Idiopathic Intracranial Hypertension - 1509 Words

Discussion History In 1890, a German physician named Quicke described a neurological condition in which patients had signs and symptoms of increased intracranial pressure without a brain tumor being present [1]. Between 1927 and 1937, Dr. Dandy, a pioneer of neurosurgery was able to gather the most common signs and symptoms of 22 patients with pseudotumor cerebri [2]. These symptoms included headache, nausea, vomiting, diplopia, dizziness, and loss of vision. It is important to note that the patient seen in our clinic was not experiencing any of the mentioned symptoms except for vision loss. According to Dr. Dandy, the most common ocular signs were bilateral papilledema and some patients had retinal hemorrhages, which indicated long-standing severe intracranial hypertension. In each case intracranial pressure was measured by ventricular or lumbar puncture and measured to be anywhere from 250 to 550 mm of water and in every instance the ventricles were smaller than normal and symmetrical. The t reatment for most of these patients was a right sub-temporal decompression. This was done if the signs and symptoms indicated a need for intervention. In most patients there was a complete, spontaneous cure [2]. A more recent prospective study of 50 patients showed the breakdown of the most common symptoms of idiopathic intracranial hypertension [3]: ââ€" Headache (92 percent) ââ€" Transient visual obscurations (72 percent) ââ€" Intracranial noises (pulsatile tinnitus) (60 percent)Show MoreRelatedThe Pathophysiology Of Bacterial Meningitis1316 Words   |  6 Pagesnormal cerebral spinal fluid circulation around the brain and spinal cord (Huether McCance, 2012)†. Furthermore, arachnoid villi may become congested and produce an effect of the enlargement of the skull and compression of the brain. Increased intracranial pressure is experienced from the combination of thicken exudate and swollen meningeal cells. Engorged blood vessels and thrombi can disrupt blood flow, causing further injury. 2. Neisseria meningitides is a form of bacteria that infects the meningesRead MoreObstructive Sleep Apnea ( Osa )2044 Words   |  9 Pages Patients with OSA have been shown to have a higher incidence of significant systemic conditions such as hypertension, cerebrovascular accident, myocardial infarction, arrhythmias, diabetes, and dementia. Some of the eye problems linked to OSA include glaucoma/other optic neuropathies, retinal vein occlusions, central serous retinopathy (CSR), papilledema/idiopathic intracranial hypertension (IIH), floppy eyelid syndrome (FES), and corneal disorders (i.e. keratoconus). This provides optometristsRead MoreHero : A Virtuous Heroes883 Words   |  4 Pagesto preserve the rights of Pakistani citizens. Heroes are not always the ones who obtain their goals. Instead, they are the people who continue to try without reward. For example, Samuel Paladino is diagnosed with an ischemic stroke, idiopathic intracranial hypertension. Bipolar disorder, chiari malformation, Tourette’s syndrome, and possibly MELAS. Many of those either cannot be cured with current technology or are not being researched in order to find a cure, meaning he will most likely be affectedRead MoreChronic Myeloproliferative Disorder ( Mpd ) Is Associated With Mass Quantity Of Platelets That Are Put Out2738 Words   |  11 PagesEssential thrombocythemia TERMINOLOGY CLINICAL CLARIFICATION This chronic myeloproliferative disorder (MPD) is associated with mass quantity of platelets that are put out by megakaryocytes Also known as Primary thrombocythemia Idiopathic thrombocythemia Has a prevalence 30/100000 in the general population11 CLASSIFICATION Not applicable DIAGNOSIS CLINICAL PRESENTATION History Half of all patients with essential thrombocythemia report no symptoms1 The rest of patient report symptoms either relatedRead MoreThe Complex Needs Of The Dialysis Dependent Patient1042 Words   |  5 Pagesan occasional change in mental status during and after his treatment. Several changes were made to his treatment plan without effect. She continued to advocate for her patient and upon extensive work-up the patient was diagnosed with idiopathic intracranial hypertension. He is being treated successfully with IV mannitol infusion during his treatments and his symptoms have significantly subsided. Ms. Gillooly performs a monthly evaluation within the hemodialysis unit to ensure we meet or exceed theRead MoreIntra Cranial Pressure ( Icp ) Measurements Are Taken Via Invasive Procedures1762 Words   |  8 Pagesvessels(5). Non-invasive devices to measure ICP would be of benefit to both space and earth applications of the device, on earth they would be advantageous for the continuous monitoring of patients suffering from hydrocephalus and Idiopathic intracranial hypertension(5), and can also used for those that are susceptible to bleeds and infections. For our study we plan on testing the device’s feasibility for measuring ICP non-invasively. Seven healthy male volunteers have been recruited to have theirRead MoreSTUDY GUIDE: EXAM 4 Essay1797 Words   |  8 Pagesrehabilitation and management of associated hypoxemia and bronchospasm. 