History and Physical Examination Essay

Admitting Diagnosis: Stomatitis possibly methotrexate related Chief Complaint: Swelling of lips causing difficulty swallowing History of Present Illness: This patient is a 57-year-old Cuban woman with a long history of rheumatoid arthritis. She has received methotrexate on a weekly basis as an outpatient for many years. Approximately two weeks ago she developed a respiratory infection for which she received antibiotics and completed that course of antibiotics. She developed some ulceration of her mouth and was instructed to discontinue the methotrexate approximately 10 days ago. She showed some initial improvement but over the last 3-5 days has had malaise, a low-grade fever and severe oral alterations with difficulty in swallowing although she can drink liquids with less difficulty. Patient denies any other problems at this point except for flare of arthritis since discontinuing the methotrexate. She has rather diffused pain involving both large and small joints this has caused her some anxiety. Medications: Prednisone 7.5 mg PO daily. Estradiol 0.5 mg PO QAM. Mobic 7.5 mg PO daily. Recently discontinued because of questionable allergic reaction HCTZ 25 mg PO every other day and oral calcium supplements. In the past she has been on pencillamine, azathioprine and hydroxychloroquine but she has not had Azulfidine, cyclophosphamide or chlorambucil. Allergies: none by history Family and Social History: noncontributory Physical Examination: This is a chronically ill appearing female alert oriented and cooperative. She moves with great difficulty because of fatigue and malaise. Vital Signs: Blood pressure 107/80. Heart rate 100 and regular respirations 22. HEENT normal cephalic. No scalp lesions. Dried eyes with  conjuctival injection. Mild exophthalmos. Dry nasal mucosa. Mark cracking bleeding in her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her heart and soft pallets. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. Skin: She has some mild ecchymosis on her skin and some erythema. She has patches but no obvious skin break down. She has some fissuring in the buttix crease. Pulmonary: Clear to precaution and alcostation bilaterally. Cardiovascular: No murmurs or galaps noted. Abdomen: Soft. None tender. Protuberant no organomegaly and positive bowel sounds. Neurologic Exam: Cranial nerves 2-12 are grossly intact. Diffuse hyporeflexia. Muscular Skeletal: Corrosive destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. Psychiatric: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychological services. She refused for now. Problems: 1. Swelling of lips and dysphasia with questionable early Stevens- Johnsons syndrome. 2. Rheumatoid arthritis class 3 stage 4. 3. Flare of arthritis after discontinuing methotrexate. 4. Osteoporosis with compression fracture. 5. Mild dehydration. 6. Nephrolithiasis. 7. Anxiety. Plan: 1. Admit patient for IV hydration and treatment of oral ulcerations. 2. Obtain a dermatology consult. 3. IV leucovorin will be started and the patient will be put on high dose corticosteroids. 4. Considering patients anxiety perhaps obtain services of Stella Rose Dickinson PHD Psychology at a later date. X______________________________________________ Liam Medina, MD Date: 06/22/—- Case Study 5 Discharge Summary Patient Name: Fanny Copeland Patient ID: 115463 Date of Birth: 10/26/— Age: 58 Sex: Female Date of Admission: 04/26/—- Date of Discharge: 05/01/—- Procedure Performed: CT scan. Ms. Copeland is seen for her summary conference from her work up here at Hillcrest Memory Diagnostic Center. I initially saw her on 04/28/—- at which time there was the suspicion of depression. She has since had CAT scan of the brain with contrast of 04/30/—- which was unremarkable. Laboratories studies were completely negative to include normal thyroid function B12 and RPR. She had a formal neurophysiological battery with Dr. Stella Dickinson on 04/26/—- she scored 136 on the dementia rating scale, which is within normal limits for her age. The test result were consistent with mild cognitive defaces manifested by problems with concept formation. Attention and concentration and verbal memory. However the patient is significantly depressed which can produce some memory problems. Her past MRI suggests someone who is experiencing stress. Impression: There was no clinical evidence of dementia but there is evidence of a depressive disorder as the cause of her symptom etiology. No further suicidal or homicidal ideation are present. Recommendations: We recommend a psychiatric evaluation and treatment with re-testing in our facility in one years’ time.

Emperors of Chinas Han Dynasty B.C. 202 to 220 A.D.

