A love for children brought them together; A kidney keeps them close at heart

<p><em>By IU Health Senior Journalist, TJ Banes, </em><a href=”mailto:tfender1@iuhealth.org”>tfender1@iuhealth.org</a><br></p>
<p>Because of a her kidney donor, Karen Murphy is living a full life. She enjoys spending time with her eight grandchildren and three great grandchildren. She’s able to care for a loved one, take daily walks, and relax in her retirement years.</p>
<p>On June 1, 2018, Murphy received the gift life from a co-worker, Beth Williams. </p>
<p>At the time, Williams was a school psychologist, and Murphy was an instructional assistant for students with special needs. They both worked for the Metropolitan School District of Lawrence Township. </p>
<p>Murphy is the mother to four daughters and will celebrate her 38th wedding anniversary to her husband, Ralph, in March. Williams has been married to her husband, Chris for 36 years. They have a son and a daughter, and one grandchild. </p>
<p>They initially didn’t know each other, but the women shared a kindred spirit. Both loved children and both had experiences with kidney disease. </p>
<p>Williams’ father suffered from kidney disease and she remembers accompanying him to dialysis. He died in January of 2016. </p>
<p>In her same circle, was a fellow educator Murphy, who was diagnosed at the age of 18 with Polycystic Kidney Disease (PKD). The genetic disease causes cysts on the kidneys and eventually kidney failure. Murphy was one of several family members who suffered from the disease. When she eventually needed a transplant, Murphy started a Facebook page, “Help Find a Kidney for Karen Murphy.” She invited others to share the page. </p>
<p>The posts caught Williams’ attention and jarred memories of her dad’s fight with kidney disease.</p>
<p>“I couldn’t t put it out of my mind. It was like constantly being tapped on the shoulder,” said Williams, 66. She talked if over with her husband and two children and once she made the decision to be tested, she didn’t look back. </p>
<p>Living kidney donors undergo an initial screening, multiple tests and evaluations to determine if they are a viable match. They work with a team of IU Health caregivers including a surgeon, transplant nephrologist, anesthesiologist, psychiatrist or psychologist, living donor transplant coordinator, and advocate, a social worker, dietitian, and pharmacist. </p>
<p>As they approach the five-year mark, the women look back over the years gone by. They named the kidney “Mr. Lefty.” They share how “Mr. Lefty” has done his part in keeping Murphy healthy. Both women have retired. Williams and her husband moved to Martinsville and she enjoys traveling . Murphy, also 66, presented Williams with a gift of a donor recipient “tree” to remember their special connection. </p>
<p>Both women have witnessed milestones in their children’s lives – marriage, medical issues, and new family additions. </p>
<p>Murphy has also had a front row seat watching how her health and well-being directly impacted her family.</p>
<p>“My oldest daughter saw me throughout the progression of the disease and was shocked in the improvement of my health in such a short time,” said Murphy. When Murphy’s sister needed a transplant, it was her daughter who stepped up to be a living donor. </p>
<p>“Knowing my daughter donated her kidney to my youngest sister shows that we all play a part in a big disease,” said Murphy. “It’s like a circle that has connected more than just two people.” </p>

“He saved my life”: Heart patient grateful for cardiologist

When Mike Moran found out he suffered a heart attack, a cardiologist at IU Health Tipton jumped into action to save his life.

By Emma Avila, epackard1@iuhealth.org, writer for IU Health’s Indianapolis Suburban Region

When Mike Moran found out he had already had a heart attack, he was shocked. He remembered driving to work in July 2016 and feeling hot, chills and shaking, all at the same time, like he was running a fever.

Two months later, he still felt more tired than normal. He went into a healthcare facility for an unrelated procedure. An EKG showed he had most likely already experienced a heart attack that he wasn’t aware of.

After speaking with his primary care provider and some additional testing, he knew it was time to consult a cardiologist. That’s how he began seeing Dr. Ali Iqtidar at IU Health Tipton Hospital.

Dr. Ali Iqtidar, cardiologist at IU Health Tipton Hospital

“He’s very thorough. He spends time with you like you’re the only patient he’s got to see all day,” Moran said.

