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Real Talk about Hospice and Palliative Care
Interview with Lauren Marcewicz, MD, Palliative Care Physician
(Podcast #038)
Dr. Lauren Marcewicz 00:00
I mean, I think the other problem is that sort of in our culture, we talk around death a lot. We don't, you know, we don't say the word we don't talk about, what are your dying plans? So we talk around it a lot. And I think that happens for families who are confronting it as well, there's a lot of talking around it. You know, like, like the whole question, what do you want to do? What do you mean, what do you want to do? There is no what you want to do, you're dying. So... and I think people are probably not as honest with with each other and with themselves as they as they could be? And that that leads to people struggling with sort of what next steps to take, and where do we go from here.
About the Psychology of Aging Podcast
Dr. Regina Koepp 00:48
I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and families. I created the psychology of aging podcast to include older adults in conversations about mental health and wellness. And here's why this is important. When we're all a little more informed about mental health for older adults, we reduce suffering and improve quality of life. And who doesn't want that? So join me, it's simple. All you have to do is listen, be willing to learn, and then share what you learn with others so that they can be included in this conversation, too. Alright, let's get started.
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About Dr. Lauren Marcewicz, MD
Last week, I had a very special conversation with Patty Webster from the Conversation Project. We talked about how to start end of life conversations. I'm continuing the conversation about end of life care today with Dr. Lauren Marcewicz.
Dr. Lauren Marcewicz has been a palliative care physician at the Atlanta VA health care system for the past five years. She's currently the physician program lead for palliative care site director for the Emory University School of Medicine hospice and palliative medicine fellowship, and adjunct assistant professor in the Division of palliative care, Department of Family and preventive medicine at Emory University School of Medicine. She also serves as a physician and the Georgia Army National Guard. In this interview with Dr. Marcewicz, we talk about end of life care. We talk about what it's like for the person at the end of their life, and also what it's like for families.
I hope that you listen to this very important episode. Because this is one experience in life we will all go through. It's universal. And while it might be scary, I want you to know, you're not alone. So join me and Dr. Marcewicz in this very important conversation. Let's get started.
Can you start by sharing a little bit about what drew you to end of life care?
Yeah, I think I think that answer is so there's many facets to it. You know, and and if you ask me today, the things I'm Share might be different than if you ask me, you know, tomorrow or a week from now, I think the biggest, biggest thing that drew me to end of life care was the idea that I wanted to be with people in their most vulnerable periods that I just sort of wanted to accompany them through their most most vulnerable periods. When I was in medical school, the, you know, as a, as a medical student, you really are not able to be as helpful as you want to be. Because you don't really know what you're doing. And you're put, you're sort of there. And as a medical student, what I found was the times that I felt most empowered, and most helpful to people were the times when I when I would just sort of chat with them. I remember this guy who was going into surgery and was really nervous about going into surgery, and just just sort of sitting there talking with him about it now that the anesthesiologist gave him drugs, which was good. And I was like, oh, that I could I could be an anesthesiologist because this is a vulnerable period. Right. But but sort of, the more that I thought about it, the more that I thought, well, what what is what is literally the most vulnerable period of anyone's life. And that's the end of it. And and when they're facing death. And so that that was probably the biggest thing that that drew me to it. Hmm.
There's something about the vulnerability that really touches you.
Yeah, I mean, I think it's all... so let's see if I can make this story relate. So, I was on the... I have a dog that I love very much and I took my dog to the beach. And so my dog and I are on the beach for like an evening, evening slash nighttime walk. And it was really dark and stormy. This is like April at the beach. So really dark and stormy. And there's no moon outside, no stars, or anything cloudy, the waves are going crazy. And we're alone out on the beach. So I've got my dog next to me, and I'm looking at the ocean. And I was like, that's scary. So very large, expansive, scary, you know, stuff out there. And I looked down at my dog. And my dog looked up at me. And I was like, kind of so glad my dog is here. And I just felt this incredible warmth. And I was just so glad that the dog was there with me. Hopefully, she was glad that I was there as well. But that I think like that's all that's basically all we can do for each other. We can just be there with each other during these scary periods. And in those spaces where people feel, how am I going to confront this alone? How am I going to do this alone? Well, you don't have to be alone. Nobody's alone. We all have people around us. And so that's really, I think, what it's what it's about.
Wow, that is a powerful analogy of the storm and the darkness and not knowing just kind of this, the vast expanse and then brewing storm and looking to your dog and your dog is giving comfort. And...
Yeah. Right just the presence of... just her presence, this thing that I love, you know, it's not like I know what she's thinking. It's not like she knows, you know, but yeah, just to have that presence with me was really calming, really great.
And that inspired you to be that presence for others.
Memorable Experiences Being with People at the End of their Life
Are there certain end of life experiences that stand out to you and your career as an end of life physician?
Yeah, how much time do you have?
Give me... I'll take your time.
Yeah, um, yes, there are, there are myriad experiences that stand out to me, I sort of get to be with people in this end of life period. And then the things that they tell me in the end, the things that I witness, right, become my story. So, in many ways, their stories, to some extent become my stories. And I think carrying them forward is part of, you know, part of, I don't know, part of the work as well. But the story... so my favorite end of life story. The one that sticks with me probably the most is that there was this gentleman who we cared for - I work at the VA. So there was a gentleman that we had cared for, for a long time at the VA and we, at some point, we'll talk I think a little bit more about what Palliative care is and sort of what we provide for people but a lot of times we're with folks for, for their whole sort of disease process or for a long period of their disease process. So we had cared for this gentleman for a long time. And he was a Vietnam veteran, and he was very afraid of dying. And what he was afraid of specifically was that he would go to hell, because he felt like he had done some things in Vietnam that he was not proud of. Never wanted to talk about those things. And so he really, his fear of dying was really about a fear of being being punished. And not sort of experiencing love or anything like that. And so I was caring for him in the hospital, he ended up dying in the hospital. And sometimes what happens is when people... so there's a lot of strange things that happen when people die, doesn't mean that that always happens. But there's often a lot of sort of strange things that go on. And one of the strange things that can happen to people is that they can have like a, what we call sort of a lucid moment. So they'll, they'll look like they're dying and, and are sort of asleep and sort of out of it. And then they might sort of come back and be able to converse and be awake and be with people and then kind of go back to this sort of out of it, dying period. So he was on my unit started to look very bad look like he was dying. So I was giving him some medication to help him through that. Talked with his wife. And now I was like, I think, I think he's actively dying. And then, you know, I ended up going home for the evening. So she told me the next morning, when I came in that what had happened, what had gone on all night was that he was looking up into the corner and talking to somebody and sort of having a full on conversation with somebody. And he, at one point, grabbed her hand and said, see what I've done. See, I did this and he would talk about other things that I've got kids and would sort of come up with these things that he had done in his life, these good things. And then the next morning when I came in, and he was awake. He was like what are all these people doing here? What? How come? You know? How come my cousin is here? How come my family's here? What are you guys all doing here. So, they sat with him for most of the day, you know, and then he ended up passing. Later on that day, into the end of the evening, he sort of slid off into more of another kind of active dying period. And so for me what I, you know, it brought such closure for his wife, his wife and I both we had a conversation about this. I mean, I think we both had the idea that what was happening was that he was, I don't know telling whatever powers that be sort of your other good things, here are the reasons maybe why. Why not everything in his life was bad, or why he might deserve kind of not to go to hell, I guess. But it brought, you know, a couple of reasons that sticks out to me is one it brought such closure to his wife, she was able to feel like, um, like, things were gonna be okay. He felt okay. I mean, after like, so he came back in this lucid period was able to enjoy his time with his people. And then was not afraid to sort of then let go and move on. Um, and for me, as somebody who sort of witnesses something like that. I mean, it's just what an awesome you know, awesome story of finding wholeness at the end of life, I think... so that's, that's probably my favorite end of life story.
Oh, and integrating these disparate experiences in life from war to creating a family and, and sort of integrating war's place in his life with his Vietnam service. And then that his life didn't stop there. And his contribution to the world didn't stop there that he had all these other aspects of his life that he could put into one whole picture. Yeah, it's a really beautiful story that his wife got to see that journey and had some peace and she had some peace in the end with it. That's lovely. Yeah.
Yeah. That's my favorite one.
The difference between palliative care and hospice
That stands out to you. Yeah. Um, well... So tell us about what you do on a day to day, like what is a palliative physician?
Yeah, yeah. So palliative care, kind of the broad definition of what Palliative care is, is care that is aimed at trying to alleviate suffering, specifically the suffering that comes with having a chronic life limiting or life threatening illness. And we often talk about people suffering, you know, suffering isn't just physical, although there's that as well. But But suffering also happens in a spiritual plane, it also happens in the social plane. And it happens kind of, to our, to our emotional psyche, I guess, as well. And so, Palliative care is really about trying to address suffering on all of those levels. So my day to day work is usually working with people who have some form of chronic illness, and that could be anything from cancer to, you know, heart disease, or bad lung disease. And I even work with people who don't have an end of life diagnosis, but have a diagnosis that's like head and neck cancer, for instance, is something that's really well treated, and we've got good ways to even cure head and neck cancer. But the treatment often carries with it so much symptomatology. And it really affects people's ability to lead their normal lives and changes the way people lead their normal lives. And so, so I'll meet with those folks in their family and try to figure out ways... try to figure out where suffering is happening and try to figure out ways to mitigate that whether that's through medications, or maybe talking to a palliative care psychologist or maybe talking to our social worker or finding other resources, or, or just hearing kind of what, you know, having somebody tell me what's going on can sometimes, I think, be therapeutic for people, too. So, that's a lot of what my daily work is with palliative care.
What's the difference between palliative care and hospice?
And so, you know, both are, I guess I'll answer that question by talking about their similarities. Palliative care and hospice both focus on quality of life rather than disease management or changing the course of a disease. And both focus on function and quality of function, how people are able to live their life. Hospice is really something that's reserved for folks who, who are in their last six months of life. And, I mean, doctors are really bad at figuring out if you're in your last six months of life or not. So we've got certain things that we kind of look at. Hospice, I often tell people, it's reserved for periods of time where we don't think that any of the medicines that we're using can change the course of the disease. So, either the medicine's not helpful anymore. Or if people sort of feel like, gosh, this medicine is making things worse than it was, you know, before I started the medicine, that's really what hospice is reserved for. Palliative Care can happen at any point in a disease course. I mean, any at any point really from diagnosis onward. And what we normally say is that people, you know, probably need less palliative care and less focus, there's less suffering at the beginning of the illness than there is kind of at the end of an illness oftentimes. And so what people need from palliative care might increase with time, to a point where Hospice is sort of maximal palliative care, I would say.
I share one of my most memorable experiences holding a dying man's hand
