Reflections and New Beginnings

Well, it appears that 2012 will not fade away quietly. We have now had snow twice in the past week and the temperatures have plunged dramatically letting us know that it is winter and it has come in like a lion.

These last few days of 2012 are a period of reflection of what I have enjoyed from the year and what changes I would like to make in the new year. The things that I have been grateful for in the past year are: 1. For my health; I had a scare this year but because I do my semi-annual checkups and I follow a preventative care things worked out well. 2. My family – we are a small bunch less than 10 of us when we get together. We have made a concentrated effort to speak to each other each week, to get together for a family meal at least once a month and to just be there for each other. 3. My job – I work in a field that enables individuals to communicate real time and I can see how this makes a difference in the quality of care we provide our patients. 4. My work team – they are fantastic and I could not have asked for a more cohesive set of men who provide quality service to our colleagues and clients. 5. My friends who although we do not manage to get together as often as we like – we know we are there for each other.

I have been very fortunate to have a home that I continue to enjoy and look forward to going to each evening and it has not been affected by the various storms we had this year. I finally took an Alaskan cruise – this is one of those things that was on my bucket list and I can now check it off. And lastly, I introduced a new exercise program, High Performance 30 into my routine and I have learned to do a very intense workout in 30 minutes – I have pushed my body to do things I was unaware I was capable of.

So what are my plans for 2013? Like most people I still wish for health, happiness and to be able to continue to financially assist my family in any way that I can.

I will continue to introduce new workout programs to my routine – I do so for a variety of reasons; to learn something new and see if I like it, to wake up my body and muscles so that they do not get complacent and routine; and, lastly to see if I lose weight or how I am sculpting my body. I will be 58 in 2013 and though I may not weigh what I did when I was 28 my body is much stronger and more defined today.

As my cousin, his daughter and her husband move to Delaware – I will ensure that I have his son and grandchildren to the house at least twice a month for some family time and a nice home cooked dinner. I cannot promise; but, I will be making a concerted effort to get to Delaware every couple of months to see my family and the new life they will have established. Work will continue to be challenging as we introduce more technology like Telestroke carts and our UC strategy is rolled out – but what a difference we are making in how our Clinicians communicate with each other and with their patients. This will ensure that North Shore LIJ remains in the forefront in their ability to become a force in healthcare.

I have also come to a decision on this blog – I am looking to try and give you a message every day. It will be short and sweet; and, hopefully thought provoking. A few words to live by – a few words to get you through the difficult days – a few words to celebrate you and your life.

I hope you look forward to 2013 – it is a new year and with it new beginnings.

As the poem states, “the stockings were hung by the chimney with care in hopes that Saint Nicholas soon would be there”.

Christmas is in less than 36 hours – the day that all good boys and girls wait for. I am all ready as yesterday it took me five hours and I saw six Lifetime/Hallmark Channel holiday movies that I had been DVRing for the past several weeks while I wrapped Christmas gifts. As always I can never believe how much I have bought – the presents placed in carry bags will take the entire back seat and floor of my car. But, it will be worth it to see the boy’s faces when they open their gifts.

The front passenger seat and floor will be left available to hold the food that I picked up per instructions from my family – it will hold the fresh ham ordered from the butcher, the pound and a half of Italian pastries from my local bakery and the two eggnogs (the one with liquor and the one without). I will take all of this down to my cousin’s house in Hartsdale tomorrow as we meet to go have a nice Italian dinner. This past week I was in the office for a couple of days and was able to give my team their Christmas gifts – a diary with all the New York information (restaurants, transportation and most needed phone numbers) I also gave them a pumpkin bread with cinnamon crumb topping that I had baked on Monday evening. Wednesday and Thursday I was able to hit the gym in the morning and then attend a few conference calls and do a lot of work for the Visual Communications Industry Group (VCI-Group) – I am President for next year and we are starting with a vengeance.

Friday although it was windy and rainy we had Breakfast with Santa at the Rock Café in Rockefeller Center. Ryan totally enjoyed himself and he does have an appetite as he downed scrambled eggs, bacon and hash browns – also he ate all of the melon that was on the fruit plate. Callum not so much – he was really being shy and didn’t perk up until almost the end when he ate a muffin and then was ready to go bye-bye.