“When Mike came to see me, he had had an EKG as part of a preoperative work up for another surgery. This EKG demonstrated signs of a past heart attack. He had also had a heart scan, which demonstrated extensive calcium buildup in his coronary arteries,” Iqtidar explained. “He had been getting progressively short of breath with any exertion. Since he was an insulin-dependent diabetic, I suspected severe narrowing in his coronary arteries. Therefore, in his case, I decided to proceed directly with heart catheterization and angiography.”

Angiography is a type of X-ray used to check blood vessels. Moran’s diabetes may have also played a role in his unusual heart attack symptoms.

“He is a diabetic, and as such, may not experience typical ‘pain’ symptoms,” Iqtidar added. “The symptoms can be those of a vague chest discomfort, coupled with shortness of breath and exercise intolerance. Diabetics will often experience what we call ‘atypical symptoms.’”

Two days later, Moran went to IU Health Saxony Hospital–soon to be IU Health Fishers, where Iqtidar performed the heart catheterization and put stents in three of Moran’s arteries.

“As far as I’m concerned, he saved my life,” Moran said. “You just don’t realize how bad you feel because it comes on gradually. I just feel so much better.”

Moran, now 69, continues to see Iqtidar at IU Health Tipton for annual follow up appointments.

“At his follow up appointments, I am very careful to tease out any recurrence of symptoms and keep a relatively low threshold for performing a stress test,” Iqtidar said. “In addition, I ensure that we review and modify any outstanding risk factors, such as high blood pressure and high cholesterol.”

Moran’s last appointment was in November, which he said he passed with “flying colors.” He is thrilled that he is feeling so much better.

“I want to live as long as I can. I have 22 grandchildren.”

With February being American Heart Month, he hopes to encourage others to focus on their heart health.

“I tell people to pay attention to what your body is telling you. And also, get regular checkups,” he added.

Iqtidar hopes people will be proactive, especially if they know they have a family history of heart issues.

“I would strongly recommend that they initiate the conversation regarding diagnosis and risk factor management early with their physician,” he said. “With advances in modern medicine, they can change the trajectory of their life significantly even if there is a strong family history of aggressive heart and vascular disease.”

Every voice matters

Imagine the emergency department
as a choir. Each person working together as the songs build up to a crescendo
before moving back down to the faintest whisper of melody.

Every voice matters, as Ryan
Matthews, MD, knows very well.

“He’s a great listener, he wants
to know what matters most and is always interested in his patients,” says
emergency medicine physician Robert Adams, DO, FACEP, FACOEP, Service Line Medical Executive Acute Care.

He continues to explain that
Matthews has maintained his engaging, curious personality from the moment he
joined the team in 2020. In fact, the doctor may very well be defined by the
term “engaged.”

“It’s more than him picking up
extra shifts—he does what he does with heart,” says Adams.

From coordinating third and
fourth year medical students, to strategizing with nursing leadership, and back
to his dedication to excellence at the bedside—Matthews puts everything he has
into what he does.

“He appreciates engaging others
and is a natural teacher in that sense,” says Adams. “He has a natural way of
connecting—of listening to others and allowing their voice. We need that more
than ever.”

And that carries over directly to
a patient’s experience. In fact, Matthews was recently recognized as the IU
Health Bloomington Emergency Department provider with the highest patient
experience score for 2022.

“Prompt, friendly,
professional all around excellent care,” says one patient. Others comment
on his consideration, dedication, and caring nature.

Overall, Matthews is a doctor
living the IU Health Values and IU Health Bloomington is grateful to have him
in their emergency choir.

Family bonds with care team while getting weekly, life-saving treatment

Every week Kylee Jones takes her two kids, Sophia and Cainin, to IU Health Ball Memorial Hospital to get blood transfusions. This has been the routine for a few years now, ever since doctors diagnosed the kids with a rare blood disorder called congenital dyserythropoietic anemia (CDA). “We have our two [nurses] who see us weekly. They’ve taken care of us for years and we just adore them,” said Kylee. “They are like our family. We see them more than our actual family, honestly.”

Serving with innovation

Innovation, collaboration, and a dedication to others—that’s what drives IU Health Bloomington.

And our teams are taking steps to ensure the future of healthcare is bright for patients like Michael Mitchell.

Watch the video above to see how IU Health Southern Indiana Physicians Vascular Surgeons Duangnapa Cuddy, DO, and David Peterson, MD, are working with leading-edge medicine to help our patients and the future of healthcare.

