.  Try as she may to hide it, she loves to learn.  She loves her teacher, her classmates, and her friends, and they love her in return.  It would be selfish of us to take that away, despite the risks, despite the hours of separation.  It would shift some of our burden onto her shoulders, force her to pay the cost of our sorrow and fear.

There are so few things we can do for her now, so very few things, but we can do this: we can give her her life, as whole and unbroken as we can manage, and an unspoken promise to fiercely guard it from even ourselves.  We can give her this.  Our last gift.

• Heroic Measures was published on Thursday, May 1st, 2014.
• It was assigned to the Cancer, Parenting, and Rebecca categories.
• There have been fourteen replies.