Emperors of China's Han Dynasty B.C. 202 to 220 A.D. The Han Dynasty ruled China after the fall of the first imperial dynasty, the Qin in 206 B.C. The Han Dynastys founder, Liu Bang, was a commoner who lead a rebellion against the son of Qin Shi Huangdi, the first emperor of unified China whose political career was short-lived and full of contempt from his peers. For the next 400 years, civil unrest and war, internal familial conflicts, sudden deaths, mutinies, and natural succession would determine the rules that would lead the dynasty to great economic and military success over their long reign. However, Liu Xis ended the long reign of the Han Dynasty, giving way to the Three Kingdoms period of 220 to 280 A.D. Still, while it maintained power the Han Dynasty was hailed as a Golden Age in Chinese history - one of the finest of Chinese dynasties - leading to a long legacy of the Han people, who still comprise the majority of Chinese ethnicities reported today.   The First Han Emporers In the final days of the Qin, Liu Bang, a rebel leader against Qin Shi Huangdi beat his rival rebellion leader Xiang Yu in battle, resulting in his hegemon over the 18 kingdoms of imperial China that had pledged allegiance to each of the  combatants. Changan was chosen as the capital and Liu Bang, posthumously known as Han Gaozu, ruled until his death in 195 B.C. The rule passed to Bangs relative Liu Ying until he died a few years later in 188, passing in turn to Liu Gong (Han Shaodi) and quickly onto Liu Hong (Han Shaodi Hong). In 180, when Emporer Wendi took the throne, he declared that Chinas border should remain closed to maintain its growing power. Civic unrest resulted in the next emperor Han Wudi overturning that decision in 136 B.C., but a failed attack on the southern neighbor Xiongu  realm resulted in a several-year campaign to attempt to overthrow their biggest threat. Han Jingdi (157-141) and Han Wudi (141-87) continued this plight, taking over villages and converting them to agricultural centers and strongholds south of the border, eventually forcing the Xiongu out of the realm across the Gobi Desert. After Wudis reign, under the leadership of Han Zhaodi (87-74) and Han Xuandi (74-49), the Han forces continued to dominate the Xiongu, pushing them further west and claiming their land as a result. Turn of the Millenium During the reign of Han Yuandi (49-33), Han Chengdi (33-7), and Han Aidi (7-1 B.C.), Weng Zhengjun became the first Empress of China as a result of her male kin - though younger - taking the title of regent during her supposed reign. It wasnt until her nephew took the crown as Emporer Pingdi from 1 B.C. to A.D. 6 that she advocated her rule. Han Ruzi was appointed as emperor after Pingdis death in A.D. 6, however, due to the childs young age, he was appointed under the care of Wang Mang, who promised to relinquish control once Ruzi came of age to rule. This was not the case, instead and despite much civil protest, he established the Xin Dynasty after declaring his title was a Mandate of Heaven. In 3 A.D. and again in 11 A.D., a massive flood struck Wangs Xin armies along the Yellow River, decimating his troops. Displaced villagers joined rebel groups who revolted against Wang, resulting in his ultimate downfall in 23 wherein Geng Shidi (The Gengshi Emporer) tried to restore the Han power from 23 to 25 but was overtaken and killed by the same rebel group, the Red Eyebrow. His brother, Liu Xiu - later Guang Wudi - ascended the throne and was able to fully restore the Han Dynasty throughout the course of his reign from 25 to 57. Within two years, he had moved the capital to Luoyang and forced the Red Eyebrow to surrender and cease its rebellion. Over the next 10 years, he fought to extinguish other rebel warlords claiming the title of Emporer. The Last Han Century The reigns of Han Mingdi (57-75), Han Zhangdi (75-88), and Han Hedi (88-106) were rife with small battles between long-time rival nations hoping to claim India to the south and the Altai Mountains  to the north. Political and social turmoil haunted the rulership of Han Shangdi and his successor Han Andi died paranoid of eunuchs plots against him, leaving his wife to appoint their son the Marquess of Beixiang to the throne in 125 in hopes of maintaining their family lineage. However, those same eunuchs that his father feared ultimately led to his demise and Han Shundi was appointed the emperor that same year as Emporer Shun of Han, restoring the Han name to the dynastys leadership. Students of the University started a protest against Shundis eunuch court. These protests failed, resulting in Shundi being overthrown by his own court and the quick succession of Han Chongdi (144-145), Han Zhidi (145-146) and Han Huandi (146-168), who each tried to fight against their eunuch adversaries to no avail. It wasnt until Han Lingdi ascended the thrown in 168 that the Han Dynasty was truly on its way out. Emperor Ling spent most of his time roleplaying with his concubines instead of governing, leaving control of the dynasty to eunuchs Zhao Zhong and Zhang Rang. Downfall of a Dynasty The final two emperors, brothers Shaodi  - the Prince of Hongnong - and Emperor Xian (formerly Liu Xie) led lives on the run from mutinous eunuch counsels. Shaodi only ruled one year in 189 before being asked to relinquish his throne to Emperor Xian, who ruled throughout the remainder of the Dynasty. In 196, Xian moved the capital to Xuchang at the behest of Cao Cao - the Yan Province governor - and a civil dispute broke out between three warring kingdoms vying for control over the young emperor. In the south Sun Quan ruled, while Liu Bei dominated western China and Cao Cao took over the north. When Cao Cao died in 220 and his son Cao Pi forced Xian to relinquish the title of emperor to him. This new emperor, Wen of Wei, officially abolished the Han Dynasty and its familys inheritance to rulership over China. With no army, no family, and no heirs, the former Emporer Xian died of old age and left China to a three-sided conflict between Cao Wei, Eastern Wu and Shu Han, a period known as the Three Kingdoms period.