Cancer diagnosis taught him: Broken crayons still color & he has a lot to share

<p><em><strong>When he was diagnosed with cancer at the age of 46, this Brownsburg resident decided it would not define him. So he wrote a book.</strong></em><br></p>
<p><em>By IU Health Senior Journalist, TJ Banes, </em><a href=”mailto:tfender1@iuhealth.org”>tfender1@iuhealth.org</a></p>
<p>He was sitting in the exam room of IU Health <a href=”https://iuhealth.org/find-providers/provider/paul-r-helft-md-6662″>Dr. Paul Helft</a> when Brad Fischer saw the poster. It read: “Broken Crayons Still Color.” </p>
<p>Fischer had just been diagnosed with gastric cancer and he was in Dr. Helft’s office to come up with a treatment plan. “I remember the words on the poster struck me because I felt broken,” said Fischer. His symptoms started with stomach aches. After visits to a primary care physician and prescriptions to help with the symptoms, the aches persisted. </p>
<p>A family history of colon cancer had Fischer on guard. He began getting colonoscopies in his early 20s. At about the same time he underwent genetic testing and put an actual name to his family diagnosis: Lynch syndrome. The condition is associated with a high risk of colon cancer and is named after the late Henry Lynch, the doctor who researched the disorder. </p>
<p>On June 14, 2018 an endoscopy and colonoscopy revealed a tumor in Fischer’s stomach. </p>
<p>“Right out of the gate, Dr. Helft talked about immunotherapy. At the time, it seemed to have spread through my lymph nodes,” said Fischer. He underwent several rounds of chemotherapy before crossing over to immunotherapy. Another diagnosis of a brain tumor with concurrent lymphomas led to more chemotherapy and radiation. In addition to Dr. Helft, he was in the care of <a href=”https://iuhealth.org/find-providers/provider/ally-khan-b-somani-md-9374″>Dr. Ally-Khan Somani</a>, <a href=”https://iuhealth.org/find-providers/provider/douglas-k-rex-md-8942″>Dr. Douglas Rex</a>, <a href=”https://iuhealth.org/find-providers/provider/aaron-a-cohen-gadol-md-6208″>Dr. Aaron Cohen-Gadol</a>, and <a href=”Dr. Michael Robertson”>Dr. Michael Robertson</a>. </p>
<p>Throughout multiple treatments and hospital visits, Fischer began writing a blog. Married to Tonya Schaffter, Fischer is the father to two daughters, ages 17 and 15. </p>
<p>“Cancer was my motivation. You get a sense of urgency with a diagnosis and I wanted to give a voice to my daughters’ futures. I wanted to give them lessons and let them know what’s in my head and heart,” said Fischer. The blog started with the title “Living with Cat Sores.” He didn’t like the word “cancer” so he asked his friends and family to call it “cat sores.” </p>
<p>His writing focused on humorous stories with a moral to the story. From there it blossomed. </p>
<p>The book: “The Sand Bucket List: Lessons for Living and Facing Death” was published in December 2022 (available on Amazon). Fischer describes the title like this: “Like a simple plastic bucket that can be used to create beautiful sandcastles on the shore by packing fine sand with the right amount of water and imagination, I wanted to create beauty in – and from – my life by packing it with laughter, learning and love.” </p>
<p>Although the book explores his family’s struggles and feelings during his fight with cancer, it’s ultimately, not a book about dying nor a story about fighting cancer. It’s a book about living and taking back life. </p>
<p>In one chapter he tells about a childhood prank of throwing a purse full of manure onto a road. When someone picks up the purse they want to throw it back, he explained. “That’s how I see cancer. I choose to throw out some of what comes with it. There is no denying some of it staying with me but there’s more than the health side,” said Fischer. “One of the things I hated is how the diagnosis changed the way everyone viewed me.” </p>
<p>Another chapter tells about how he went scuba diving with his wife and was distracted and floated away from her. “The lesson was that everyone deals with a diagnosis differently and we needed to be open with each and recognize that coping. I want my daughters to know that it’s easy to fall in love but you have to be deliberate about staying in love,” said Fischer. </p>
<p>When asked about his hobbies and interests, Fischer said: “Cancer has taught me that I’m much bigger than my job and my interests. I want to be someone who is a learner, who helps people laugh and find joy. I’m someone who brings love to other people’s lives.” </p>

Team member couple meets, falls in love, delivers two babies at IU Health North Hospital

Stacey and Sergio Landaverde’s love story began at IU Health when the two met in the hospital cafeteria. Now, several years into their marriage, the two are still convinced they found ‘their person.’ “I’ve never met someone who wants so many good things for me in life,” said Stacey, who’s family is forever connected to IU Health North Hospital. “Not only did we meet here, but we delivered both our kids here so… we’re both kind of tied to [this hospital] at this point. I got my whole family from this place.”

