Monday, December 31, 2007

New Year's!

"Musa, what is your New Year's resolution?"

"Let's see, number 1- do not tell others my resolutions." Musa is a smart kid.

It's hard to believe that 2007 will end in a matter of hours and we will soon ring 2008. With the New Year also comes the deluge of resolutions. There is also the challenge of reprogramming our pens/pencils/brains that it is 2008.

***Note to self: remember to write 2008.

As we bring in the New Year, we take with us memories of 2007 and hope that 2008 will be even more amazing (at least this is my wish). I really can not complain. 2007 has been unforgettable.

I graduated from college, started medical school, moved to SF, and started my new life as a medical student. Most importantly, I have been so lucky to be surrounded by my family and some wonderful friends, old and new.

I have no idea what 2008 will bring.

In the Spirit of the New Year's I will lay out my resolutions in a nicely organized list for my reference. By no means do I expect my resolutions to dictate my life; it will just offer some guidance.

Ok, here goes (in no special order):

1. Spend more time with family and friends.
*There will always be an endless list of "stuff to do" (as demonstrated by this resolution list), but as I get older I am realizing the importance of the individuals who make the moments of my life memorable and meaningful.

2. Discover and better define my spiritual self
*Let's leave at this. This is an evolving and personal quest requiring lots of introspection and inquiry.

3. Maintain a balanced life
*As a medical student, it is so easy to get bogged down by the details, stress, and studying. But as the old saying goes: "work hard and play hard." Life is always a balancing act and it is time to learn how to gracefully do this.

4. Stay Healthy
*As a future physician, I would like to be an example so that I can truly practice what I preach. So, this year I aim to eat 5 servings of vegetables and fruit per day and excercise every day. This will be difficult. But honestly, I exercise to live and I live to eat. I would like diversify my workouts, spend more time outdoors, and one-day run a marathon. I will start by training for a 10K or...5K. Baby steps.

5. Explore SF
*Everyday I feel so lucky to be surrounded by a city that is bustling with life and culture. I have yet to imbibe the essence of the city. I'll start with more regular runs through Golden Gate Park (see how I can multi-task and accomplish goal 4 and 5).

6. Give back to the community
*I look forward to teaching elementary school students about science and continuing my work at the student-run free clinics in SF and Sacramento. I hope I can incorporate my photography into service work and find new ways to impact the lives of others. Any ideas?

7. Be more creative
*Spend more time behind the lens of my camera and writing about anything and everything.

8. Become informed about current events and health care issues

9. Solve the health care crisis
*Ok, this is highly ambitious. But I'd like to be involved somehow.

10. Learn outside the box
*Lectures and textbooks can only teach me so much. There has to be a more effective way to retain information.

11. Master languages: Punjabi, Urdu, and Spanish

12. Cook more and cook for the people I like

13. Learn more about my classmates and their stories

14. Travel somewhere outside California (and possibly outside the United States)

15. Figure out what "kind" of doctor I want to be so that I can give a response to every person that asks me what "kind of doctor I want to be."

16. Enjoy Life. Stay Happy. Stay Calm. Stay Free.

Happy New Year's everyone. I look forward to celebrating the first few moments of 2008 with my dearest friends. Best wishes with your resolutions and enjoy the last hours of 2007.


Friday, December 28, 2007

Little Brother Always Know Best

Musa and I are finally in agreement about something: more time off leads to more ineffectiveness. Little brothers always know best.

I also love that Musa will go out of his way to make you happy with expensive gifts or ridiculous jokes. Not to mention, Musa definitely gives amazing fashion advice (whether you like it or not); he will be first to point out an ugly sweater or color clash when he see its.

So, when I tell Musa that he is my favorite little brother, I really mean it. (He is my only younger brother, but I still mean it)

It is hard to believe that I will be returning to school in five days. And there is so much unfinished business. 15 days ago, I was just thinking how I would have all this time to do all those things I put off during the busy hours of medical school: reading, cooking, writing, exercising, reunited with friends, learning how to sew a loose button, etc...

Although, I am not nearly close to marking things off my rather ambitious list, I know I have been having an unforgettable vacation. Sure, I have not traveled farther than Sacramento (definitely no European getaway), but I have spent the days doing the most important things: enjoying the company of my dear family and friends.