Yes. A nice way of putting it. I was thinking about my favorite end of life story. I trained in hospice at the Palo Alto VA. And I remember I was bedside with a patient and his extended family came in, so not people who he saw regularly, not people who had been with him on the unit regularly. And I went in the room, just to introduce myself and to see how the patient was doing. He's laying in his bed, and he was nonverbal. He was sort of in active dying stage. And he had sort of kind of gruff, fully kind of crackly breathing and not responding to any conversation. His eyes were closed, he looked like he was sleeping. And I was holding his hand but he had a firm grip. So his family was sitting down and I was in talking with the family and him and kind of orienting them to how to engage with the person who's dying. And so I'm standing there and holding his hand and they're telling me stories about him. And I'm telling them, Oh, tell me about your loved one, like, tell me, tell me what your favorite memories are, so he can hear you and I can hear you. And so they are. And at one point, his hand is warm. And it's, I have small hands, I'm a petite person, his hand was like big, and it enveloped my head, and it felt so good. And then, but at one point, I put his hand back on to rest on his body. And was going to go, and I was asking, and the family was asking me, Should we hold his hand? And as I was going to go, he reached his hand back over to grab my hand and held it again. And I was just like, Oh, my gosh, if there is any question, if there is a person still in there, when the person is dying and not able to respond, if there's any question that has just been answered for me. And then I took his hand and put it in his family members hand so that they could have time because I'm not his... I mean, in those moments, because they're so intimate, I feel like he is my family. But, but technically, I am not. And I want his family to have time with him. So then I put his hand in his families, whoever that person was to him, in her hand, and, and just kind of held it there to kind of orient his hand to hers. And then I, you know, said goodbye and left. And it was just such a powerfully intimate experience that this person who's actively dying, knows the meaning of connection, like what you were saying in that storm, and that in some level, he's wanting to connect and have contact and humanity and warmth. And it was a, it was just a beautiful moment that will last forever for me, and hopefully, for his family that they get that opportunity with him, too. I think even at the moment, I don't even know if I remember this right. But in my mind, I'm thinking, I wonder, at that moment, we were even talking if he could understand or hear us, because families often have that question bedside.
And, and maybe that's just something I'm making up now. But if that was a question in their mind, I hope that was answered then too, right? It's just, these end of life moments are so powerful, and they can be so simple, like hand holding, like, incredibly powerful. It's just a beautiful, beautiful thing.
Yeah, there's a lot of meaning sort of wrapped up in a lot of the stuff that we do.
How does someone qualify for hospice care?
Let's go back for a second. So, how does the person get designated from palliative to hospice? So, I know there's their six month mark. But to qualify for hospice care, do two physicians have to agree that the person is....
No, not really the way that it works... So Medicare, hospice is really a Medicare benefit. And that's where it comes from. And Medicare has sort of done the most research on hospice and everything. So Medicare has guidelines for kind of what, what qualifies people for hospice, and so that's different based on different diseases. So for instance, for heart disease, it's sort of intolerable symptoms. A patient is either not a candidate for advanced therapies, like a heart transplant, or an LVAD, or patient is optimally managed on all of the medication that they have, and kind of can still have symptoms, despite all of that optimal management. So those things have been associated with a six month survival, you know, in all of the Medicare data. And so what normally happens is, let's say a patient is in a hospital, or a patient is seeing their primary care doctor, the doctor who's taking care of the patient in the hospital, or the primary care doctor can make a referral to hospice, after you know, discussing it with the family or whatnot, and then what hospice will do hospice will look at kind of all the characteristics of the person and look at kind of the medical evidence and say, yes, this meets criteria, or no, this doesn't meet criteria. A lot of times what hospice will do as well is they'll, you know, they might be iffy about whether or not the patient meets hospice criteria, but they'll admit the patient to hospice and kind of see what happens over the next, you know, 60 to 90 days, as the patient sort of stabilizes, as the patient gets better then those things would mean that, you know, they're not at end of life. But if the patient kind of continues to deteriorate and they're seeing sort of worsening function and worsening symptoms, then you usually keep the patient on hospice. I've had people people graduate from hospice, I mean, I have had a guy who had metastatic colon cancer four, and he had been on hospice for two years, was not getting any treatment. But they said... he said, Sorry, they sent it back to me. And they said, I mean, he's not, he's not declining, he's kind of looking longer. And so, you know, I mean, who knows? Who knows? I always say, I'm not in charge, right?
Yeah. There are bigger powers at play.
That's right, exactly.
Does a person have to have a DNR to be eligible for hospice?
Um, now, there is some question about does a person have to be DNR to be eligible for hospice? Or can they stay full code?
They can stay full code. So agreeing to a natural death or agreeing to not be resuscitated is not a strict requirement for being part of hospice. And people have different... I mean, you know, I think sometimes people, we talk about this a lot in palliative care. So, sometimes people with a lot of resuscitations on E, where people get CPR, and then kind of, you know, come back to full function and full life. And so there's, I think, there can be a lot of misunderstanding about what actually happens in CPR. And so, you know, we might, we might live more with the Hollywood reality than sort of being able to see what it's really like. I also think sometimes people are like, gosh, why wouldn't I want that last chance? Or maybe I need my family to see that people are doing everything for me or whatever. There's lots of reasons why people might elect to, not allow natural death. Lots of reasons why people might say, No, I want the paramedics to come in and do CPR. I think sometimes what happens is, you know, if somebody... sometimes I'll ask people, do you envision dying at home surrounded by, you know, sort of your stuff and people that you love, and if so, then you know, maybe Hospice is for you. On the other hand, if you really do envision dying in the hospital ICU with somebody, you know, doing CPR on you, and that's what you envision, then maybe hospice isn't for you, because Hospice is something that's designed to keep people out of the hospital. And so if you're going back into the hospital, you know, for any attempts to change things, even if those things can't be changed, then, you know, then... but your doctors might decide that Hospice is probably not the best thing for you. It just depends on what people envision and what their goals are. We talk about that a lot.
What do families tend to struggle with the most when it comes to end of life care?
Yeah. What do you notice families tend to struggle with the most when it comes to end of life care?
Yeah, I mean, I think it's probably a minor thing, but I think the thing that people struggle the most with is feeding and food and eating, you know, so the, the natural pathway for all of us is going to, I mean, unless we have something catastrophic happen, you know, the natural pathway for diseases to take over our bodies is that we, we just don't have a desire to eat. Like when you have the flu, you're not thinking like what's the next thing to eat because you just look crappy the entire time. That's easy, right? So that's, that's essentially what happens when people have lung disease or heart disease or cancer is that they don't, at some point, they don't want to take in food and then it doesn't matter what they take in, they're still going to lose weight and kind of have an... and not get enough nutrition and that's just because they're sick. But for all of us food is how we show people that we love them. Food is how we care for people when we have parties, we put food on the table. We have guests over, we put food on the table. We all get together for Thanksgiving and for Christmas dinner and Easter dinner and, and Passover and you know so all of those ways that we use food to show people that we love each other people want to do that at end of life, right? Like that's, that's what people... why isn't he eating I make him his favorite foods and he doesn't want to eat it. And so that, I mean, that can be a real struggle, right? When you want to do something for somebody to show that you love them. And so you make their favorite food, and that they've loved for 30, 50 years, and then they don't eat it anymore. That's, that's really hard to take, like, cooking or like what, you know, what is it? And so I think people, I think people struggle a lot with that. And I guess I would just say, it's, it's natural, it's natural for people to... I once heard somebody say, you know, as people are dying, they become less interested in the things of this world, and more interested in the next world. And so all of that is based on what you think about is coming afterward. Right? But, you know, that made a lot of sense to me, the person said, Look, people don't talk as much, they're sleeping more, and then they're not eating. And, and all of that is because whatever work is happening in their body, it's about the next place, they're going to, it's not about trying to keep people here. And that's true. You know, when we sleep, when we eat, it's about us trying to stay here, trying to participate in this stuff that's here. So...
What does the dying person struggle with the most when it comes to end of life care?
What do you notice people who are dying tend to struggle with the most?
Um, I think, you know, I'll say people who are actively dying, I think, I don't know what they struggle with. Because I don't know, I don't know what's happening in there most of the time. So we try to treat the symptoms that we think we're seeing and, and hopefully, they're not struggling with any of that stuff. But I think people who are kind of like, before you get to an actively dying place, I think people struggle a lot with doing what feels right to their, to their family. I just took care of a gentleman who, you know, whose family was basically like, they had asked... he had very advanced cancer, and his family said, you know, can we get a second opinion? And I said, Well, sure, you can do that. And I said, I'm gonna recommend to you that, you know, the reality is probably that there's not going to be a second opinion available for him just because of how sick he is. But yes, if you want to do that, that's fine. And I sort of gave them some, some options and talked with them about what that might look like. And so they said, you know, at the end of the meeting, they sort of looked at him and they said, Well, we we want to do whatever you want to do, you know, we don't really want you to be an experiment of any sort. But we want you to do what you want to do. And he heard this part and was like, I can't, I can't handle the sadness that, you know, the tears that are coming from my mom and the tears that are coming from my son, I want to live and we're going to, you know, get a second opinion. And then privately, he would say he just wanted to go home with hospice. And his family, they came up to me after the meeting, they were like, I think he just doesn't get it. I think he just doesn't see. And I said, You know, I think really, he's trying to protect you, and you're trying to protect him. And that's what you both are doing. And while you're trying to be honest with each other. That's kind of what's happening here. So, I think that's, that's the struggle that I see a lot of times is that people want to do what their loved one... everybody's trying to be different. Right? The person who's dying is trying to be different to their family, and the families trying to be different, and people end up not being. I mean, I think the other problem is that sort of in our culture, we talk around death a lot. We don't, you know, we don't say the word we don't talk about, what are your dying plans? So we talk around it a lot. And I think that happens for families who are confronting it as well, there's a lot of talking around it. You know, like, the whole question, what do you want to do? What do you mean, what do you want to do? There is no what you want to do, you're dying. And I think people are probably not as honest with with each other and with themselves as they could be. And that leads to people struggling with, with sort of what next steps to take and where do we go from here?
Yeah, I think in the in the mindset of it being a gift, but then it creates a struggle. As you were talking about that in my experience in hospice and working with families that end of life is the gift of the magic story... where there's a couple and the female member of the relationship has long beautiful hair. And the male member of the relationship has his grandfather's watch or something special, but the battery on the watch is dead. And, and he's lamenting the loss of this watch because it's not working because the battery's dead, or some piece is missing. And she says, Okay, well, there's an important... maybe it's Christmas, I don't remember. And I'm gonna cut my hair and sell it to get this piece for the watch. And then he says, Well, I love her so much. And I love her beautiful long hair, that I am gonna sell my watch to buy a beautiful clip for her hair. So then it comes time like to see each other for Christmas, or whatever it is. And they present their gifts, and she has no more hair, she has no hair for the clip. And he has no watch for the, for the battery. And all they have is their love for each other. Right. And they're, they're demonstrating their love in these really profound ways. But then they're missing this key ingredient, which is like the importance of the connection and the time together. And that so often when I hear these stories, like you're describing from your work in palliative care, where the person who's dying may have the wish, just simply to die in peace, surrounded by his family, without a lot of medical drama happening around him. And families like, well, we want our loved one to have this life and we want to keep them like go and do a last wish trip or something and keep them going and help them see their grandchildren and, like and so how do we do that? And they're both having their own narratives. And so they're essentially cutting their hair and selling their watch. And then they never get the conversation that's like the healthy end of life conversation of how can we do this as a family peacefully, honestly, how do we talk about these things? And because all that's left really is their love for each other, they're not gonna have, of course, the hair is gonna be gone, and the watch will be gone. And all they have is each other. And so how do you like, maximize that? Right, and these conversations?