Six degrees of separation: Organ recipient believes god answers prayers

<p><em><strong>In every practical sense, this living organ donor and recipient were strangers. Now, the recipient says their connection is one of several answered prayers in her life.</strong></em><br></p>
<p><em>By IU Health Senior Journalist, TJ Banes, </em><a href=”mailto:tfender1@iuhealth.org”>tfender1@iuhealth.org</a></p>
<p>She thought it might be a female. Amanda Bilger had no idea who was her living liver donor. She couldn’t imagine someone offering up an organ to a stranger. </p>
<p>“It’s such a major surgery and a lot of men are the breadwinners so I couldn’t imagine very many men being able to take off that much time from work,” said Bilger. As time went on, she began to change her suspicions. Bilger attended an event raising awareness for organ donation where she was introduced as a living donor recipient. A family member of the donor heard Bilger mentioned and put two and two together. The event was two months after the transplant. </p>
<p>Just less than a year after Bilger’s liver transplant, her suspicions were confirmed when she came face-to-face with Bret Schmutte, the man who was an altruistic organ donor. At the request of both recipient and donor, the two were introduced. </p>
<p>Today, on National Donor Day, Bilger shares the story of meeting the man who gave her the gift of life. </p>
<p>Within minutes of meeting, Bilger and Schmutte realized they are both from Noblesville; they share the same March birthdays – just one day part. And now they celebrate their one year of liver transplantation on March 7. </p>
<p>It was late summer of 2007 when Bilger was diagnosed with Primary sclerosing cholangitis (PSC), an inflammation that causes scars in the bile ducts. She was 30. Over time, the scarring resulted in liver damage. </p>
<p>“I had a lot of skin problems that couldn’t be explained by anything and then I had bloodwork and it showed my liver enzymes were super high,” said Bilger, who grew up in Frankfort and worked as a professional photographer. She had just celebrated her first year of marriage to her husband, Zach Bilger and they were ready to start a family. As her condition progressed, specialists suggested pregnancy could be risky and possibly cause her disease to advance more quickly. </p>
<p>On the day she shares her story, Bilger wears a bright green vest – the color for organ donation. She also wears a silver wishbone charm around her neck. The charm is engraved on the back, “our little miracle.” </p>
<p>When Bilger and her husband realized the risk of her carrying a child, they began a search for a surrogate. They are now the parents of two daughters – both biological embryos – delivered by the same gestational carrier. Their youngest is 8; their oldest is 12. </p>
<p>As her disease progressed, Bilger said she grew so thin her bones were visible, she was swollen and jaundiced. </p>
<p>“I wanted my girls to have memories with me, but I started to notice how different I was looking in pictures with them. My. eyes were a scary yellow, and my skin didn’t match theirs anymore and it made me sad. I also didn’t want them to see me get any sicker,” said Bilger, who was in the care of IU Health’s <a href=”https://iuhealth.org/find-providers/provider/marwan-s-ghabril-md-6276″>Dr. Marwan Ghabril</a>. By January 2022, she was listed for transplant. </p>
<p>Little did she know, a man living in the same town was researching his own plan to become a living donor. Schmutte grew up in Fishers, Ind. graduated from Cathedral High School and received his bachelor’s degree in accounting with a minor in computer science from Marian University. </p>
<p>He married his wife, Nora, 28 years ago and together they have three children. </p>
<p>“My mom is a nurse and growing up I always saw her helping people. She was definitely a role model to me and my four siblings,” said Schmutte. Later in life, when he was living in a rural area of Colorado and learned of a need for medical volunteers, he received his EMT certification. </p>
<p>“I knew about the concept of being a living organ donor but I didn’t give it much thought when my kids were younger because I thought about them and their needs,” said Schmutte. Later, he decided to go through testing to become a living liver donor. He didn’t know who would be his recipient; he just knew someone needed his liver. </p>
<p>At IU Health many recipients receive kidney and liver transplants from living donors. </p>
<p>Last year, IU Health performed 160 liver transplants. Donate Life America reports there are 14,000 people in the United States on the waiting list at any given time for a liver transplant. The number of patients waiting far surpasses the number of deceased donors. Many patients spend years waiting for a liver donor. Living donors reduce that wait time. An organ from a living donor can function better and last longer than one from a deceased donor because it is coming from a healthy, living donor. Like kidney donation, liver donation is done by working with a team of IU Health transplant experts including surgeons, donor coordinators, social workers, dietitians, pharmacists, and financial coordinators. </p>
<p>Living donors undergo an initial screening, multiple tests and evaluations. The transplant involves removing a portion of the donor’s liver and then using it to replace the diseased liver in the recipient. The liver regenerates and returns to full function within a month. Both kidney and liver donors are typically discharged from the hospital within a few days.</p>
<p>“I consider myself very healthy. It was certainly a difficult surgery, but I feel like I recovered quickly and quite well,” said Schmutte. He and Bilger were both in the surgical care of IU Health’s <a href=”https://iuhealth.org/find-providers/provider/chandrashekhar-a-kubal-md-7466″>Dr. Chandrashekhar Kubal</a>. </p>
<p>“What I’d tell someone thinking about becoming a living liver donor is to talk to your family first because surgery does not come without risks,” said Schmutte. </p>
<p>And on the day that Schmutte met Bilger for the first time, he said something else became very clear to him.</p>
<figure><img src=”{asset:3127620:url||https://cdn.iuhealth.org/news-hub/amandaandbret2.jpg}” data-image=”3127620″ style=”opacity: 1;”></figure>
<p>“I went into it with my focus on the recipient. After meeting her family, I realized it’s much bigger than that,” he said. Every family member wrote a personal letter to Schmutte expressing their appreciation. Bilger presented Schmutte with a special t-shirt and a key chain inscribed with a bible verse and the date of her transplant.</p>
<p>“It took me like three and a half pages of writing to express my gratitude,” said Bilger. “This is another miracle, another answered prayer. What do you say to express that kind of gratitude? It’s not like he pulled over and helped me change a flat tire. This is so much bigger and I think the best way to show my gratitude is to live the longest and healthiest life I can to take care of my family and to not take anything for granted.” </p>