19. Silicosis, pp. 1278. Is a type of pneumoconiosis resulting from the inhalation of free silica (silicon dioxide) and silica-containing compounds. 20. Pulmonary Hypertension, pp.1296-1298. is defined as a mean pulmonary artery pressure above 25 mmHg at rest or 30 mmHg w/exercise. Pulmonary artery pressure is lower than systemic arterial pressure and is normally 15-18 mmHg. It is more common in women than in menRead MoreNU 545 Unit 2 Essay10921 Words   |  44 PagesCNS disorders produce nausea and vomiting Involves CNS injuries that: involve the vestibular nuclei or its immediate projections; impinge directly on the floor of the fourth ventricle; or produce brainstem compression secondary to increased intracranial pressure 22.Define seizure and status epilepticus. What is the medical significance? Know benign febrile seizures. - (Pg 550) Seizure: a sudden, transient disruption in brain electrical function - - - caused by abnormal excessiveRead MoreCase Study on Copd4135 Words   |  17 Pagesfurther irreversible damage to the lung tissue. Talk to your doctor about annual flu shots and regular pneumococcal vaccines. * High blood pressure. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). * Heart problems. For reasons that arent fully understood, COPD increases your risk of heart disease, including heart attack. * Lung cancer. Smokers with chronic bronchitis are at a higher risk of developing lung cancer than are smokersRead MoreSocm Study Guide Essay30404 Words   |  122 Pages MF-0217 Pick from a list which are the most common chronic diseases. Prevalence of Chronic Diseases(Number of Cases per 1000 persons) | | Condition | All Ages | Chronic sinusitis | 134 | Arthritis | 129 | Deformities | 129 | Hypertension | 108 | Hay fever | 101 | Heart disease | 86 | Hearing impairment | 86 | Visual impairment | 58 | Asthma | 56 | Chronic bronchitis | 54 | Hemorrhoids | 36 | Dermatitis | 35 | Diabetes | 30 | Indigestion | 27 | Back ailments

Salinger s The Catcher Of The Rye - 2057 Words

The Underlying Literary Movements in The Catcher in the Rye Everybody has their problems. Everyone has their downsides, their pitfalls, their quirks. Holden Caulfield, the protagonist of the novel The Catcher in the Rye (written by J.D. Salinger), is definitely worse than most people. The book is a flashback in which Holden reflects upon is flunking out of four private high schools. If this wasn’t enough, after his most recent expulsion from Pencey Prep, you’d expect a person to try and improve his life; Holden is the exception to this generalization. The entire book focuses on his downward spiral towards depression as he reconciles with his past. Throughout the story, we see Holden adopt a variety of personas as he contemplates the past, exhibiting ideals that reflect moments in American literature. Thus, we see him grow as a person and review ideals as Holden tries to gain a sense of who he is and what the next steps he needs to take to forward his life. A prime examp le of Holden’s emulation of literary ideals comes when the reader is given the ultimatum of whether Holden is truly a psychotic person or if there is deeper meaning towards his slow slip into psychosis. The moment goes in depth on the postmodernism theme when Holden describes to his sister his beliefs towards the poem Comin’ Thro’ the Rye. Through his eyes, he imagines a field of rye; thousands of kids playing in acres upon acres of rye and no supervision. Now take that field and add a cliff severing theShow MoreRelatedSalinger s The Catcher s The Rye 1310 Words   |  6 Pagesthings. Technology has advanced tremendously since the 50’s, when Holden was a teenager. Cell phones, laptops, apple watches, flat screen TV’s, electric cars, and so much more exist now. However, there are a few aspects of life that are timeless. Even today, teens struggle with relationships, the quest to find out who they truly are, and the pressure to be the best at every thing they do. I believe that The Catcher in the Rye, by J.D. Salinger is relevant because in today’s society the younger generationRead