I don't know. I mean, that's, that's a great, that's great. I mean, I think the idea that people have different narratives of, of, like, what's happening, and what they're doing is totally spot on. And I see that, you know, all the time, and sometimes it's okay, and it works out. And then sometimes people are just, you know, totally at odds, like think about all of the dysfunctional ways that we love each other. You know, when everything's okay. There's lots of, you know, somebody's nagging too much this or somebody, you know, whatever, right, like, all of the ways that we are not perfect. And then that stuff comes out, you know, 100 fold, when there's a crisis. And so, yeah, you just... we're not used to being honest about our emotions with people. Not even the people that are really close to us, you know, we're not used to having... I'm not used to having really frank conversations with each other and certainly not with, you know, who has frank conversations with their kids, right, like we try to avoid those things. So it just... yeah, you can have a lifetime of like, having made it through a lifetime of small dysfunctions or whatever, right, that we all have. And then it comes time for this huge monumentous thing, this huge piece of crisis for everybody. And, I mean, sometimes people just can't navigate that. But you're right, then are left with sort of this connection with each other. Hopefully, or...
Yeah, yeah... all sorts of variability in between. Yeah, we are complex creatures, I guess. And, you know, the other piece is that I'm working with families with severe and terminal or chronic and terminal illness. You know, the quality of our relationship before the illness strikes kind of influences how our relationship and the journey will go after terminal illness is identified. And so it can, it could go in so many directions. And so it's, I think the end of life journey starts at birth, because you're, we're relying on... but we have to rely on our relationships, to get us through life and then get us through the dying process. And however that attachment goes through life, kind of influences our experience at the end of life. But... Yeah, I digress. Um, oh, can you talk about... let me not be so chipper when I say this. Hold on one second. Can you describe the active dying process? You mentioned active dying.
What does it mean for someone to be "actively dying"
Yeah. So when people are actively dying, they kind of, you know, I made the mistake of sort of describing this once to somebody as almost like falling asleep. And he didn't want to go to sleep, you know, for four months after that. But the final sort of common pathway for death, when somebody has a chronic illness is that organs start to shut down. And as organs start to shut down, whether that's your heart or your lungs, you know, one of the major... two of the major organs that start to shut down are your kidneys. And those kidneys are super sensitive to kind of everything that's happening in the rest of the body. And so, kidneys shutting down, and liver shutting down, those are the things that filter toxins from our body. Once those start to shut down, toxins start to accumulate. And as toxins start to accumulate, we get more confused. And so there might be a period of confusion where people are actually kind of a little bit, a little bit confused. And I think that can be scary for loved ones. And I think it's actually scary for patients a lot of times as well. After that, as that confusion I think gets worse people or sometimes people don't even go through a period of extreme sort of awake confusion. But as people go through that they get to a space where whatever's happening mentally, we can't, we can't really see what that is. So they look like for all intents and purposes, like they're in a coma, I guess would be the best way to say that, you know, really hard to arouse, not participating in conversation, you might be able to get like a moan if you ask something specific to the person, but just really not able to tell us kind of what's going on with them. People, sometimes you'll see people who might have some different... sort of struggling to breathe. And so we always look at sort of whether the nostrils are flaring, or whether people look like their brow is furrowed or whatnot, those are signs that people might be uncomfortable. More often than not, people are pretty, you know, pretty calm in the later sort of stages of that. And so I would say that that's anywhere from, you know, hours to, you know, 12 hours to three days before somebody actually kind of... kind of dies. I think as the dying process goes on, people, can't swallow. So you get the pooling of secretions sort of in the back of the throat. And, you know, I think people commonly refer to that as the death rattle or hear that and so you, I mean, you can certainly hear, you know, gurgling in the back of the throat. We don't think that's painful for people. We don't think it's distressing. We don't see people with sort of furrowed brows kind of trying to do something about this gurgling. I think it bothers families a lot. It's really... it can be really loud. And it can be really sort of distressing to hear your loved one going through that. And then the cardinal sign of, of the thing that I always look for when I'm trying to figure out sort of what the trajectory is for somebody, how far away from death do we think this person is when people stop urinating so less than 100 CCS or 100 ml of urine in a 12 hour period suggests that the next that death is going to come within the next 12 hours? So people are pretty out of it. I don't think I've ever seen anybody be alert you know, and some people can't have a conversation and I think maybe sometimes people want something like that to happen but people you know, wouldn't be able to say goodbye I love you and you can have the black car or you have my... you know, those things kind of can't happen during an active dying process.
And the majority of people have an active dying process that they die from illness.
Yeah, right from natural causes or illness. And sometimes, I mean, I would say sometimes that can be... that whole process can be fast or slow, depending on what's going on. So if it's an infection, for instance, that is causing this, this shutdown of organs, that can be pretty rapid, I mean, we can be talking a matter of several hours, and that whole process kind of gets sped up. If it's the heart failing, you know, it could be anywhere from hours to days if it's maybe something more like the liver having shut down from sort of long standing liver disease that might be a little bit longer. So it just, it just sort of depends on sort of where people were at before they started the dying process, and kind of how bad whatever the final insult really is to their body.
What tips would you give to families who are starting that end of life process?
Yeah. What tips would you give to families who are starting that end of life process?
I think, so I'll say a couple of things. I think, first, knowing that dying is a process. And it's not. You know, I don't think that dying is a moment even... we talked about kind of like time of death. And it's this one specific moment in time. And I don't, I don't really think that that's how that happens. I don't think that we can tell that. But I think the shutdown of the body happens over time. And it's happening. You know, I joked that we're all dying, right? But we are... like our shutdown is slowly, slowly happening over the course of time. And so when you know that you have a diagnosis, you're going to die in different ways, right? You might die to the person that you were, or you might die socially, you can no longer bowl, or you might die socially, because you can't be a doctor anymore, or what. And so there's all of these different, different processes that happen at throughout the dyeing process. And so just sort of knowing that it's a process, it's not going to be a moment. I think, helpful and important. I think the other tip that I would give people is, you know, really make space for honesty, and I don't... I hope that doesn't land in like a, What is she talking about kind of way, I really think we all have different expectations for each other all the time, especially in a marriage, you know, or in a patient or parent child relationship, or in sibling relationships, we have all these expectations based on what society tells us and what we have experienced from each other before. And thinking about, at least thinking about making space for, you know, what would it look like if we were honest about what we needed from each other? If we were honest about what we wanted, if we were not, not sort of hung up on all the expectations that we have for each other and focused on being honest, what might that look like? What might that bring? I think those are a couple of tips that I would have. And then the third thing I'd say is just I mean, some people feel like they can trust their doctors. And so if you have a relationship with a doctor where you feel that that's the case, you know, talk to your doctor about about all of the concerns, and all of this stuff that you're worried about, I think doctors a lot of times are pigeon holed into like, we're going to talk about blood pressure. Today we're going to talk about your diabetes or whatever sort of the kind of key points and sometimes you can go to a, you can have heart failure for two years and go to the doctor for two years and be getting worse all the time. But never have had a conversation about end of life. Never have had a conversation about what that might look like, what options might be, you know, because each time you're just sort of going through the checklist of what might need to be talked about. And so if you have a doctor that you trust, I would talk about function and talk about the things that concern you about about end of life and what are we dealing with? And what's this going to look like and how do I get help and sort of all of that because the more planning that you can do up front when you're healthy and we can do the running around that you need to do and getting things in order and all of that and thinking about your wishes. The earlier you can do that the better. This isn't, this isn't stuff like a one day, I'm going to decide, oh, that's how I want to die, or Oh, that's how I'm going to think about CPR, right? Those things require a lot of thoughts. And so just giving the time and the space for that, I think from the outset is good.
The Importance of Anticipatory Grief
To allow some grace for the emotional preparation for all of that. You're talking about this process of anticipatory grief and ambiguous loss of losing bits and pieces of yourself or of your loved one over time. And that ambiguous loss where the person is still there, but they're different, or not the same. And then this anticipatory grief, I'm preparing for the end emotionally and saying goodbye, and bits and pieces over time, that if caregivers and us if we're active if we're in the dying process, if we take the time to do that, to grieve in an anticipatory way or to experience the loss, even when it's ambiguous, like it's sort of gone. But it's still here, when it's not clear, and if we allow ourselves the sort of space and grace to do that, and actually help with the aftermath of when the person does die, and is no longer physically here. And that what we know about caregivers who engage in anticipatory loss process, or anticipatory grief process, if they do it in a healthy way, they have a healthier outcome with grieving down the road. And so that's actually, I think, an important part of the process for our human psyche and spirit is, even though difficult to engage in the process of grieving even before the person is gone.
Yeah, I mean, I think, you know, we're, there's, like, we're gonna be here, you know, for a certain period of time, like no matter what, that's often what I tell people like, yeah, you can't be the person that you were, you just, you can't because of memory loss, or because of functional loss or whatever. But you're still here. And so what the trick is, is to now figure out how do you be you with all of this newness? Right? How do you still... because you're still you, but how do you make that new you fit into the body that you have? Or the stuff that's going on? For you?
Yeah, and then it becomes a real family thing, because the person might still see, yes, I'm myself, but the family then might be responding to the person, no, you're sick, we need to step in. And so then the whole system needs to adjust, and right to look at where the person is capable, and where the person can be upheld and honored, sort of valued, where they can contribute. Is there anything else you would like to share with people who are embarking on this end of life journey, anything that stands out to you?
Final Words of Wisdom
I mean, I just, you know, we're all gonna go through it. And, I think... So, obviously, I have the opportunity to think a lot about all of this, because I do it every day, but it is a gift. I know. Gosh, I hope that doesn't sound glib, but it is a gift to know that dying is coming. I mean, if you consider you know, like, I had a friend whose dad died in a car accident, and the trauma from that, right, the trauma from an unexpected death is deep, and we get through it for sure. But like to think about what a blessing it is to know, to know that you can spend time with the people that you love, you know, can arrange for meaningful time with the people that you love, or you can, you know, say goodbye, the possessions that you have that you really love, or see this one place one more time, whatever those things are. That is a real gift. And it's a gift if we use it in that way, right? If we don't look at it as something that we need to fight and battle and argue about. And you know, and something that we need to ward off at all costs, but rather is a gift that is bestowed on us for the opportunity to use it appropriately, then I think, I don't know, maybe it'll go a little bit easier for all of us. I would like to think it's going to be scary. It's going to be scary no matter what. But having somebody who sort of, you know, back to my dog, having somebody who non judgmental is just like, yep, I'm here with you looking at that same expanse. I think... I don't know, maybe that's a good thing.
I really appreciate your time and contribution to the show and then all the work that you do with our nation's veterans and with being with people at the end of their lives and, and with families at the end of their loved one's life. So, I really applaud you for the work that you do and appreciate the care that you give. So, thanks. Thanks for that and for being on our show today.
Thank you so much for having me. It was it was great to have the opportunity to have this chat.
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The B2B Marketing Lab hits the news stand!
B2B Marketing Magazine, the prime UK publication for our industry, ran an article in their February edition on Inbound Marketing (page 30 seeing as you ask!), where Alex Blyth investigates the increased attraction and growing hype.
Case studies, useful advice and of course, comment from The B2B Marketing Lab. Have a look at our Newsroom for more coverage.