Coming from a family of six kids- it is always challenging to work around six different busy schedules. Even though we spend months away from each other, when we come together- it feels just like "old times."

Change is inevitable and it does become more and more difficult to get the people you truly care about in one place at the same time increasingly challenging. Working out the logistics will remain an eternal struggle (and I dear say it does not become easier).

As a friend puts it, logistics can become the bane of your existence. I agree. But when details are workout out, schedules arranged, and we can finally get together with the people we care about (even for a short time), it makes it all worth it.

How I will miss these blissful days of nothingness, endless jokes, spontaneous adventures with my closest friends, pointless car trips, movie nights with sibling commentary, and family dinners. I suppose I'll just have to make the most of the dwindling days of vacation...

Monday, December 24, 2007

Merry Christmas!

You know it's Christmas time, when the familiar red and white suit, black boots, and white beard becomes ubiquitous, which usually happens right after Thanksgiving.

I am a little concerned about Santa's diet- cookies and milk-- along with his risk factors for heart disease. I certainly hope that Santa makes lifestyle modifications during the off-season.

I know Santa makes a list and checks it twice to find out who is naughty or nice. I hope to make the "nice" list. By now, I am really hoping Santa has made it to my name (which I doubt since I'm at the very bottom, with a last name that starts with "Z").

Santa, if you are still checking your list, here is my wish:

*Can you please help us fix the health care crisis and give health care to over 45 million uninsured? So many individuals are denied basic sersvices for so long that by the time they seek health care they must deal with life-crushing injuries or chronic conditions that could have been prevented with earlier detection or treatment.

In a society that places such high value of freedom and life, why is health care a privilege rather than a right? I am not the first to ask this question, and yet the question has gone unanswered for too long.

If not, that's alright; I understand that even Santa has limitations. Health care seems to be the buzz word in the upcoming election. So, maybe between the democrats (and maybe the republicans), we might have a possible solution (probably not).

We'll just have to see what Santa brings.

Merry Christmas and Happy Holidays everyone! I hope Santa delivers everything on your wish lists.

Friday, December 21, 2007

Are you really breaking a sweat?

The thing I love about the gym, aside from the climate-controlled environment, has to be consistency in calorie counting. Any machine has the ability to magically deduce the exact number of calories you burn during any workout. Today I burned 298 calories during a 2 mile run.

Machines are consistent with numbers. For the last five years, the treadmill has always registered the same number when I run at a certain speed for a certain amount of time.

And I would think, after years of conditioning, my body's ability to burn calories would have changed by now. (It actually should and the calorie count should be different).

In a recent NY Times Fitness and Nutrition Article, Gina Kolata raises a similar question. The title appropriately captures the central message: "Putting Very Little Weight in Calorie Counting Methods."

Honestly, how much weight can we place in those calorie counts, when the counts are determined for the "average" person? Who exactly is this person? And how can you account for gender, muscle mass, age, diet, resting heart rate, an individual's typical activity level, among other factors that would further vary and complicate the big red number that displays on the dash?

In a quantitative society that measures everything from waistlines to portion sizes to bust sizes- I suppose we need a number to measure fitness. But we must not take the number to mean everything, it's just a baseline.

I am guilty of using the number to gauge how effective my workout is. But I have become more attuned to using my heart and sweat rate to assess if my gym time was used effectively. So, if I am drenched and my heart is really beating, I know it's a good day in the gym. And it does not take a fancy computer to determine that.

So, next time you think of rationalizing the 300-calorie scrumptious artery-clogging cookie because you burned 350 calories on the elliptical or treadmill, you may want to think twice (or just cut the cookie in half)- your heart will thank you later.

Image: "Treadmill."

Wednesday, December 19, 2007

Farewell to Dean

Last Thursday, I received an e-mail from a classmate that was forwarded by a second year; it was a message from our Dean, announcing that he was being dismissed from his position as the Dean of UCSF School of Medicine.

My initial reaction was pure shock. I think the first year students, by virtue of being at the bottom of the food chain, learn about things last. But apparently the news was just seeping out to faculty, other classes, and the UCSF community. Did I mention the press?

The details are quite fuzzy. The University has published a release that outlines the reasons for his dismissal; the primary reason stemming from discrepancies in financial reports (and it's a two-way argument, with no way to know who is actually correct).