We walked to Grand Central and I was able to stop by Godiva Chocolatier to buy the chocolate Santas for the boys and chocolate snowflake lollipops for the rest of the family. We took the boys to the Train museum where they had the train sets up and running – both Ryan and Callum were fascinated by them. Each walked away with something; Callum a train and Ryan a book on the architecture and engineering of Grand Central.

The week has been full and will culminate in the next couple of days – I hope that each of you have completed your Christmas shopping, baking and cooking. May you enjoy the next week with your family and friends and the true meaning of the season.

Merry Christmas and Happy Holidays to All.

Highs and Lows

A week of highs and lows. And I know it has been the same for each of you – how could it not have been?

Monday began as we worked with our partner, Cisco to bring Santa Claus to our littlest patients at our Cohen’s Children’s Medical Center. My team and I dressed up like elves and through video conferencing technology we had Santa Claus speak to the children, ask them what they wanted for Christmas and then he told them how much he, Mrs. Claus, Rudolph and the rest of the reindeer loved them and how he would visit them on Christmas Eve. Our littlest patient was Ella, 9 months old – the nurses asked us to please bring our iPad in and have Santa speak to her as she was a very astute little girl. When Ella saw Santa on the iPad she got very animated and her arms and legs were just bouncing around – when Santa said good-bye and waved, so did Ella wave back at him.

Our oldest was 18 years old and she asked for a car for Christmas. She wasn’t the only one who asked Santa for a car we had a 15 year old who proceeded to let Santa know in no uncertain terms that she had had a very difficult year, that she had been good and wanted an Acura for Christmas – she finally backed down and stated that if she could not have the Acura she would settle for a Camry. Her mother was there taking pictures and watching her banter with Santa. Lastly, at one point we saw the Nurses crying and could not understand why – the children were enjoying themselves, they were each given a blanket as a Christmas gift, and some had spoken to Santa Claus more than once. What they told us was that some children had not spoken since they had been admitted to the hospital. This is the first time they had heard them speak and it was to tell Santa what they wanted for Christmas and that they loved him. I felt blessed to be able to participate and to bring some joy to them while they were in the hospital.

Friday between conference calls I was cooking for my nephew and his children who were coming over to see my Christmas decorations. I made pumpkin bread with a cinnamon crumb topping – Callum loves pumpkin bread although he calls it pumpkin cake; the recipe I used makes three 8 inch loaves which was wonderful. I then had to bake a yellow cake and frost it with chocolate icing otherwise I would not hear the end of it from Callum who always expects cake when he comes to my house. Dinner was salad and a Puerto Rican dish we call pastelon – it is made with ripened plantain bananas and ground meat. I gave Gerard all the leftovers and kept one of the pumpkin breads to give my boyfriend – the one thing I have never done was bake for him and I know he likes these types of breads. Saturday found me at aqua aerobics and then I was supposed to go visit my boyfriend – plans changed and he decided to come to my house instead and we would have a light dinner. What to cook – light dinner – hmm. I ended up making a stacked salad of tomatoes, goat cheese and avocado with basil vinaigrette; with that we had steamed green beans, grilled chicken with a mushroom sauce. He very much enjoyed the meal, had a piece of pumpkin bread and we shared a bottle of red wine. Those were the highs.

The low for everyone in our country was the realization that elementary children were killed in Newton, CT. They were only 6 and 7 years old and as President Obama said, “they had their whole lives ahead of them”. No time is ever good to lose your child; but, it is especially hard to lose them right before Christmas knowing that you were looking forward to seeing their expressions on Christmas morning. For all of us who have little ones in our lives, hug them a little harder, kiss them and always tell them you love them.

Children are our future – they represent the innocence that we all once possessed. Keep them close in your heart.

This week I have been reflecting on the season and how to make it a good holiday for individuals I do not know. Given the economy and Hurricane Sandy it appears that this year more people than ever need our support.

Since mid November I have been trying to do whatever I can with as many organizations that I can support. At my gym, Club Fit they were collecting coats – I went into my closet and felt fine parting with a brown pea coat that I had for the past two years but hadn’t worn that often. They also collected food for the various food pantries in the neighborhood and I was able to go into my kitchen cabinets and give tuna fish, pasta, sauce, cake mix and icing – it is amazing how many individuals go hungry every day especially children. And now, Club Fit is collecting for “Toys for Tots” and I was able to give them a toy and some books for little children – Christmas is for kids and they should see it as a magical time like our children do.