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Demand Keeping Pace With Supply of Office Space, New Report Says
ORANGE COUNTY, CA-Latest report from market watchdog says that business start-ups and expansions have created a healthy market for office space.
By Joel Cone | October 16, 2000 at 01:01 AM
ORANGE COUNTY, CA-The number of companies leasing office space in the county expanded faster in the first three quarters of 2000 than at anytime in the past decade. According to ta third-quarter market report, scheduled to be released next week by Voit ommercial Brokerage of Woodland Hills, net absorption of available office space in the county totaled 2.8 million sf through September. By year-end, absorption isexpected to run more than 3.5 million sf.
"What's going on now is demand is keeping pace with supply. We had 2.8 million sf of positive absorption and 2.7 million sf of space deliveredto the market," says Jerry Holdner, VP of market research for Voit and the report's author. "So developers are happy because they're not overbuilding."
Holdner attributes such a dramatic increase in absorption to new business startups and existing business expansion, rather than business moving into the county.
"You would think that companies are moving here. Some of that is going on, but it's only maybe 10%. It's a small percentage compared tothe technology boom we're seeing," Holdner notes.
The new numbers are a stark contrast to the 111,000 sf of net absorption the county experienced during 1999. The low number reflects the move of large corporations like Flour Corp. and First American Title InsuranceCorp. from leased space to build-to-own. Between the two alone, hundreds of thousands of sf of leased office space was released backinto the marketplace. In 1998, by comparison, net absorption was 1.4 million sf, so last year's numbers could be considered an anomaly in the market.
The current trend in new construction in the county is large floorplate, class A office buildings. Most new product is being built in the airport and south county regions where vacancy rates are 8.1% and 8.4%,respectively. By contrast, the north county area currently has no new construction under way due largely to an almost 14% vacancy rate, Holdner says.
With the airport area almost out of available land, most new construction is flex-tech product in the Irvine Spectrum and Aliso Viejoareas of the south county region. The average asking price for leased space is $2.43 per sf in the airport area and $2.24 per sf in southcounty.
With a total of 84 million sf of office space for lease in the county, the report notes that 10.8 million sf, or about 13%, was available during the third quarter.
For a copy of the Voit report, e-mail a request to: [email protected] mailto:[email protected]