The story has also been picked up by major news journals, such as the US News Today, SF Chronicle, and NY Times. Interestingly enough, the description of Dean on wikipedia was modified last Thursday to include the recent firing.

The headline for the Chronicle says it all: "UCSF medical school fires dean in dispute over finances." Until more details are released, I have no idea what to believe since both parties seem to be in disagreement...


It's odd. I can still vividly remember our college dinner with Dean not so long ago. We all went around the table, introduced ourselves, and mentioned an interesting talent. He was an avid spinner and Springstein fan. This was my first interaction with him, aside from seeing him at our White Coat Ceremony.

During the White Coat Ceremony, he opened his speech, by pointing to the door and asking any student who wanted to leave, to leave now (and no one would look).

And by the looks of it, he seemed content working at UCSF. There was no way of knowing about all the turmoil happening behind the scenes. It goes to show how well buffered medical students from the truth. I really wish we were more in the loop about things.

It will be interesting to learn more (if they plan to share anything else with the medical students) when we return to school in the New Year's.

Whatever the case may be, we have been reassured by our administration that the resources that sustain us (medical students) are still in place. And the global search for his replacement is well underway. Interested?

Tuesday, December 18, 2007

Rain, Kitten, and Spicy Indian Food

The rain was falling today. The wet weather dampened more than the roads; it also dampened my desire for an outdoor run. So, I made my way to the gym for a quick cardio and ab workout.

There is something odd about going to a new gym. I was actually returning to my undergraduate gym, so it was not entirely new. It was just different. There were new treadmills with TV sets in the display that would be great replacements for the current treadmills in the UCSF gym. I think it's all about adjusting to an new gym habitat.
The rain did not just confine me to the indoors; I had company- my parent's new kitten, Paloo, that is as gray as the clouds on a rainy day. I spent my afternoon in the kitchen alongside my mother who was cooking up a storm (no pun intended). I would also periodically entertain the kitten with an orange ball. The kitten is like a ball of energy and I wonder when (and if) he sleeps.

I'd like to think cooking is simple. But I always disprove my theory when I'm with my mother, who demonstrates that there is an artistic quality to conjuring tasty and delicious food. There is a certain amount of knowledge, experience, and skill that goes into any pot of spicy chicken curry, or keema kaboobs, or chappatis. My mother makes the best cook and teacher.

Today we prepared kuftas (meatballs), chicken and beef kaboobs, tandoori chicken, and zerda (a sweet yellow rice). There is no recipe book or protocol. My mother just knows the correct proportions of red pepper, garlic, and spices. It is pure skill.
The aroma of masala, caramelizing onions, and boiling rice filled our home as we cooked. It's these smells and my mother's company that I miss when I am hurriedly preparing dinner during evenings in San Francisco.

So, while I'm here- I'm taking it all in--the sound of rain tapping on the windows, the playful kitten and all his antics, the aroma of nostalgia, the unique cooking lessons, and the taste of spicy Indian Food. Want some? Maybe I'll cook for you if I'm in the mood.

Saturday, December 15, 2007

Sicko, How sick are we?

Vacation has begun. I've made my way home and am experiencing the beauty of spare time so far different from the busy days of lectures, clinical interlude, preceptorship, and general day-to-day activities of a medical student.

There is so much I want to do-- all those things I've been telling myself I will accomplish once I have the time: cooking, mastering Punjabi (the language my parent's speak), cooking (which I have begun), running, reading, writing, traveling, etc. Everything just seems so attractive when you are in school.

Now that I have the time, I find sitting around and doing nothing even more attractive.
There is a novelty to relaxing (or as my little brother says, "chillaxing"). It's the best feeling. What concerns me is that these days are numbered. Vacations become more and more rare as you get older and starting working in the real world.

Today was spent so far from the real world. A nice shopping trip that culminated with my first (and a momentous) visit to a local IKEA. What a world! And to think I have missed out on this splendid collection of interior decor with unpronounceable Swedish names when I was furnishing my small apartment in San Francisco.

I know now where I will be buying future furniture. What I find to be most odd (and really wonderful) is that IKEA also sells food. My siblings really savored the ooey-gooey Cinnamon rolls that pack a whooping 400 calories per roll.

Speaking of health, I finally got to watch Michael Moore's Critically acclaimed "Sicko," a documentary that critically examines the deteriorating American health care system.