MoreSalinger s The Catcher s The Rye 1303 Words   |  6 PagesIrving Howe, a literary and social critic said, â€Å"The knowledge that makes us cherish innocence makes innocence unattainable† (BrainyQuote). The Catcher in the Rye, a novel by J.D. Salinger tells of a very important part Holden Caulfield s life. Holden, a 17 year old from New York, writes about the events that follow him flunking out of Pencey Prep School. Holden is very critical of everyone around him, except the small group of people that he protects with his life. He cherishes the youth childrenRead MoreF. Salinger s The Catcher Of The Rye1121 Words   |  5 Pagesnovels in English-speaking countries, J.D Salinger’s Catcher In The Rye deals with Holden Caulfield’s past trauma which is the triggering factor in his depression, anxiety and alienation. Holden tells an unnamed person what has happened in the three days prior to his mental breakdown. Through Holden’s relatable characteristics and Salinger’s narrative treatment, the book continues to engage audiences across generations. The way that Salinger writes gives the audience a very personal and insightfulRead MoreD. Salinger s The Catcher s The Rye 1872 Words   |  8 Pages J. D. Salinger s novel is often called, . . . the forbidden fruit in the garden of literature (The Catcher 116). J. D. Salinger is a writer from the 1950s, a time where literature has questioned the ideas of traditions placed in a community. Through his life and through his characters Holden Caulfield and Phoebe Caulfield in the 1950s realistic fictional bildungsroman The Catcher in the Rye, the postmodernist author J. D. Salinger focuses on the theme of self isolation in society in orderRead MoreAnalysis Of Salinger s The Catcher Rye 3756 Words   |  16 PagesSummer Reading-TASIS 2014 Rising 9th Grade Mainstream English The Catcher in the Rye by J.D. Salinger and Fahrenheit 541 by Ray Bradbury Please write a typed or handwritten response (200 words each in the language relevant to your course) to each of the following prompts on each of the works assigned for the course(s) you will be taking in 2014-2015: The Catcher in the Rye Initial Understanding: What are your thoughts and questions about the story? You might reflect upon characters, theirRead MoreAnalysis Of Salinger s The Catcher Rye 1074 Words   |  5 PagesJournal Responses Salinger’s The Catcher in the Rye has been pronounced a literary classic for its atypical portrayal of adolescence, to effectively convey the protagonist’s alienation and confusion. The introduction of The Catcher in the Rye is underpinned by disorder and confusion through a stream-of-consciousness narration, which digresses from one subject to another. Consequently, Holden’s multitudinous thoughts and feelings appear to lack a cohesive pattern. Additionally, Holden’s prevalentRead MoreJ.b. Salinger s The Catcher s The Rye 1319 Words   |  6 PagesJ.D. Salinger’s Use of Symbolism in The Catcher in the Rye J.D. Salinger is well known for his works. His most famous being The Catcher in the Rye. Two other of his famous works include Nine stories and Franny and Zooey. J.D Salinger is also well known for his sense of humor that he includes inside of his books. The Catcher in the Rye has become an essential work to be studied in academic literature and its course of study. This book entails many uses of symbolism throughout theRead MoreAnalysis Of Salinger s The Catcher s The Rye 1052 Words   |  5 Pagessociety. In J.D Salinger’s The Catcher in the Rye, Salinger reveals his abomination for phoniness through Holden’s experience with the adult world. Phoniness creates a structured society where the connotations of success are deceptive. In addition, it sets standards and expectations for how individuals should act based on their social status. Furthermore, it interferes with one’s honesty by abolishing their authenticity and sincerity. In The Catcher in the Rye, Salinger suggests how the lack of authenticityRead MoreAn Analysis Of Salinger s The Catcher Rye 1106 Words   |  5 PagesAdrianna Leal Ms. Allie English 6 October 2017 Learn from life and move forward In the novel, The Catcher in the Rye, Salinger uses many symbols and themes as a way to protect Holden from adulthood, his individuality, and childhood. While in high school, Holden seems to struggle with his school work and with his outlook on life. As many obstacles come his way, his main self battle would be having to grow up, become mature, and enter adulthood with excitement and confidence. Holden often usesRead MoreAnalysis Of Salinger s The Catcher s The Rye 2525 Words   |  11 PagesThe Catcher in the Rye (1951) by J.D Salinger is a book with a truly controversial history by being banned from bookstores, libraries, etc. during the time of its release and even now is very scarcely being brought back into the high school setting to be taught as part of the high school curriculum. While being confronted about reasons for being banned, protesters of this book give very vague arguments on why it should be banned such as â€Å"its a very filthy book,† or â€Å"its expl icitly pornographic.†