redpajama_set_name: RedPajamaCommonCrawl


To learn more about the history of aviation, students can explore the Centennial of Flight website, which was commissioned for the 100th anniversary of the Wright brothers' flight. A searchable timeline starts with the development of fire-powered rockets in first millennium China, and students can read essays about the evolution of flight and download videos that include rare footage of early aviation experiments. Students can trace how airplanes have become essential for both national defense and transportation as well as how they paved the way for space exploration.
[NOTE: Educators Guide previously posted.
added, making it well-worth another visit.
-A gallery of kids' volcano artwork.
-Virtual field trips to numerous volcanoes worldwide.
puzzle, dot-to-dot, and a game that simulates volcanic eruptions.
-Two fictional volcano stories by a children's author.
*LEGENDS - Read the fascinating legends associated with volcanoes worldwide.
*PARKS - Virtually visit 20 National Volcanic Parks.
*CURRENT ACTIVITY - Read Blog posts about the latest volcanic action.
*FIND VOLCANOES - Use a map to locate volcanoes worldwide.
*VOLCANOLOGY - Learn what it takes to become volcanologist!
Note: We make every effort to recommend websites that have content that is appropriate for general audiences. Parents should ALWAYS preview the sites for suitable content.
Click Schooling (Clickschooling) is a Federally Registered Trademark.
Students can have their voice heard on one of the biggest challenges of our times: whether we can move away from using fossil fuels and if we should, how should we do it? PLANET FORWARD is an innovative, viewer-driven program that debuts on the Web (http://www.planetforward.org) and culminates in a primetime PBS special a week before Earth Day (check local listings for exact show times). The broadcast is driven by people's ideas about the nation's energy future. The most provocative and interesting submissions to the Web site will be featured in the broadcast, taped before an audience at George Washington University and featuring experts, scientists, policy makers and business leaders, as well as the selected citizen journalists. Students must be over the age of 13 and have parental consent in order to participate.
volcano. Its latest eruption began in 1983 and hasn't stopped.
This site includes a complete narration for this program.
Plus Watch a Preview and Links and Books.
The first of two videos in which Nobel-winning physicist Leon Lederman sets up shop at a desk on a street corner and encourages curious passersby to ask science questions. A link is provided to the second installment.
Thurs., March 26, 2009 - Youth Science Forum: Why?
Hi! It's Tuesday, September 23, 2008 and time for Science at ClickSchooling!
format, and Dr. Dave answers them through the podcast series titled, "Why?"
your ipod, or burn them to a CD for listening in the car!
When you get to the site scroll down the page to see the menu of "Why?"
*How does your brain make your fingers move?
*Why Isn't Greenland A Continent?
*Why Don't the Oceans Freeze in the Winter?
*Why Do We Have Tonsils and an Appendix?
*What Came First the Slug or the Snail?
*What is the Shape of Space?
*What Makes Some Ice Clear and Some Ice White?
*How Do Bees Make Honey?
Click on any one, wait for the download, and listen to Dr. Dave's answer.
home, interactive science games, science fair projects, and more!
Movie Worksheets available for Astronomy, Biology, Business, Chemistry, Economics, English, Environmental Science, Foreign Language, Geography, Geology, History & Government, Math, Meteorology & Climate, Oceanography, Physics, Technology, Bill Nye Worksheets, NOVA Movie Worksheets, and Other.
"Showing videos and the occasional Hollywood film in the classroom is an innovative way to demonstrate concepts and expose common misconceptions while providing a thought provoking change of pace for students.
Thurs., March 26, 2009 - Regents Review Live!
Viewing RRL! programs require Windows Media Player.
Programs: English, Math, Earth Science, Living Environment, Chemistry, Physics, Global History, U.S. History, Spanish, French, German, and Italian.
In celebration of Earth Day, a guide to online resources produced by the Science Reference Section of the Library of Congress as well as relevant sites from other organizations.
Here you'll find lesson plans about wind energy, organized by grade.
September 20, 2008 "Earth Science Sites of the Week"
GEO CACHING, Earth Cache (suggested by Steve Kluge) The Geological Society of America hosts the Earthcaching division of Geocaching. In essence, earthcaching is geocaching with the added value of educational content. There is a pretty detailed downloadable manual that includes, among other things, how to use your GPS and tons of ideas for setting up earthcaches on your campus.
"Visiting an EarthCache site is a great way to learn more about our wonderful world. It can take you to many places that you would not normally visit, and teach you about why those places are special or unique.
GEOGRAPHY DICTIONARY, ITS (suggested by Danny Harrington) The resource has been developed in response to my own frustration at there not being any comprehensive Geography dictionaries or glossaries on the web that are free open-access and appear reasonably easily on search engines. I believe that restricted/subscription access to dictionary web pages is wrong. The terms defined do not belong to anyone. The definitions compiled here have been rewritten from a huge variety of academic sources and are based on my own educational experiences and my experience of teaching Geography in Hong Kong since 1997.
WATER RELATED ACTIVITIES, (suggested by Dr. Prajukti (juk) Bhattacharyya) This website might also be useful for folks interested in oceanography-related activities. The following activities were provided by various educational organizations and educators for inclusion on the Visit to an Ocean Planet CD-ROM.
Visit to an Ocean Planet CD-ROM - $5.00.
CORAL REEFS Reefs on the Web (suggested by J. Michael Nolan) Here is (part of) the collection of websites on coral reefs and reef-related resources. This list comes mainly from the research I did, but many are websites that the coral-list community sent to me.
Furthermore, we wish to shift the question often asked in popular culture from "Are we certain we're responsible for global warming?" to "Given the risks and uncertainties of global warming, what is the best action to take?"
EARTH SCIENCE REGENTS REVIEW, Kevin Allison (suggested by Phil Medina) watch an hour long review of earth science content.
Enter your birth date and see how many hours you have slept, minutes lived, and days to retirement.
IMAGE BANK, (suggested by Thomas McGuire) The Earth Science World Image Bank is provided by the American Geological Institute (AGI) for the purposes of enhancing Earth education. This Image Bank is designed to provide quality images to the public, educators, and the geoscience community. The Imagebank also allows non-professionals to market their images.
Hi! It's Monday, September 22, 2008 and time for Math at ClickSchooling!
everything from basic math to SAT test prep classes.
addition, subtraction, multiplication, division, decimals, and fractions.
*Pre-Algebra - Learn the basics, use graphs, and understand vital concepts.
discover the Pythagorean Theorem. Special section on triangles too.
and delivered with a sense of humor which makes learning that much more fun.
and more. Bookmark this site to return often.
[NOTE: To read complete article, scroll past the ads.
Home Page: http://www.mathworksheetscenter.com/ - previously posted.
Companion to an exhibit that "showcases collections from across the [Smithsonian] institution that illustrate Mexico as a place of human, scientific, and historical wonder." View selected images and short essays on topics such as early cultures, religion and festivals, New World foods, natural heritage, languages, labor, changing borders, money and stamps, and popular culture. In English and Spanish. From the Smithsonian Latino Center.
Background about the Model T Ford. "It was on October 1,1908, ... that the Ford Motor Company unveiled the little machine that many historians think of as the most significant automobile of all time -- the 1908-1927 Ford Model T." Includes discussions of the car's features, specifications, and changes to the car in the mid-1920s. From How Stuff Works.
This site "features significant automobiles of the American experience. Each vehicle has made a substantial contribution to the auto industry in design, production, or engineering." Includes photographs, advertising, specifications, and related material about cars such as the 1896 Duryea, 1908 Model T Ford, 1948 Tucker, and 1965 Ford Mustang. From the Henry Ford museum.
Copyright 2008 by Librarians' Internet Index.
This list, based on the number of weeks a song was on the Hot 100 List, and weighted by its ranking, provides some real surprises, both in terms of the numerous one-hit wonders that are there, and the long-time hitmakers who are barely there or not at all. This should generate any number of heated discussions.
"Children exposed to a multi-year program of music tuition involving training in increasingly complex rhythmic, tonal, and practical skills display superior cognitive performance in reading skills compared with their non-musically trained peers, according to a study published in the journal Psychology of Music.
terrific tool to have handy.
syllables) appears on the right side of the screen.
Wilfred (Bill) Drew, M.S., B.S., A.S.


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Payal Ki Jhankar (1968) hit song lyrics collection. This movie stars Kishore Kumar, Rajshree, Jyotilaxmi, Dhumal.Its songs are Aye Mere Soye Hue Pyar, Tu Aaye Na Aaye, Mukhde Pe Gesu, Mai To Pehli Ghata, Aye Mere Soye Huye Pyaar, Abba Kahe Na.
A jungle beauty, conniving employees, mother's pressure to get married and memory loss complicate a wealthy male's life.


*Interim defensive coordinator Ruffin McNeill fiddled with more of the Oklahoma Sooners' defense than he initially let on.
*NFL teams are making eyes at Lincoln Riley.
*Hate college football's targeting rule? Don't count on the NCAA revising it any time soon.
*Much obliged to the folks at Bring on the Cats for inviting me on this week's show.
*I've been watching Designated Survivor on Netflix for some reason. This has to be one of the corniest depictions of life in White House in pop culture history, and that's saying something.


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Le sue ricerche spaziano nei campi della psicologia cognitiva, dell'informatica (in particolare nel settore dell' intelligenza artificiale), dell'economia, del management e della filosofia della scienza. Con circa un migliaio di pubblicazioni, molte citatissime, è uno dei più importanti scienziati sociali del XX secolo.

Attività scientifica
Simon non è stato solo un uomo universale, ma un pensatore veramente innovativo. È stato tra i padri fondatori di molte tra le più importanti discipline scientifiche, inclusa l'intelligenza artificiale, l'elaborazione dell'informazione, la teoria dell'organizzazione, il problem solving, i sistemi complessi e la simulazione al computer della scoperta scientifica.

Il genio e l'influenza di Simon sono evidenziati dai molti premi ricevuti, tra i quali: il premio Turing della Association for Computing Machinery (1975) insieme ad Allen Newell per aver dato "contributi fondamentali all'intelligenza artificiale, alla psicologia cognitiva e al trattamento delle liste" (1975); il Premio Nobel per l'economia "per le sue pionieristiche ricerche sul processo decisionale nelle organizzazioni economiche" (1978); la Medaglia Nazionale per la Scienza (1986); e il premio della American Psychological Association per gli eccezionali contributi alla psicologia (1993).

Ha analizzato in maniera sistematica il comportamento decisionale degli individui all'interno delle organizzazioni, osservando che costoro non si attenevano ai criteri imposti dalle teorie normative. In particolare ha evidenziato come la scelta effettuata da un individuo non rispetta gli assiomi fondamentali dell'approccio logico. Quindi un individuo più che fare scelte ottimali, fa scelte soddisfacenti, sia per i vincoli svolti dalle organizzazioni sia per i limiti imposti dal sistema cognitivo umano.

Simon è stato anche un pioniere nel campo dell'intelligenza artificiale, creando con Newell i programmi "Logic Theory Machine" (1956) e "General Problem Solver" (G.P.S.) (1957). Il G.P.S. è stato forse il primo tentativo di separare la strategia di problem solving dall'informazione sui problemi da risolvere. Ambedue i programmi furono sviluppati usando il linguaggio Information Processing Language (IPL) (1956) sviluppato da Newell, Cliff Shaw e Simon.

Ha ricevuto, il 12 ottobre 1988, la laurea magistrale honoris causa in Scienze politiche dall'Università degli Studi di Pavia.