Moms should not suffer in silence

“As a mom to two NICU babies, I lost my own sense of identity during my postpartum years after each pregnancy. The anxiety, the guilt and the stress I felt was very isolating and overwhelming at times,” says Megan, who, for personal reasons, did not want to use her last name.

According to research from the Children’s Hospital of Philadelphia, perinatal or postpartum mood and anxiety disorders (PMAD) affects one in seven mothers. These feelings can be mild, moderate or even severe. These feelings get in the way of doing activities of everyday living, particularly caring for a new baby and oneself.

“Once I finally started talking about my feelings and my experiences with my family and other moms and parents, my support system grew and my anxiety felt more manageable,” adds Megan who is a Maternal Child Health social worker at IU Health Arnett.

There is a period of normal adjustment after having a baby when women feel physically and emotionally overwhelmed. When the baby blues last beyond a three-week period and begin to interfere with everyday living—there is a safe place to land.

Megan from Mother Baby

“Moms should not suffer in silence,” shares Megan. “Moms deserve a place where they feel like they are not alone. A place where they can talk about their experiences without feeling judged. Maternal mental health matters to the whole family. If moms get the help they need for their mental health, it can have a positive effect on their entire family.”

Mother to Mother Connection provides space to be heard

Megan is now co-leading a support group with neonatal intensive care unit (NICU) nurse Shari Hertz. Mother to Mother Connection is a safe space for moms to come and meet others who are struggling with similar feelings and experiences — and learning that taking care of yourself is just as important as taking care of your baby.

Shari with NICU

“Being a mom, even under the best of circumstances, is hard,” says Hertz about her own journey. “For a woman struggling with postpartum depression or anxiety, it can be overwhelming. As a NICU nurse, I see moms who are facing the extra challenges that come with having their newborn in intensive care. It is important to me that these moms have somewhere to turn for support, to share their personal experience, to feel a sense of belonging and community, to feel safe. The mother-to-mother support group gives moms this opportunity as well as a link to other resources if they need them. I’m proud to be a part of it.”