He leaves no stone unturned when criticizing a system that has left over 40 million Americans uninsured. He delves into the corrupt profit-generating HMOs, who will go through great lengths to deny any patient that would be a high cost to the company. He exposes government officials and highlights inherent fallacies in our approach to taking care of the sick.

He raises some good points. Interestingly, Americans spends one of the highest amounts on health care and yet we rank so low (just above Slovenia). In addition, he compares the US health care system to that of socialized systems, such as the NHS in Great Britain and the systems in Canada, France, and Cuba. At all these places, healthcare is essentially FREE!

Ironically, he closes the movie by taking 9/11 Rescue workers out of the United States to seek health care since they were denied services in the US. And of all places he chooses, he goes to Cuba: first to Guantanamo Bay and then to a hospital on the island.

I am saddened by the central message Moore delivers. How sick are we? And why are so many people denied a fundamental right?

The American health care system appears to be in shambles. We seem to be patching up a hemorrhaging system that really may need to be completely reconstructed from the base. How we go about this- I wonder? Should we move to a socialized (government-run) health care system? A completely privatized system?A hybrid system of sorts?

I do not have the answer and neither does Michael Moore. If you do, please post a comment; I am interested in learning.

I just know this will not be the last time this issue will appear in my blog. I am curious to learn about ways to solve our problems. I'll report back once I can get the facts. For now, I recommend watching the film "Sicko" to anyone curious to learn about how bad the health care system really is.

Wednesday, December 12, 2007

Day 2 of Scoping in Clinical Interlude

"I would not give that liquid to my dog. I just want to eat," said Mr. B during rounds. He was referring to the liquid diet that is given to patients about to undergo a GI procedure, such as an upper endoscopy to explore for any evidence of ulcers that are bleeding.

When we spoke with our last patient today, he was frustrated and unable to comprehend why the doctors had to keep him in the hospital and keep performing test after test to explain why his lab tests were indicating he had lost half his blood volume.
In our last day of interlude, we started with grand rounds at 8 AM. Sitting in a lecture hall, we listened to a talk about celiac disease for the first hour followed by another lecture about the liver and genetics (the content completely surpassed my comprehension).

Once we arrived at the VAMC, we joined Dr. M. We met our first patient to get his consent for the colonoscopy. There are a few risks involved with any procedure. The major risks include bleeding, perforation, and anesthesia-related complications on the heart and lungs.

After consenting two patients, we observed a colonscopy and an upper endoscopy. We also observed an ERCP (Endoscopic Retrograde Cholangiopancreatography), which uses a combination of X-rays and endoscopy to visualize the pancreas and gallbladder, along with the biliary duct system. Before entering the patient room, we were given these heavy leaded vests to protect us from the X-rays.

In our second day of interlude, we felt a bit more at ease. When we walked with Dr. M from the GI unit to the ICU, I felt like I was actually jogging to keep up with him. But we felt like we were part of the team when we rounded on the in-patient consults. And today, I also listened to our patent's lungs and hearts, and got to learn about their histories and stories.

I walk away from interlude with a picture of what my third year rotation (and subsequent years in medicine) will look like. Dr. M was a fantastic mentor. He included us on his team and made an effort to teach us. I look forward to wait awaits us in the years to come.

Tuesday, December 11, 2007

Scoping and Medical Anthropolgy: Day 1 of Interlude

Image: "Polyp"
The endoscope looks like a black hose that is as thick as a finger. A camera sticks out from the end. The scope is snaked either up through the mouth or from below during a colonoscopy (a very uncomfortable procedure).
To visualize the internal geography in the digestive tract, an endoscope was used today during our clinical interlude in the GI/Endoscopy Department at the VAMC. Colonoscopies are performed to visualize the colon and bowels, primarily to screen for colon cancer. If you are male and over fifty (or have a family history of colon cancer), you will probably have to endure this procedure. Rest assured, the procedure is typically performed under anesthesia.
The stomach and colon should have nice regular folds on the mucous membrane. Any unexpected outpouches that form on the walls are bad. They are called polyps and can become cancerous if left to grow uncontrollably.
These polyps are "mean-looking," as the attending put it and need to be nipped. Once identified, a blue dye is injected to outline the submucosal layer. Using a plier-like instrument, the GI internist can return to the site, open the mouth of the pliers, and clip away the polyp. Once removed, the polyp is sent for biopsy and a tatoo (carbon-based blue ink) is left at the site to assess any future growth.