Contributi economici
Herbert Simon ha realizzato cambiamenti importanti in microeconomia. A lui si deve il concetto di organizational decision-making come lo conosciamo oggi. È stato il primo a discutere questo concetto in un contesto di incertezza, e per il lavoro su questo argomento è stato insignito del Premio Nobel nel 1978.

Lavorando nella "Cowles Commission for Economic Research", l'obiettivo di Simon era di collegare la teoria economica con matematica e statistica. I suoi contributi più importanti riguardano l'equilibro generale e l'econometria. È stato fortemente influenzato dal dibattito marginalista iniziato negli anni trenta.

Un contributo importante riguarda le ricerche sull'organizzazione industriale, dove ha sostenuto che l'organizzazione interna delle imprese e le decisioni sul business non sono conformi alle teorie neoclassiche sulle decisioni "razionali". Simon ha scritto numerosi articoli sull'argomento, concentrandosi sulla questione delle decisioni sotto l'ipotesi di comportamento nota come razionalità limitata.

"Comportamento razionale", in economia, significa che gli individui massimizzano la loro funzione di utilità sotto i vincoli dati (ovvero limiti di bilancio, scelte limitate...) ricercando il loro interesse personale. Il termine razionalità limitata indica la scelta razionale che tiene conto dei limiti cognitivi e conoscitivi. La razionalità limitata è un argomento centrale dell'economia comportamentale, riguardante i modi in cui il processo decisionale influenza le decisioni. Le teorie sulla razionalità limitata abbandonano alcuni assunti della teoria dell'utilità.

Simon decise che il modo migliore di studiare questi temi fosse quello di utilizzare modelli di simulazione. Perciò s'è interessato di intelligenza artificiale, interazione uomo-computer, principi di organizzazione di uomini e macchine, processi informativi, uso del computer per studiare problemi filosofici e implicazioni sociali della tecnologia del computer. Alcune delle ricerche hanno riguardato il cambiamento tecnologico e i cambiamenti nel processo dell'informazione.

Come cittadino di Pittsburgh, ha fornito consulenza alla cittadinanza su varie questioni, incluso l'uso di fondi pubblici per costruire stadi e i metodi per raccogliere le imposte.

Teoria della "razionalità olimpica"
"Razionalità olimpica" è un termine coniato da Herbert A. Simon per definire la razionalità piena di un soggetto.
Quando Simon parla di razionalità olimpica (olympic rationality, nell'originale) si riferisce a un contesto di stipulazione contrattuale. Simon distingue infatti due tipologie di contratti: contratti completi e contratti incompleti.

I primi sono contratti che dovrebbero essere sviluppati tra persone che possiedono entrambe razionalità olimpica. In questo caso le parti saranno in grado di prevedere tutte le situazioni verificabili nell'ambito del loro rapporto e inserire all'interno del contratto determinati comportamenti da assumere nel caso in cui le situazioni si verifichino.

L'altra definizione di contratto è quella di contratto incompleto. Questa tipologia di contratto è stipulata tra persone che non sono in possesso di razionalità olimpica. Per contratto incompleto si intende, quindi, quel contratto in cui non sono state calcolate tutte le situazioni verificabili. Il contratto incompleto è un contratto che, perché venga rispettato nella sua totalità, avrà bisogno di un giudice o un arbitro che decida il comportamento che le due parti dovranno assumere in una determinata situazione.

Simon usa un'immagine efficace per fare distinzione tra i due modelli di razionalità.
Usa l'immagine della mano di un individuo che prende, senza tremolii, un oggetto da un paniere.

Perché ciò possa avvenire, il soggetto deve essere in grado, in un breve lasso di tempo, di individuare ciascun oggetto del paniere, individuare le caratteristiche e prenderne uno dal paniere con la mano decisa. Dato che questo implica che l'individuo sia in possesso di razionalità olimpica, è più probabile che la sua mano, mentre sta per cogliere un oggetto dal cesto di elementi, sia una mano tremolante; quindi non decisa sulla scelta dell'oggetto.

Opere (selezione)
 Administrative behavior; a study of decision-making processes in administrative organization, New York, Macmillan Co., 1947.
 Public administration, New York, Knopf, 1950.
 Models of man: social and rational; mathematical essays on rational human behavior in society setting, New York, Wiley, 1957.
 Organization, con James March, New York, Wiley, 1958.
 The new science of management decision, New York, Harper, 1960.
 The architecture of complexity, Philad, 1962.
 The shape of automation for men and management, New York, Harper & Row, 1965.
 Human problem solving, coautore Allen Newell, Englewood Cliffs, N.J., Prentice-Hall, 1972.
 The sciences of the artificial, Cambridge, MIT Press, 1969.
 Models of discovery : and other topics in the methods of science, Boston, D. Reidel Pub. Co., 1977.
 Models of thought, New Haven, Yale University Press, 1979.
 Scientific discovery as problem solving, con Pat Langley e Gary L. Bradshaw, Pittsburgh, Carnegie-Mellon University, 1980.
 Models of bounded rationality, Cambridge, Mass., MIT Press, 1982.
 Reason in human affairs, Stanford, Calif., Stanford University Press, 1983.
 Protocol analysis, con K. Anders Ericsson, Cambridge, Mass., MIT Press, 1985.
 Complex information processing : the impact of Herbert A. Sim on : 21st Carnegie Mellon Symposium on Cognition con David Klahr e Kenneth Kotovsky, Hillsdale, N.J., Erlbaum, 1989.
 Models of my life, New York, Basic Books, 1991.

Edizioni in lingua italiana
 Il comportamento amministrativo, traduzione di Administrative behavior, Bologna, Il Mulino, 1958.
 Teoria dell'organizzazione, traduzione di Organizations, Milano, Edizioni di Comunità, 1966.
 Direzione d'impresa e automazione, traduzione di The shape of automation, Milano, Etas Kompass, 1968.
 Le scienze dell'artificiale, traduzione di The sciences of the artificial, Milano, ISEDI, 1973.
 Informatica, direzione aziendale e organizzazione del lavoro : la nuova scienza delle decisioni manageriali, traduzione di The new science of management decision, Milano, Angeli, 1979.
 La ragione nelle vicende umane, Bologna, Il Mulino, 1984. ISBN 88-15-00488-2
 Casualità, razionalità, organizzazione, Bologna, Il Mulino, 1985. ISBN 88-15-00934-5
 Modelli per la mia vita, traduzione di Models of my life, Milano, Rizzoli, 1992. ISBN 88-17-84202-8
 Scienza economica e comportamento umano, traduzione di Models of bounded rationality, Torino, Edizioni di Comunità, 2000. ISBN 88-245-0581-3
 Bounded rationality e razionalità giuridica / tre scritti di H. A. Simon, Bari, Adriatica, 2007. ISBN 978-88-89654-13-2

Note

Voci correlate
 Intelligenza artificiale
 Satisficing
 Problem solving
 Ricerca operativa

Altri progetti

Collegamenti esterni

 Herbert Alexander Simon la voce in The Concise Encyclopedia of Economics, sito "Library of Economics and Liberty". URL visitato il 2 novembre 2012.
 Herbert Simon Collection archivio digitale nel sito della Carnegie Mellon. University libraries. URL visitato il 2 novembre 2012.

Vincitori del premio Turing

redpajama_set_name: RedPajamaWikipedia


text:
package com.smoothsync.smoothsetup.wizard;

import android.content.Context;

import com.smoothsync.smoothsetup.microfragments.UpdateAccountMicroFragment;
import com.smoothsync.smoothsetup.model.Account;
import com.smoothsync.smoothsetup.utils.AccountDetails;

import org.dmfs.android.microfragments.MicroFragment;
import org.dmfs.android.microwizard.MicroWizard;
import org.dmfs.android.microwizard.box.AbstractSingleBox;
import org.dmfs.android.microwizard.box.Box;

/**
 * A step which updates a password.
 *
 * @author Marten Gajda
 */
public final class UpdateAccount implements MicroWizard<AccountDetails>
{
    private final MicroWizard<Account> mNext;

    public UpdateAccount(MicroWizard<Account> next)
    {
        mNext = next;
    }

    @Override
    public MicroFragment<?> microFragment(Context context, AccountDetails accountDetails)
    {
        return new UpdateAccountMicroFragment(accountDetails, mNext);
    }

    @Override
    public Box<MicroWizard<AccountDetails>> boxed()
    {
        return new WizardBox(mNext);
    }

    private final static class WizardBox extends AbstractSingleBox<MicroWizard<Account>, MicroWizard<AccountDetails>>
    {