Patterns Of Inequalities In Health Health And Social Care Essay Free Essays

string(84) " anxiousness and depression to self-harm and self-destruction \( Wildmen, 2003 \) \." Health inequalities are defined as the differences in wellness attention or in the distribution of wellness determiners between different population groups ( Woodward A ; Kawachi 2000 ) . Health inequalities can be breakdown in to four key subdivisions. The first 1 is inequalities are unjust. We will write a custom essay sample on Patterns Of Inequalities In Health Health And Social Care Essay or any similar topic only for you Order Now Inequalities in wellness are unwanted to the extent that they are unjust besides unfair. Inequalities become â€Å" unjust † when deprived wellness is itself the effect of an unfair distribution of the societal determiners of wellness. For case the mortality rates between people from different societal categories or unequal chances in instruction and employment. The 2nd is inequalities affect every society. Condition that lead to tag wellness disparities are damaging to all members of society. Some types of wellness inequalities have clear effects on the remainder of society, such as the effects of intoxicant and drug abuse, the spread of infective diseases, or the happening of force and offense. The 3rd is inequalities are evitable. Disparities in wellness are evitable to the extent that they branch from identifiable policy option exercised by authoritiess for illustration ordinance of concern and labor, revenue enhancement policy, public assistance benefits and wellness attention support. The last 1 is intercessions to cut down wellness inequalities are cost effectual. A public wellness programme that reduces wellness inequalities can besides be cost effectual. The instance can be made to give precedence to certain programmes for case, heightening entree to cervical malignant neoplastic disease screen in low income adult females on efficiency evidences. In contrast, few programmes designed to cut down wellness inequalities have been officially evaluated utilizing cost effectivity analysis. History of Health inequalities Health inequalities have been known since the societal and public wellness reform of the 19th century, when Chadwick and Rowntree began to document them. It was grounds on societal inequalities and of unequal entree to wellness attention in Britain that provided the force per unit area to put up the public assistance province and the National Health Service in the post-war period. An rating in the late-1970s illustrate that Britain was falling behind other states in wellness betterment, despite 30 old ages of the public assistance province. This led to the Black Report in 1980 on inequalities in wellness. The Black Report demonstrated that although overall wellness had improved since the debut of the public assistance province, there still remained widespread wellness inequalities. It besides highlighted the chief cause of these inequalities was economic inequality. The study found that decease rate for work forces in societal category V was twice that for work forces in societal category I therefore demoing the spread between the two was increasing, non cut downing as was expected ( Carter, 2002 ) . The Acheson Report was published 18 old ages after the Black Report, but both show comparing. The Acheson study present a contrast to The Black Report in that it illustrates the troubles of undertaking wellness inequalities despite seemingly improved status. Conveyance and country of abodes Conveyance is critical in enabling entree to people, goods and services, therefore promotes wellness straight through the accomplishment and care of societal webs. Forms of conveyance, such as walking and cycling promote wellness straight by increased physical activity and decrease of fleshiness. A deficiency of conveyance may take to damaged wellness by denying entree to people, goods and services and by deviating resources from other necessities. In add-on, conveyance may damage wellness straight, most notably by inadvertent hurt and air pollution. Sing conveyance in a inequalities facets, deficiency of