During interlude, 2 other classmates and I, stood alongside the GI fellow and observed how this exam is done. Two screens projected the live footage from the scope that was advanced through digestive system. We were protected by an oversized yellow smock (that reminded me of those smocks you were in kindergarten when finger painting). How I miss finger-painting...

When we first arrived on site after traversing the labyrinth of white buildings that is the VA, we were a bit anxious and confused about our role. It was like we were picked up and thrown into a completely different world.

The goal of interlude (as stated on the index card they gave us) was "designed to introduce 1st year medical students to the inpatient setting early in their careers. Similar to a medical anthropologist, the student will observe, study and discuss the cultures of inpatient units..."

Is medical anthropology a fancy term for shadowing?

While most of our classmates were spending the day in in-patient settings, we were in an out-patient setting. "They cheated you from an internal medicine team experience," said one of the GI fellows.

In all honesty, everything is new to me and I was just interested in learning about GI and what a typical day is like for individuals on the service by interacting with health care providers and patients. We did make a trip to the ICU, where we observed scoping from the mouth in a patient with COPD. We also saw how dialysis is performed in a patient with kidney failure.

When our attending, the "liver guy" arrived, we spent the afternoon with him. He specializes in disorders that affect the liver, such as cirrhosis and portal hypertension. The patient we saw had an uncanny resemblance to Leonardo Da Vinci, except our patient was pale and had a distended abdomen. I look forward to learning more about his story tomorrow, when my classmates and I will interview him.

After making our journey back to campus (it takes 2 buses to get home), we culminated our evening with a UCSF Advisory College Holiday Party, where we enjoyed good food and wonderful company, while exchanging stories of the day's adventures. I definitely had my share of scoping stories to share. And there will be more to come tomorrow during Day 2 of Interlude.

Monday, December 10, 2007


Marnee Thai is by far one of the best Thai restaurants in SF. The vegetarian Pad Thai is my personal favorite. Savoring every morself of food was well worth the half-hour wait we endured.

What started as a lunch with a few classmates, turned into a party of 15 or so classmates. I absolutely love the cohesiveness that bonds us. We got together to celebrate the end of Cardio and the beginning of new friendships and the approaching Holidays.
It's hard to believe how fast the year is going. Before we know it, it will 2008!

And speaking of the Holidays, a second trip to Union Square was in order. There is nothing quite like kittens and puppies in the Macy's window that are up for adoption, strolling around the square, coming face to face with pencil-thin mannequins and being overcome with the consumerism that accompanies holidays.

Although today was our Cardio Final, we are not quite done, yet.

For the next two days, we start Clinical Interlude as a part of our Foundations of Patient Care. We are scattered all over the spectrum of medical specialities. Each of us will spend two days in different worlds, everywhere from the ED to the OR to internal medicine to psychiatry to Pediatrics to OB/GYN.

I will be spending my interlude in Internal Medicine at the UCSF Veteran Affairs Medical Center. The objectives have been laid out for us, but I have a very nebulous idea of what I will actually be doing.

I am excited and I look forward to spending my time as a part of a medical team in an in-patient setting. Hopefully, I can contribute with my new-found cardio knowledge. Well, we'll see. I just know I will have to be up extra early for the one-hour commute to to the VAMC.

Cheers to the end of Cardio!

Saturday, December 8, 2007


The weekend continues to unroll with no fun in sight. The sun was shining. I could feel the heat on my skin while I studied from the fifth floor of the library. The whole city was shining and bright.

Heart Failure is no fun. And obsessing about physiological abnormalities of the heart and trying to figure out why a bad heart just keeps getting worse in congestive heart failure does not make for an exciting weekend.

Seems like every time I study heart disease, I am more inclined to jump out of my chair and run to get some exercise. Studying (and sitting sedentary along with stressing) just seems so bad for my heart.

There is one thing I've accomplished this block: I have developed a semi-regular gym and exercise schedule. Exercise. It's a good thing.

Well, distracted-- I am. I'm thinking less about the heart as I write this and more about Tabula.

What is Tabula, you might ask?

Tabula reflects the creative side of UCSF students, staff, and faculty. It is a semi-annual literary supplement published in the Synapse, the UCSF student newspaper. It provides a forum for individual expression in images and words, including poems and short stories. It is simply beautiful.