        WizardBox(MicroWizard<Account> next)
        {
            super(next, UpdateAccount::new);
        }

        public final static Creator<Box<MicroWizard<AccountDetails>>> CREATOR = new SingleBoxableBoxCreator<>(WizardBox::new, WizardBox[]::new);
    }
}

redpajama_set_name: RedPajamaGithub


text:
Employees, union shocked by proposed Müller Wiseman Dairies depot closures
By Mark ASTLEY contact
12-Jun-2013 - Last updated on 13-Jun-2013 at 11:31 GMT
More than 140 jobs at Müller Wiseman Dairies' Whitburn and Keith distribution depots could be lost if the proposed closures are approved.
Related tags: Robert wiseman dairies
Müller Wiseman Dairies has opened talks regarding the proposed closure of two distribution depots in Scotland – an announcement that has left the Union of Shop, Distributive and Allied Workers (USDAW) and many unaware employees "shocked."
The company – formerly Robert Wiseman Dairies – announced yesterday (12 June 2013) that it had launched a 45-day statutory consultation on the future of its distribution depots in Keith and Whitburn.
If it pushes through the proposed closures, more than 140 jobs will be on the line – including 116 at the Whitburn depot and 25 at its site in Keith. An additional 15 administrative and management roles are also under review across the business.
Müller Wiseman Dairies has stressed, however, that in the event of closures, some employees will be offered the opportunity to transfer to distribution roles at the company's Aberdeen and Cambuslang depots – where up to 103 positions could be created.
Union and employees "shocked" by announcement
USDAW, which represents workers at both depots, admitted it was caught off-guard by Müller Wiseman Dairies' announcement.
"We're shocked by this announcement and will be working closely with the company to look at all of the options short of compulsory redundancy," said USDAW national officer, John Gorle.
"We'll be busy during the next few weeks talking to our Reps and members on site to go through the company's plans and to consider the best way forward. These are uncertain times in the sector as companies reorganise their manufacturing and distribution networks but USDAW will be doing all it can to protect jobs and represent the workforce," he added.
Workers at Müller Wiseman Dairies' Whitburn depot appear equally as surprised by the news.
In response to a Facebook post by the West Lothian Courier, several workers from the plant claimed not to have heard the news from Müller Wiseman Dairies, but from friends, on the news, and on the social media sites.
"I work at the Whitburn depot and I find out about it on Facebook! And I was working today and still didn't get told," said one man.
"I work for this company….and only found out through a friend," another added.
Review of operational and administrative efficiencies
Müller Wiseman Dairies' consultation on the future of the distribution depots is part of a wider review of its operational and administrative efficiencies of the business.
Commenting on the consultation, Müller Wiseman Dairies managing director, Carl Ravenhall, said that despite its "excellent network" of distribution depots it must "adapt to changes in the requirements being made of us by customers."
"We operate in a very competitive environment and it is important that our structure reflects the current and future needs of the business. It is right that we properly review our network, taking into account the views of our employees and their representatives," Ravenhall added.
Related topics: Manufacturers
First Milk plant closure proposed following cheese contract loss
Müller boosts UK yogurt presence with Nom Dairy acquisition
Arla Foods UK to close Ashby-de-la-Zouch processing plant
Farmer coalition urges UK processors to increase milk prices


Books|Harper Lee's 'Go Set a Watchman' Brings Division and Curiosity to Monroeville, Ala.
Harper Lee's 'Go Set a Watchman' Brings Division and Curiosity to Monroeville, Ala.
Ms. Burchfield and her teenage daughter, whom she named Scout, bought two copies of Ms. Lee's new novel, "Go Set a Watchman," which was being released at midnight on Monday.
Al Jazeera came, too. And CNN and The Daily Telegraph. So did an Atticus Finch impersonator from Baltimore who also does a Dean Martin impression.
At the Ol' Curiosities and Book Shoppe, the only bookstore in town, about 200 people showed up. That's a lot for a sleepy Southern town like this, but the store had expected twice as many. They had even hired a food truck to feed the crowd. The cooks stood idle most of the night.
Many residents of Monroeville, not to mention its Chamber of Commerce, had hoped, and planned, for a grand Harper Lee moment, ever since HarperCollins announced plans for the book's publication in February.
Maybe the lower turnout was because you have to drive 25 minutes off the interstate to get here, some speculated. Or because it's a workday. Or maybe it's all the controversy.
So for the hundreds of visitors who showed up to take walking tours, wander through the library and enjoy free popcorn from the teenager running the Chamber of Commerce booth, the day was focused as much on analyzing the new book's implications as on enjoying being at the epicenter of one of the biggest literary events in decades.
"People are already shocked that there was another book to begin with, and now that they are starting to see what's in it, it's just going to get worse," said Marie Klepec, a medical assistant and Monroeville County Museum volunteer who goes to the Methodist church that Ms. Lee attended.
Some stores in other parts of the country saw an uptick in foot traffic on Tuesday. "It's controversial, and I think that's bringing a lot of people in," said Mary Ferris, the assistant manager of the Penguin Bookshop in Sewickley, Pa., which had a midnight party with a champagne toast, and has sold nearly 100 books and ordered about 50 more.
But Monroeville, like a Southern matron with a family crisis but a party to host, put on its best face on Tuesday. A spokesman for Gov. Robert Bentley declared Tuesday "Go Set a Watchman" Day, and the museum sold commemorative silver cups for $55 each that would be filled with cocktails at 4 p.m.
Spencer Madrie, who owns the town's sole bookstore with his mother, said it had been struggling financially. Then, like a gift from heaven, a new work was discovered by the most famous author in Alabama. He put 27,000 copies on order, and said on Tuesday afternoon that they had sold at least 8,500, most of which were preorders.
All morning, a small handful of volunteers took turns reading from the book in the courtroom where Ms. Lee grew up watching her father, the lawyer A. C. Lee, work his craft.
Monroeville remains divided about whether Ms. Lee, who had a stroke in 2007 and has been in a 15-bed assisted-living center since then, wanted the new book published.
The Alabama historian Wayne Flynt, who visited Ms. Lee on Monday and delivered a stack of press coverage, is adamant that she welcomed it.
The new book, he predicted, will ultimately transcend its racial implications and be seen as a study in how young children view their parents as perfect and then, between the ages of 13 and 30, see them as deeply flawed.
Baron Windham, 24, a Navy pilot living in Florida who grew up in South Carolina, had only recently read "To Kill a Mockingbird" and was instantly fascinated, so on Monday he drove to Monroeville. He took a walking tour and dressed in a seersucker suit for the midnight release party. On Tuesday, he began reading the new novel.
The controversy stems partly, he said, from the inability of many readers to accept what was a common perspective among 1950s Southern conservatives. "The new Atticus is more like the classic Southerner who believed integration was the right thing to happen but worried that to do it quickly would cause damage," said Mr. Windham, who is white.
"Anytime Monroeville can get publicity, and it's good publicity, we welcome it," said Annie Hill, 50, who works for the museum and doesn't think Ms. Lee approved of the book's publication.
In a town where almost half the residents are black, she was one of only a handful of African-Americans celebrating the book's release — on a day meant to honor a novel that took on with full force the racism Ms. Lee saw in her hometown during the 1950s.


Today, "Fake Miniature picture" is popularized by iPhone digital filter App.
But the original Fake Miniature expression was made by optically, "Tilt-Shift" Lens.
The lens is often used perspective and focus control to avoid defocus in product pictures.
But for the Miniature picture, the lens is used for adding defocus effectively.
I have tried to attach old SLR lens on iPhone to use narrow focus expression as SLR camera.
And this time, I tried to attach Tilt-Shift Lens to see Real Optical Miniature picture in iPhone.
The result may not good.
The resolution was not enough, and you saw fringe patterns in the pictures.
You should choose digital effect first, to make the Fake Miniature pictures in iPhone.
But, I succeeded to make the impressive miniature pictures.


There are so many parts to wellness, and they go way beyond food. This ebook talks through parts of food and their interaction with the body in a very general way, but gives you the idea. See what you think, and learn more as there are so many compounds in food, and also how our body digests foods that are linked to anxiety, depression, skin issues, weight management and inflammation.
This goes way beyond Kilojoules in and out, but into the chemistry of what we eat.
Self care is essential, not an option!!
There are so many ways we tell ourselves what we think of ourselves. What we say in our mind when we do good, or not; when people give complements, or critique; what we choose to do that is either health supporting or not.
Life happens, but it is how we interact with life that determines how 'well' we live it. It all occurs based on our choices and self respecting our needs at any given moment. I am not promoting anyone to neglect commitments, or to ignore abuse or withhold from others. What I am promoting with this concept is, first get clear of what is important to you, and from this space make choices that support your values, and those who are important to you.
Compromise is part of this, but when they are consciously made and negotiated from a place of love, for self and the others involved. It creates a very different feel and outcome.
If we continue to do what we have always done, as the saying goes, we will get what have always gotten. Is this how you see the rest of your life? There is no judgement here, and I will support people which ever way they choose, as long as the choices are not morally, ethically or against my personal value system. Just like you, I too have the choice to say no, and most certainly done so in the past, even when close family members expected me to participate in blackmail or other unsavory actions and thoughts. There has to be a line in each person's life where we stand for what they honestly believe in and while it is painful to let those people go with love to follow their chosen life path, self care, respect and honor is important and each of us are required to assess and stand for what we believe in.
The wheel of life is a useful tool to help you identify where you perceive yourself to be in your life in relation to the various life compartments such as Relationship, Work/Career, Relaxation, Health etc.
We all talk to ourselves, and beside the common thought that self talkers are going insane, I would suggest the opposite. Each voice we hear is a messenger in disguise, and certainly holds pearls of wisdom if you are open to talking with them as you would talk to a pal or trusted friend.
TO start the process, download the information and activity sheet and start really talking with yourself to learn, grown and heal.


text:
layout: page
title: Rivas Inc. Seminar
date: 2016-05-24
author: James Walker
tags: weekly links, java
status: published
summary: Ut eget elementum lorem. Pellentesque.
banner: images/banner/meeting-01.jpg
booking:
  startDate: 04/27/2016
  endDate: 05/01/2016
  ctyhocn: ANDNOHX
  groupCode: RIS
published: true
---
Proin ut ornare magna. Aenean odio nibh, commodo eu turpis a, tincidunt faucibus nulla. Donec bibendum efficitur bibendum. In scelerisque nec turpis non pretium. Curabitur sit amet dui enim. Nunc sed egestas dui. Sed consequat augue vel orci volutpat, sed ornare ligula blandit. Suspendisse potenti. Aliquam erat volutpat. Praesent pellentesque, ligula sed ultricies consequat, orci eros egestas enim, ut bibendum elit tortor vitae ante.