entree to transport is experienced disproportionately by handicapped people, older people and people socioeconomic position, peculiarly single life in distant or rural countries ( Elgar, 2006 ) . For case, single life in council house where hapless entree to transport may restrict work and preparation chance. An addition in monetary values and a limited scope of goods available to persons whose deficiency of entree to transport denies them chances to shop for necessities. Environmental barriers in entree to transport experienced by people with physical disablements. Deprived urban countries tend to be characterised by high traffic volume, taking to increased degrees of noise and air pollution and important rates of route traffic accidents without the benefits of entree to private conveyance. The cost of rail and local coach menus has addition well Campbell ( 2005 ) studies that about one 3rd in existent footings since 1990. This in bend has had the most impact on those single with lower income. Bettering public conveyance may take to improved entree to people and installations fundamental to wellness, such as store, parks wellness attention friends and households. This consecutively should take to betterment in quality of life and wellness. The authorities policies â€Å" Better conveyance † place a increasing in usage of public conveyance by the general population would in bend lessenings air and noise pollution. The Independent enquiry into Inequalities in Health Report recommends the farther development of a high quality public conveyance system which is integrated with other signifiers of conveyance which is a sensible monetary value to single. A lessening in the usage of vehicles would take to a decrease of accidents. Unemployment Employment and unemployment is a important factor taking to ill wellness. Carter ( 2002 ) surveies emphasise that non merely is employment a primary beginning of position in Western states, but it is besides important in supplying intent, societal support, construction to life and a agency of take parting in society. Therefore if the person is unemployed this can be a possible major hazard to wellness for the population of working age and their households. In 1997 the international Labour Office stated two million people were unemployed in the UK, besides around a 3rd of unemployed adult females and half of all unemployed work forces had been unemployed for one twelvemonth or more. The bulk of unemployment persons tend to hold a important inauspicious consequence psychological and physiological wellbeing. This can include symptoms of anxiousness and depression to self-harm and self-destruction ( Wildmen, 2003 ) . You read "Patterns Of Inequalities In Health Health And Social Care Essay" in category "Essay examples" In relation to physical wellness, unemployment brings a important hazard of morbidity and premature mortality. Johnson, ( 2008 ) place that all major mortality causes was systematically higher than mean among unemployed work forces. He besides found that unemployed adult females had higher mortality from coronary bosom disease, hurts and self-destruction. There are many to better an single wellness during the clip they are unemployment. Bettering fiscal support during unemployment can increase living conditions and resources needed for wellness, including entree to nutrient, shelter and warming. Being unemployed may besides better their ability to by apart of their communities cut downing societal exclusion ( Richter, 2005 ) . Government policies aimed at the creative activity of employment chances, apprenticeship for immature unemployed people, improved degrees of instruction and preparation for immature unemployed people. De Vogli, ( 2009 ) place cardinal factor is the remotion of barriers to work for parents with dependent kids. This should better the opportunities of wellness increasing employment opportunities in add-on to other good effects on wellness and its determiners such as income and lodging Education Education has the chance to play numerical functions in act uponing inequalities in wellness. It has an of import function in act uponing inequalities in socioeconomic place. Educational makings determines an person ‘s labor market place, therefore act uponing at that place income, lodging and other material assets. As a effect, instruction is a traditional path out of poorness for single life in hapless community. Education besides has a function in fixing kids for life. For illustration, guaranting person has the practical, societal and emotional cognition and accomplishments to make a full and healthy life. It has a