“Being a part of leading this support group is so important to me because I can help other moms build their support system and give them that safe space to feel heard. I have learned that moms connecting with other moms is vital to the motherhood journey,” says Megan.

Mother to Mother Connection

When: First and third Friday of every month, 10 am – noon

Where: IU Health Arnett Hospital, third floor, room A3010

Free and open to all mothers

Call 765.838.7961 or email MomSupport@iuhealth.org to learn more.

An armful of DAISYs

Mandatory education–two words that can strike dread into the hearts of many busy healthcare workers. For five nurses at IU Health Bloomington, a mandatory two-hour seminar turned out to be a fib (and not the medical type of a-fib).

A large banner reading “Congratulate our DAISY Award Honoree!” and a group of leaders and loved ones were not what they expected to see when they opened the door. And as they filed in with surprised faces, the DAISY Award recognition ceremony began.

One by one, each DAISY Award honoree was read their nomination form, received their pin and statue, and given a warm hug. Learn more about these DAISY nurses below.

Vlad Vukanovie, RN

Part of the 3E Adaptive Acuity team, Vukanovic was nominated by the dialysis team, who described him as a strong promoter of communication and grace.

“He is such a pleasure to work with and goes above and beyond when needed,” they said. “Vlad’s communication with our team is always impeccable…He knows his patients well, not just the surface things, but truly knows his patients, making it easy for others to care for these patients too.”

The nomination also described a “particularly trying day” for this nurse when he exhibited grace and patience to mold the situation into “controlled chaos.”

“Vlad truly embodies the IU Health way, and his commitment to team, compassion, purpose and excellence is clear to all who cross paths with him!”

Kate Stoops, RN

A patient’s friend nominated this emergency department nurse after their loved one came to the hospital to seek help.

“She was so empathetic, supportive, and validating,” they said. “Not only did she talk my friend through every aspect of the procedure and paperwork, but she took multiple opportunities to ensure their comfort.”

Through open communication and a focus on the patient’s experience, Stoops ensured they felt comfortable, cared for, and validated. The nominator added that they appreciated Stoops taking the time to ensure they knew how to support their friend in the future.

“Kate has a very positive and approachable attitude, and her bedside manner is so inspiring and comforting,” they said. “She has an incredible heart and talent in this field, and she is beyond deserving.”

Shannon Goldman, RN

This endoscopy nurse’s DAISY nominator described her as one of the nurses “who work in areas of the hospital that patients often do not remember or even know their names because of the situation of their illness.”

Nonetheless, she continually provides extraordinary care and holds herself up to a high bar she sets for herself.

“Every patient interaction, she brings smiles, laughter, and kindness to a level that disarms the patients who are frustrated or scared,” the nominator said. “Shannon effortlessly manages to put these patients at ease, makes them feel heard and listened to and not spoken to like they don’t understand. And when they don’t, she explains to them in a way in which they can.”

Julia Blubaugh, RN

A team member recalled the extraordinary lengths she went to for a readmitted patient in their nomination letter for this pediatric nurse.

“While most of the pediatric team is aware of the patient’s previous medical complications, Julia has gone above and beyond to ensure that this particular admission was at least better than their previous.”

This included getting the patient directly admitted to pediatrics since they knew the history, setting up trick-or-treating on the unit for the patient’s child, making sure the child and spouse could visit often, bringing her outside to get fresh air, and even bringing her a brownie every single day Blubaugh worked.

She was also a fierce advocate for the patient and worked with many teams to ensure the best care possible.

“Julia went above and beyond the call of duty to ensure they could have a preserved (and hopefully improved) quality of life. If one were to review the ANA scope and standards of practice, Julia’s care was an extraordinary example of each standard. Julia is always an amazing nurse and anyone would be lucky to have someone like her caring for them.”

Bo McCain, RN

McCain is on the adaptive acuity team on 5E, and his nomination came from a very thankful patient who recalled the nurse being one of the first to arrive for a rapid response.

Described as “extremely calm and focused,” McCain helped the patient, in turn, feel calm as they focused on him.

“I was extremely impressed with his perseverance and compassion,” the patient said. “He seems very humble, and it was very nice to have such driven people in a definite time of need. Much appreciation.”