* Quisque et nulla vel nisl porttitor varius mollis ullamcorper ex
* Nulla nec sapien luctus, faucibus lectus in, molestie arcu.

Fusce volutpat sed felis sed lobortis. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Pellentesque sed tincidunt urna. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Sed tincidunt aliquam elit, eget venenatis dolor porttitor non. Vestibulum vel nunc a augue dapibus ornare in rutrum ex. Nunc sagittis ullamcorper augue vitae sagittis. Morbi eleifend sem quis sem varius tristique vitae sit amet arcu. Morbi sapien risus, vehicula et est at, tempus sagittis nulla. Aenean pulvinar purus massa. Sed id placerat erat. Nulla facilisi. Vivamus a felis tincidunt, convallis nunc sit amet, cursus est. Sed sed mi risus. Fusce venenatis eget purus sit amet commodo.


~ Level 1 Sponsor: For a contribution of at least $1,000, your institution will be recognized as a sponsor in the conference program and also receive a half-page ad.
~ Level 3 Sponsor: For a contribution of at least $3,000 your institution will receive Level 2 benefits as well as a complimentary table in the Exhibit Hall.
If you are interested in sponsoring or co-sponsoring an event at the conference, please contact Robyn Davis (robyn.davis@millersville.edu) directly to discuss possibilities.
SHEAR's conference program will be available not only as a printed program but also in electronic format at our website. This means that in addition to SHEAR's membership and conference attendees, the program (and your advertisement) will be accessible to thousands of historians, students, and others interested in the early American republic. An estimated 1,500 SHEAR members and contacts will be invited to access the electronic program, and the 500 conference attendees will receive a printed copy at the meeting. Additionally, a PDF of the program will be available permanently on the SHEAR website archives.
A half-page ad is $180 and measures 4½"w x 4"h. Full-page ads are $300 and measure 4½"w x 7½"h. Print copies will be black and white. Digital copies will be full color.
Each file must be submitted as a 300 dpi, high resolution, image and font embedded, JPG. Files submitted in other formats or requiring reformatting will be returned for reformatting. Please send all materials robyn.davis@millersville.edu.
SHEAR provides exhibit tables for presses and other organizations, and also sponsors its own collective exhibit where it displays titles for presses that do not wish to reserve a table. An exhibit table (6'x30" skirted table, two chairs) is $350. Display on the collective table is $30 per title for the first three titles and $10 for each additional title.
Exhibit set up is Thursday from 3:00 pm on.
Hall hours: Friday, 8:00 am – 5:00 pm; Saturday, 8:30 to 5:00; Saturday, 8:30 to 11:00 am.
Exhibit breakdown is Sunday from 11:00 am to 1:00 pm.


text:
Samir Javadzadeh ( pron. ; born 16 April 1980, Baku, Azerbaijan) is an Azerbaijani pop singer. He was selected as the Azerbaijani representative, along with Elnur Hüseynov, to perform at the  Eurovision Song Contest 2008. They performed "Day After Day" finishing 8th overall.

Career
Samir Javadzadeh graduated from university with a degree in business in 2002. In 2003, he finished five-year courses in music, specializing in mugham. After serving in the army for a year, he became a member of the pop band Sheron for the next three years and eventually started pursuing solo career.

Originally, Samir Javadzadeh was not named among those who competed to represent Azerbaijan at Eurovision. On 2 February 2008, the jury chose Elnur Hüseynov over two other candidates (Aynur Isgandarli and the rock band Unformal), and it was then revealed that the winning song "Day After Day" would be performed as a duet by Hüseynov and Javadzadeh. In an interview following the decision, one of the coordinators of the contest (and author of the lyrics of "Day After Day") Zahra Badalbeyli stated that it was not contrary to the contest rules for Elnur Hüseynov to invite another performer or more to sing with him, and that it was his and Javadzadeh's mutual agreement to perform the song in a duet.

Personal life
In July 2012, Javadzadeh announced his plans to get married.

In 2011 he allegedly attacked the brother of Elnur Huseynov, Alvin.

See also
Azerbaijan in the Eurovision Song Contest
Azerbaijan in the Eurovision Song Contest 2008

References

External links

1980 births
Living people
Eurovision Song Contest entrants for Azerbaijan
21st-century Azerbaijani male singers
Eurovision Song Contest entrants of 2008
Musicians from Baku
English-language singers from Azerbaijan


If your a real serious player who wants to learn strategy while playing poker with you free poker money you must sign up for an account at Poker Strategy. They are simply one of the best strategy sites online today and will provide you the tools for a successful poker career if you want one. Sign up with PokerStrategy.com and win big. Its a serious site for serious players.


Many classrooms across the country have classroom pets, ranging from frogs to hamsters to rabbits with the hope of teaching young students lessons about responsibility, empathy, and treating animals humanely. As long as the proper precautions are taken, those lessons just might be learned.
Experts caution that there are certain pets that are never appropriate for classrooms. These animals include reptiles such as lizards and snakes, which could potentially cause salmonella, and other animals that are removed from the wild such as chinchillas and frogs. Animals like birds and rabbits aren't easily handled by large groups of children and although they make good pets in the home, they are not well suited to life in a classroom.
My top pick for a classroom pet is a guinea pig. Guinea pigs generally like to be handled, seldom bite, and whistle when they're excited. Guinea pigs can even recognize familiar voices and scents. When I was a humane educator at the Santa Barbara Humane Society, I would take students on tours of our shelter, and every time I walked into the room where the guinea pigs were housed they would start whistling for me when they heard my voice because they knew I'd give them treats. The children were always amused by this and some would later ask their parents if they could adopt one due to the good experience they had at the Humane Society.
Although children tend to want direct physical contact with a pet, fish tend to be a great addition to a classroom. Fish are colorful and active and can provide a soothing effect for children. Fish have also proven to be helpful in keeping children focused.
Rats and mice are social, easy to handle, and simple to care for. Rats and mice are most appropriate for older children. Young kids tend to have difficulty holding these small rodents and they may become loose in the classroom.
Once careful research has been done and a classroom pet has been chosen, a teacher needs to be willing to be the responsible caregiver for the animal they have chosen. Classroom pet care should not be any different than caring for a pet in your home. The animal should not be left in the classroom when school is not in session; doing so may result in missed meals, a dirty cage, and lack of water. Fish can be left over weekends, provided a time-released fish food capsule is given. Ensuring proper pet care demonstrates to students that even classroom pets need full-time dedication. Teachers who provide proper care for classroom pets serve as humane role models for children.
These days many parents are taking an active role in their children's classroom. When I worked at the Michigan Humane Society in Detroit, we would receive calls from concerned parents stating that their child's classroom pet was not being cared for properly. These concerns were mostly rectified by an educational visit to the teacher. If you feel that care is lacking in your child's classroom, you can approach the teacher and offer help in a friendly, constructive way. If the teacher admittedly cannot meet an animal's needs, you can offer to help find a home for the pet, or recommend the Humane Society. If the animal's welfare is in danger and there is no action taken by the teacher, you can contact the school principal or local animal control.


First off, I want to congratulate both of you. I know you must be over the moon and I'm excited about what this all means for your lives together and for the future. It's huge. Monumental even. And I want to celebrate that with you when I'm able to do it correctly.
As happy as I am for you, I am overwhelmingly sad for me. I'm not sure if I could ever explain how complicated this is unless you experienced it yourself. And I'm thankful that you will never know. It just makes it really hard to talk through.
I'm sorry for the silence. I've wanted to call or email, but I've just not been able to. My heart has been very tender the last few days. Still trying to work through a lot of complex emotions. Still trying to claw my way out of the hole from my negative test. Just... still trying.
As much as I wanted to have that squealing phone conversation with you filled with happy tears and hopes for the future, I was just not in a place to do that when I got your email. I will get there. I promise you. It just may take me a little longer than I hoped. I hate that my infertility has robbed me (and you) of this experience. I just pray to god that you understand. I love you with all my heart. Nothing will ever change that. And I hope that I haven't hurt you or our relationship with my silence. That is that last thing I wanted.
I think I'm honestly looking forward to our talk now. I think I might be ready.
Wow. What an incredibly well written email. This is SO hard when someone so close to you gets pregnant, not to mention gets pregnant so quickly and easily. There aren't words to describe it but you did a pretty darn good job.
Thank you for your sweet, sweet comment on my blog. I'm so encouraged to hear that my words and our story really can help someone else. And yours will too. Keep telling it.
My sister is pregnant with baby #2 and I often feel some of this guilt that you talked about feeling with your friend. My old BFF on the other hand is due to deliver her 4th child in the next few weeks. My relationship with her has drastically changed in the last few years and we are not close at all anymore. But my sister has figured out how to be supportive. IF certainly turns our world and our relationships upside down.
Looking forward to keeping in touch with you and cheering you on!!
I totally feel where you are at my sister is pregnant with her first. It will be the first grandchild and it kills me because I was pregnant and having a baby and it went away and now 15 cycles later still no baby. I cried and cried when she told me, uh freaked out actually and not in a good way. It's been about a month and I can now talk to her and be almost happy not quite there but getting closer.


text:
Andrée Brunin (La Madeleine, 13 februari 1937 – Bavinkhove, 1 april 1993) was een Frans schrijfster en dichter.

Bibliografie
 La pensée (kinderboek)
 Histoire du petit bonnet (kinderboek)
 Recueil de chansons de colonies.
 La pluie verse des larmes d'argent (roman)
 Fille du Vent (gedichten, 2003)

Frans schrijver