At the office we collected food and necessities for families. I again gave coffee, pasta, tuna fish and diapers. I know that seemed strange; but, they were asking for simple things like toilet paper, paper towels and diapers. Diapers are not cheap – I know I buy them for Callum for when he is at my house; there was a diaper package that he has outgrown that was never opened – so better someone make use of them than my throwing them out.

Each year I go to Barnes & Noble and buy members of my family a calendar for next year – at the same time this year I asked if they were already collecting for books for the schools – they were. I asked them to charge me $20 for books for the children; the woman at the cash register who usually checks me out chose books for the older children. She told me that most often they are forgotten in this program so I was happy to have done that. I love to read and I think there is no greater gift than that of a book. A book can take you to different lands, different cultures or a different time – it lets your imagination grow or it can teach you to cook, relax or to be a better person.

The last thing I did was for our office – every year we do the “Adopt a Family” program; this year we adopted two families. One is a Mother with two daughters ages 3 and 5; and a Mother with a son age 10. Both of these Mothers are in programs which help them to get back on their feet, find a job and a place to live. Most often they are not asking for toys; but, for clothing simple things like pajamas, socks or winter clothes. I cannot just buy for one individual – I had to buy for both families and something for each one in the family. I bought everyone pajamas – including the Mothers. In my family the children always receive new pajamas for Christmas which they wear on New Year’s Eve – many of you have heard me say this, it a tradition from my Mother who felt that you should never let the New Year catch you in something old; hence, the pajamas. I also bought the girls a dress, socks and underwear and a toy. For the boy in the other family I bought him shirts, sweatpants, socks and underwear. Each of the Mother’s also received slippers. Lastly, they had asked for toiletries – what a simple thing that we all take for granted; but, they do not. For each Mother there is shampoo, conditioner, moisturizer, soap, toothbrush, floss and something a little luxurious like a nice body lotion. When you feel good about yourself – you project that. What I enjoy most is that this is anonymous – they do not need to know who gave them this – I am just happy to know that I am blessed and fortunate enough to try to make this a special time for someone else. I know that the children in my family will have a good Christmas – I want these children to have a good one and maybe create some memories for them.

So if you can, share with others the meaning of the season. Giving.

Honor Your Body

I asked you to stay tuned for this week’s blog because I would not be able to give you the full story until now. Be it safe to say that November was a very long and stressful month and I have much to be thankful for.

I am very good about keeping my doctor’s appointments and they all pretty much hit around the same time, my generalist, the dentist and my ob-gyn – like clockwork I see each of them twice a year; in the spring and in the fall. This October I went to see my ob-gyn for my semi-annual checkup and received my prescription to have my annual mammogram. I always have my mammogram done in October during breast cancer month. I go to the imaging center at my local hospital, Hudson Valley as it is only a half mile from my home – the staff is friendly and it is usually a 15 minute visit as I am in and out.

The appointment as usual was uneventful and I was out in the 15 minutes like I expected – I had my appointment on October 26th and since it had already been two weeks since I had seen my ob-gyn and had not heard anything from her all was good. But, it wasn’t. I received a letter from the radiologist who had read my mammogram films that there were some abnormalities and that I needed to have additional testing. I was nervous and made an appointment immediately for November 7th. Nothing to do but wait for the day of the appointment to come – but, I was sure it was nothing.