societal function in fixing kids to lend to the full in society. This can affect educating them about utilizing services, doing kids aware of their democratic rights and duties ( Bromberg, 2003 ) . Sing instruction in an inequalities facets, kids from hapless backgrounds is measured by being in reception of free school dinners. They are found to hold lower educational accomplishment that their equals. Mana A ; Huston, ( 2008 ) place kids on free school dinners as an index of poorness. They conducted research screening that a high per centum of students eligible for free school dinners have a low per centum of students with a least five base on ballss at GCSE level A star to C. Higher proportions of students in School exclusion and hooky are associated with increased engagement in offense and other harmful activities. In the long term, school exclusion and hooky are associated with unemployment, homelessness, adolescent gestation and captivity ( Mana A ; Huston, 2008 ) The Independent enquiry into Inequalities in Health Report recommends the proviso of extra resources for schools functioning kids from disadvantage groups to heighten their educational accomplishment. The Revenue Support Grant expression and other support mechanisms should be reviewed more to reflect demands and socioeconomic disadvantage. This is likely, but non convinced to be accompanied by a decrease in inequalities in accident rates. Promotional Intervention and Policies The Government has besides played its portion through a scope of national programmes. These include Certain Start designed to back up the development of pre-school kids from disadvantage households. Change4Life prevents households from going corpulence and the National Strategy for Neighbourhood Renewal which developed to back up an incorporate attack to regeneration in the most disadvantaged communities. The UK Fuel Poverty Strategy which supports lodging betterments targeted at vulnerable family. Change4Life Is a promotional run that aims to forestall people from going overweight by promoting them to eat better and by more activate. It is the marketing constituent of the Government ‘s response to the addition in fleshiness in the UK. The run aims to animate a social motion in which person ‘s who has an involvement in forestalling fleshiness, such as concern, health care professionals, school, charities, households or persons can play their portion. The Change4life advertisement run launched in January 2009 and in the early phases targeted immature households with kids aged 5-11 old ages. Six months in Change4life had a great response from immature households. 85 % of female parents reported that the run makes them see about their kids ‘s wellness, and over 360,000 households have already signed up in order to follow a healthier life style ( Department of wellness, 2009 ) . Certain Start Certain start is a promotional run that brings family-support services for households with kids under 5 old ages old. Their purpose is to undertake child poorness and societal exclusion working with parents, attentions and kids to advance the rational, physical and societal development of babes and immature kids so that they can boom at place and when they are go toing school. Certain Start coaction with service suppliers from the statutory sector like wellness, societal services and early instruction, community administrations and parents themselves. There provide integrated services for immature kids and their households based on what local kids need and parents want. National Strategy for vicinity reclamation policies The National Strategy for vicinity reclamation was created in 2001 and has two overall purposes. To cut down the spread between the most disadvantaged vicinities and the remainder of England and in the worst vicinities to accomplish less offense, better wellness and better educational making. A cardinal construct is that vicinities should non be below a certain degree. This degree cover the full scope of Government activity and many are incorporated into the relevant Public Service Agreements for illustration wellness, instruction and income. UK Fuel Poverty Strategy The UK Fuel Poverty Strategy was established in 2001. It chiefly focuses is to better energy efficiency and cut down the costs of fuel for fuel in hapless families, since the income steps which form portion of a long term solution are being addressed in wider poorness and societal exclusion policies. To accomplish these marks, a scope of programmes and steps have been put in topographic point. This include go oning action to prolong the downward force per unit area on fuel