And the website cover (of candles) is actually a photograph from my personal collection: "Timeless," an image of hope, inspiration, and guidance.

Please take the time to be inspired and check out Tabula: (when you get to this site, just click on the candle picture and entry will be granted).

Back to studying...


Thursday, December 6, 2007

The Rain Starts to Fall

The rain has started to fall. Winter is officially here.

Rain always makes for a logistical nightmare. You have to remember the umbrella (which I always forget), a rain coat, and proper shoes. And forget about having a great hair day. It's static city around my long tresses of curly hair.

I guess I'm just distracting myself. We have our cardio final on Monday (hence the heart picture).

With rain and gray clouds, I might actually end up find myself studying (or not....)

A wet San Francisco has a novelty that I am just starting to take in.

So, I might just be staring out this large library window overlookin the city with a distant gaze.

Oh well...there is always the weekend (to get even more behind).

Wednesday, December 5, 2007

Bleeding Gums

Pregnancy does "funny things" to a woman's body. Jane was complaining of bleeding gums, which seems to be common with pregnancy. According to her physician, the condition will go away once the pregnancy is over. That seems like a simple solution.

Other women will complain about chills, edema (swelling), backaches, cravings, among other things. Pregnancy is an odd thing; the body's hormones, blood circulation, and metabolism are in overdrive.

Today was another one of Jane's prenatal appointments. It seems like March 2nd is far away. But it is really about 2 and half months, since twins usually deliver early or are delivered during a scheduled C-section.

While we waited for the nurse, a photographer from a baby resource website asked us if we were Middle-eastern (we are not). Jane and I have been mistaken for being sisters. He was looking for a face for the new Middle-eastern prenatal informational website.

I guess it would be kind of interesting for Jane (or for anyone expecting) to be a pregnant model.

*Note to self: bring camera to next visit

At our next visit, I have to remember bring my camera. Jane wants pictures to remember what she looked like during pregnancy. "This is the first and last time I will be pregnant," she said jokingly.

Everything is looking great. Baby A and Baby B are both growing. Jane placed my hand on her stomach, letting me feel the baby's heads. I really can't tell you what I was feeling. It was just harder than other areas of her stomach. The babies did not kick so much today, but later they will (and I can't wait to feel the kicks).

While we waited (today we were in the clinic for 2 and a half hours), I got my blood pressure measured: 115/54. I'm not the only one interested in blood pressure. All the husbands also get their blood pressures measured.

We did get to hear the baby's hearts beating. A normal heart rate for an adult is less than 100. For a developing baby, the normal heart rate is higher, between 120-160. Each Baby's heart was beating loud and fast; I could make out the lub-dub over the swooshing sound of the doppler.

It's hard to believe there are two babies growing inside the bulge of Jane's stomach. I wonder how much bigger the stomach will have to grow to support Baby A and Baby B. It's simply amazing how the body adapts to make a nice home for the growing babies, and watching Jane transform each time I see her.

Sunday, December 2, 2007

It's Starting to Feel a Bit Like Winter

The calm before the storm. That is what this weekend is (the weekend before our Cardiovascular Final, next Monday). So, I decided to enjoy this weekend.

Food, friends, mentoring, photographs, Christmas trees, shopping-- just a few of my favorite things.

Saturday was all about Med-Link, a mentoring program that pairs medical students with high school students, who come to UCSF each month for a Saturday session that is filled with science, college, and clinical sessions. I met my mentee, MM, and learned more about her goals, family, and life.

We talked about pursuing our passions, my passion being medicine and hers being politics. MM definitely reminded me about the importance of challenging ourselves to achieve new goals and learn more about ourselves in the process. I mean you'll never know until you try, right?
Here are some photographs from good times on Sunday that are just reminders that it's winter (and Christmas is just around the corner), in case you have yet to brave the shopping centers.

Location: Union Square

This is one really big tree in the center of Union square. I love Christmas decorations. There is something so beautiful about red and green, glass ornaments on a pine tree, and shiny lights. I have yet to outgrow my fascination with Christmas lights and decorations lighting up a house on a dark, cold, night.
Well, the calm will soon evolve into a turbulent storm, as the studying really begins! Stay tuned for the never-ending excitement.