I get to the imaging center and proceed to give them all my information again. The technician lets me know that the abnormalities are in my left breast and that we need to take some more pictures. It isn’t just one or two; but, four images – I am then told that I can dress and come back to the inside waiting area – I know this isn’t going well. The technician lets me know that the radiologist wants to speak to me; he begins with telling me that he understands my nervousness that his baby sister has breast cancer and that I should consider everything. I am in a bit of shock; he now points out to the abnormalities that they had seen in my mammogram – they are calcifications and he is trying to reassure me that they are probably benign; but, that I need to have a biopsy and that they can do it. They have also gone ahead and called my ob-gyn, her concern is that they are being aggressive with the biopsy and she would rather observe and in three months review new films; but, we decide to go for a second opinion. I agree with her and on Friday I provide her with a list of imaging facilities in Manhattan that take my insurance. We decide on one that is considered the best in the city – I call them and I was told I could stop by at any time and give them my films and documentation. I drop them off on Monday, November 12th – for some misguided reason I thought the radiologist would see me there and give me the results. What was I thinking? They have other patients – they would need a couple of days to review it and get back to me. On Thursday I receive a call, it is the Imaging Center and they open the conversation with, “we are calling you to set up an appointment for your biopsy”; not, “we reviewed your films and documentation and have decided that you need a biopsy”. Okay – forget the niceties and just schedule it; after going through calendars and appointments we settle on Wednesday, November 21st – the day before Thanksgiving at 1:30. I am nervous – I have told my family and a few close friends; as well as, my ob-gyn who is surprised that they have chosen the biopsy route. Everyone keeps assuring me it will be fine and I will be happier knowing what the final results are. On Tuesday, November 20th we had our Board of Trustees meeting and I did not get home until 8:15 – on my home line there is a message from the Imaging Center stating that if I could they would like me to come in at 11AM instead of 1:30. I call and leave them a message that 11AM would be fine. Wednesday morning I go to my HP30 class and do my work out – come home, take a shower and get ready to go to the city for the biopsy.

I get to the Imaging Center and provide them with all my information – I then am greeted by the technician who shows me where I can undress and put on a robe, she then takes some newer images and advises me how the biopsy will be conducted. I learn that I am not having an aspiration but a core needle biopsy. I will be throughout the session and will have local anesthesia – I will also be seated throughout the entire procedure. I have never heard of a core needle biopsy; and, am surprised at the procedure – it requires many x-rays to ensure that the needle is positioned in the exact location to drill and extract the calcifications. At one point the drilling hurt and I was given more localized anesthesia – the technician and surgeon kept a running conversation throughout the procedure and ensured I looked at them and not at what was happening to my breast. An hour later it was complete – sutures were on, I was given an ice pack to manage the swelling and was told that I could not lift anything heavy, exercise or immerse my breast in water for the next five days. If the sutures did not fall off in five days then I could remove them.

They removed all of the calcifications; as well as, some tissue around it to send to the pathologist. I would not know the results of the biopsy until the following Wednesday given that Thursday was Thanksgiving, they had Friday off, were closed on the weekend, etc. So it would be a week of not knowing. The good news was that the way it was growing and given that it was just noticed on this year’s mammogram that if it was not benign I was in a good position for it to be treated successfully. That evening I was meeting my family to take my cousin out to dinner for his birthday – they heard the news and we all just tried to think positively. Thanksgiving was the same with my telling my niece that I don’t understand how she manages with large breasts – my left breast being swollen was getting in the way. I had some pain and I could see through the sutures that I had bled some. The Thanksgiving weekend was difficult because I could not work out – I could not decorate for Christmas as all the containers with the Christmas decorations weighed anywhere from 25 to 50 pounds and I could not lift them. So I watched many Christmas movies and read a few books. Wednesday could not get here soon enough.

On Tuesday I was in our conference room setting up a meeting for our CTO when I could see on my cell phone that it was my ob-gyn calling. I had to finish setting up the meeting and then I called her back. She let me know that she received the pathologists report and it was benign; as she put it there was no pre-anything. What a relief. I then told her that the biopsy was not just an aspiration; but, a core needle biopsy – and that I was surprised at the procedure. She advised that this was the best procedure; but, in truth if they had told me what they were going to do there would be no way that I would agree to the procedure. My family and my friends were each relieved to hear the good news.

I am back to working out and thankful for having good health. My advice to each of you is to please make sure that you do all your preventative checkups. Take care of your body – it is a gift and will last you your lifetime if you give it some tender loving care.

Most importantly, thank you to my family and friends who stood by me this past month.

This has been a very quiet weekend – I have not had a weekend where I was doing nothing in FOREVER and I am not sure that I like that much time on my hands. I cannot give you all the details for this time of respite this week; but, I promise I will next week when I can give you the full story.