measures, guaranting just intervention for perverse households, and back uping the development of energy industry initiatives to battle fuel poorness. To go on action to cut down poorness and societal exclusion recognizing that these are assorted jobs. In decision it is clear that wellness inequalities are a important concern in Britain. The instance survey shows how wellness inequalities are relentless and hard to alter. They are besides widening and are likely to make so unless we do things otherwise. This means turn toing non merely the short-run effects of evitable sick wellness, but besides the longer-term causes. The Government and assorted national programmes are determined to assist cut down wellness inequalities in Britain by making a fairer and more merely society that will let all single and communities to profit more equitably from public services investing. How to cite Patterns Of Inequalities In Health Health And Social Care Essay, Essay examples

Tiny Influences free essay sample

â€Å"Please, can we have a story?† â€Å"Okay, but only one because it’s bedtime.† The two scramble for a place on my lap as if it’s stadium seating. Their freshly shampooed heads dampen my shirt with a fruity fragrance. As I turn the page, I hear a crisp rustle that comforts me more than any other sound. While Kyle and Marissa are lost in the magic of the story, I am drawn back in time to when their adventure began. I remember traveling through the Neonatal Intensive Care Unit thinking how polished and organized it was compared to the rest of the hospital. My shoes squeaked across the linoleum. The tang of antibacterial soap lingered. A steady thrum, thrum, thrum of monitors came from every direction. Pushing through the maze of incubators, I saw the crowd of white coats before I heard the alien cries. When I first laid my eyes upon my brother and sister, they were tiny, red, squealing bodies in a sea of frantic doctors. We will write a custom essay sample on Tiny Influences or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Fear grasped my heart at the sight: The twins appeared inhuman. Fused eyes greeted me like those of a newborn kitten. I gaped. I boggled. Their size was minute. One pound 13 ounces and one pound 15 ounces are just numbers until they are attached to living, breathing beings. All I got was a glimpse and then the doctors dragged us away since we had not washed our hands. We were oblivious to the immense danger of germs to these premature lives. Retreating to a hospital room, my family gathered around the bed with tear-streaked faces. I felt like I’d swallowed a boulder. I scrunched the bedspread between my palms. I searched my family’s faces. No one seemed to know where to look. Each had the same question: â€Å"How could children so delicate possibly survive?† We said a heart-felt prayer that our new family would make it. I knew at that moment that it was out of our hands. During the next three months, Kyle and Marissa fought despite the odds. A morphine injection was essential just to touch their bodies. A micro-ventilator kept them alive, providing every bit of oxygen. Each twin underwent thoracic heart surgery during their first week of life. They endured numerous blood transfusions and spinal taps. Pneumonia infected their bodies four times. Sucking wasn’t instinctive. They needed training to do just about everything, but they succeeded and finally came home. When I supported their fragile heads that first time, I experienced terrifying rapture. It was so strange to hold these infants I had gazed at for months but had never been able to touch. I could not fathom that Kyle and Marissa were real. Peering into the pairs of blue eyes, I thought of what they had endured to be nestled in my arms. Coming home, however, did not mean they were normal babies. On the contrary, they needed constant attention. Exposure to any bacteria could kill them; consequently, they barely left our house for a year. So, our family became the hermit crabs of the block. Surgical masks were regular attire, and oxygen tanks were necessary appliances. Neither flu shots nor friends with colds were negotiable. In short, Kyle and Marissa took up the majority of my life. As I finish reading the book, I examine their captivated faces and realize the twins have no memory of these experiences that I will never forget. Their lives are not about what they conquered but what they confront each day. Recently, a woman said to me, â€Å"You are so good with those kids.† In contrast, I believe they have been â€Å"so good to me.† Caring for them has taught me more than I could ever hope to give in return.