This past week has been busy – not – because it was Thanksgiving; but, because on Tuesday we supported our Annual Board of Trustees and 2013 Budget. This is the most important event that we do for the entire year and it must go flawlessly. This meeting is always held the Tuesday before Thanksgiving and is a 5 hour event. Our set up began on Monday with the entire day tables, chairs and microphones being installed, taped down and tested. The video conference was tested to the sites we would be connecting to and the streaming company made sure that we had a strong signal. Tuesday arrived and more testing was conducted, sites were connected via video conference, all microphones were tested and wires taped down. The combined conference room would hold close to 100 individuals, primarily Board of Trustees and the Executive Management of each of the hospitals. This meeting would highlight our accomplishments for the year and focus on the budgets for 2013. Other than letting you know how this meeting is conducted – why am I making it a blog this week? I am making it a blog this week because of the generosity of the organization I work for and the Trustees on our Board. As you all know we in the Northeast have suffered through Hurricane Sandy and then a nor’easter a week later. Many of us were unaffected except to be inconvenienced with no power for a few days or a couple of weeks; but, many more people lost their homes, their cars and some even their jobs.

At North Shore LIJ Management put a fund together for employees to make sure that they could live somewhere, have a mode of transportation and even borrow money at 0% interest to get their lives back together. What I did not know was that the Chairman of the Board of Trustees was asking the Trustees for donations to help the employees. A couple of them had run into employees who were at the hospital working despite having lost everything – and I do mean everything; but, the clothes they were in. The Chairman proceeded to announce how only 42% of the Trustees had donated to the Employee’s Fund and that he was prepared to make them very uncomfortable. The meeting proceeded and the budget was presented to the Trustees and approved; but, just before the meeting was adjourned one of the Trustees raised her hand – when she was called upon she told the Chairman that she and her husband had discussed and agreed to donate $500,000 to the Employees Fund and she challenged her fellow Trustees to do the same.

I was shocked as was my team to see this couple donate a half million dollars so quickly. I was also proud and honored to work for an organization where the Board of Trustees considers and supports the employees of the organization. I have only before worked for Fortune 500 companies and those Boards have only been concerned with the money they were receiving for attending the meeting and/or the value of the stock. This Board is totally selfless and truly cares for the employees and their livelihood. Every day I am honored to work for this organization.

Thanksgiving was quiet with just immediate family and the food was delicious. This year besides buying the pies, I also baked corn bread (fresh, no Jiffy mix here) and pumpkin bread – these are two things that Callum likes and I am always happy to bake or cook anything he will eat. As I said the rest of the weekend was quiet and I was pretty much limited to what I could do – but, that is next week’s blog and I will fill you in on the full story then.

For now – let’s be thankful for what we have and Stay Tuned.

Life has begun to get busy – and Thanksgiving isn’t even here yet. How many of you are beginning to feel the crunch? In November we have two birthdays in the family, my nephew and his father, my cousin. Gerard’s birthday was this past Saturday and I asked him when he wanted to celebrate – he said, Saturday. Friday I went food shopping and then that evening I found out that he had to take a class on Saturday so could we celebrate on Sunday. No problem. Saturday I took my two workout classes and bought gift cards that I needed for his birthday. That evening I set up the table and wrapped his gift. Sunday I went to Zumba, then to the bakery to pick up Gerard’s birthday cake. At home, cake in the refrigerator and all the pots, pans were out for when I needed them. Now some “me” time, I watched CBS Sunday Morning News with Charles Osgood – it was their “Eat, Drink and Be Merry” episode and one that I enjoy. I tape this show every Sunday morning since it comes on at 9AM and my Zumba class begins at 9:15 – it is a wonderful show and gives you vignettes of different things happening in the world, the nation both with a look to culture and just expanding a little bit of our mind. I wholeheartedly urge you to try it.

Now, it is time to get everything prepped. I made the salad and placed it in the refrigerator – the only thing I needed to do was to slice the avocado before putting it on the table. I peeled and sliced the onions for the mushrooms and onions I would serve to place on the steaks and I peeled and cut the potatoes and placed them in water to make mashed potatoes. Now I was getting one of the appetizers ready – I wrapped cantaloupe in prosciutto and scored with a toothpick, placed saran wrap on it and placed it in the refrigerator. I soon hear Ryan at the front door so out come the crackers, cheese and pepperoni on to the cocktail and the melon with prosciutto. I had bought Gerard the Sam Adams Winter Lager and Callum has decided he would like some chocolate milk and we are watching the Jets on the television. A wonderful afternoon with family.

Siobhan and Matt arrive not too much later and everyone has something to drink while we just sit and talk about the new house, Thanksgiving dinner – what are we having, who is making what (she is making turnips for her brother as part of his birthday gift); and, besides having purchased the pies I agree to make cornbread and pumpkin bread. We also discussed celebrating their father’s birthday – it is not until November 29th but he will not be in New York for it – so on Wednesday evening we will take him to Banzai Hibachi in their town. Today I ordered a birthday cake for him and I will pick it up on Wednesday on my way home from an appointment in the city. The remainder of dinner went fine with steamed vegetables, mashed potatoes and steak. Callum who loves cake and addresses all cake as “birthday cake” could not wait for us to bring it to the table. He was also the last one to leave the table as he ate his entire piece. Since we all enjoyed the cake – I ordered the same one for Gerry for Wednesday which we will have after our dinner at Banzai. I also picked up the gift cards for Gerry – I have some CDs for him; but, he has gotten a little difficult to buy for.

Is it terrible to say that I am looking forward to Friday? I will sleep a little later than normal since my High Performance 30 class isn’t being held and the balance class is not until 10:15. Since Thanksgiving is so early I will not be putting up my Christmas decorations – I will wait until the end of the next week and do it then. Instead I will watch some of the Christmas shows I have DVR’d since Lifetime and the Hallmark Channel decided to air them right after Halloween. Then because we are now in full holiday season I will look to take three (3) workout classes on Saturday – my only problem is that since two of them are Zumba classes I will have to wear a knee brace on each knee – they are beginning to hurt in some classes and I need to start protecting them. Surprisingly on yesterday’s CBS Sunday Morning News they announced that the average weight gain in the 6 to 7 weeks of the holiday season is only 0.8 pounds not 5 to 7 like most of us have thought. Doesn’t mean we can indulge – but, does state everything in moderation.

Have a wonderful Thanksgiving with your families.

Getting back to normal – I think that is what all of us want in the tri-state area. For some of us like me that will be easy to do – for some 40,000 others in this area; what is normal? What will their futures be? Will they continue to live in this area? I have been working from home for the last two weeks, as a result of this I have not experienced sitting in line for hours to get gas. I had filled up my tank the Sunday before Hurricane Sandy hit and in these past two weeks I drove to the gym and the grocery store; along the way I would stop at the cleaners, bank, Post Office and Home Depot. Today I topped off my tank although I was only at half a tank – I am so glad I have a Honda CRV which is excellent on gas. I have been able to work from home these past two weeks; projects are on schedule, meetings have been held and daily I have spoken to my team. But, tomorrow it is time to get some normalcy – I will go into the city for a meeting, Tuesday I will go into the office and then on Thursday back into the city for another meeting. I will only need to drive out to Long Island for one day and this will certainly be easy for me on gas since it is over 100 miles roundtrip. Do you realize that in 11 days it will be Thanksgiving? As a family we have chosen a day to celebrate it – this year it will be on the actual day, Thursday. It will just be the family as we are a small group it will only be 9 of us at the dinner. As always I will buy the pies, the Godiva turkeys for the family and I am thinking of baking a couple of bread loaves to bring.

My gym, Club Fit is collecting coats and food for the Thanksgiving season. I brought a coat in last Monday and tomorrow morning I will drop a large shopping bag full of food. This is the time of year to acknowledge how fortunate we are – and to help others have a good holiday season.

I am expecting that when I get back into the office we will have notification on the family we will have adopted for the holidays. We will receive an email with what they need and what the children would like for Christmas – as usual I tend to go overboard and will look to buy them everything on the list. I can’t state enough how much the holidays especially Christmas is for children and there is no greater joy than to see them get excited when they receive a present.

This year one of our hospitals was chosen by Cisco, one of our vendors for their Santa Program. We are all excited about this – on December 10th Santa will come to the hospital, we will stage an area for him and then he will video conference with the children at the hospital. We will look to set up a small video conference system in the play room where the children who are active can sit down and chat to Santa; for those children who are bedridden we will bring an iPad into their rooms and they will be able to chat with Santa from the iPad. Every single one of us are excited to be working on this program – it again personifies the holiday season and I have been told that there will not be a dry eye amongst us. This is normal – to be thinking of the holiday season, of Thanksgiving dinner with the family and how to help others who are not as fortunate; but, who are entitled to a wonderful season also.

I hope that for most of you – you are back to normal. At this time, please think of those that normal is an unknown.