Crude Oil and US Gasoline Market

Crude Oil and US Gasoline Market Introduction Crude oil is a mixture of naturally occurring hydrocarbons. Found under the earth’s surface, crude oil is extracted and separated into its simple components. The components of crude oil include kerosene, jet fuel and gasoline. As a product of crude oil, gasoline is used as engine fuel in automobiles.Advertising We will write a custom essay sample on Crude Oil and US Gasoline Market specifically for you for only $16.05 $11/page Learn More In the United States, crude oil is majorly imported from foreign markets. After its importation, the crude oil is then separated into its components in refinery processes of fractional distillation. It is after this process that gasoline, like paraffin and jet fuel, is supplied to distributers and finally, to consumers. This paper seeks to discuss the opinion that the â€Å"gasoline market in the United States and the market for crude oil are significantly independent†. The paper will look at facto rs that determine the supply, demand and the price of gasoline in the United States as well as the determinants of the demand, supply and prices of crude oil. The paper will then analyze the correlation between the two markets with the aim of identifying whether or not, there exists a relationship between the two markets. Market of Gasoline in the United States The gasoline prices in the United States’ economy are dependent on a lot of factors. Among these factors is the â€Å"unanticipated disruption of U.S. refinery output† (Killian 100). Events like fire that abruptly halts the operations of the refineries have been characterized with â€Å"significant increase in the real price of gasoline† (Killian 100). These particular disruptions however have less significant effects in the prices of the imported crude oil. The phenomenon is expected to have the reverse effect of reducing the price of crude oil as a result of reduced demand which is insignificant in the world market. The factors determining the demand for crude oil and the price of gasoline in the United States such as disruptions results in specified shocks in supply and demand are not easily predictable. It was also noted that the price of gasoline in the United States has some relation to the global market of crude oil. The prices of the two commodities remained high during the period of time ranging from 2002 up to 2008. However, the prices fell in the period of 2008 while the global supply for oil remained the same. A study of the global economic recession that was experienced during the period beginning in 2008 explained the cause of price changes. It was realized that before the recession, there was a high global demand for crude oil over the supply of the same. This pushed the prices up with respect to the laws of demand and supply. The fall of global demand following the recession therefore led to the reduced prices experienced since the year 2008 (Killian 92).Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More The market of gasoline in the United States is also determined by a number of internal factors which are independent from the market of crude oil. One of such occurrences was the â€Å"damage to the gulf coast drilling wells and refineries† (Gas, 3). The damages for example would translate to the shortage of gasoline leading to subsequent increased prices. The high prices of the gasoline can also be attributed to the government policies that have over time been oriented to only one aspect of controlling the price. The â€Å"chimney plan: to perpetuate the nation’s addition to cheap petroleum† (Gas 3) has been criticized as a profit oriented move rather than price control. It is however viewed that steps to reduce the consumption of gasoline would rather reduce the price as opposed to increasing its supply (Gas 3). The Marke t of Crude Oil In the earlier decades, the rises in oil prices in the United States were attributed to political aspects like the wars in the Middle East and embargoes by the Arab states as retaliation to the United States’ support for Israel, which limited supply of crude oil into the United States from the Middle East countries. The major determinant in the oil sector is still recognized to be its supply relative to its demand. The industrialization of countries like the people’s republic of China and India has put pressure on the global supply of oil due to the relatively increased demand. The threat of the United States’ supply of oil has been worsened by the move of oil supplying countries in the Middle East to reserve their oil for domestic use. The increased consumption by the two giant countries, China and India, has led to increased global oil prices due the increased demand. There is therefore need for â€Å"international effort to reduce demand for o il† (Katel 7). With this respect, no solution has been identified to help control the prices downwards. This factor is beyond the control of the United States according to professionals in the energy sector. According to Medlock, â€Å"it is going to be difficult for the energy supply to expand production at a significant enough pace to drive down prices† (Katel 7). The external drivers of the international oil price is passed to the price of crude oil in the United States and subsequently the prices of the separated components of the crude oil of which gasoline is part (Katel 24). Volatility Relationship between Crude Oil and Petroleum Products The prices of crude oil also depend on a number of features in the oil producing countries. A research study by Lee and Zyren indicated that stability in these countries significantly determines the prices of crude oil. According to the research, wars such as the â€Å"invasion of Kuwait and gulf war 1† caused instability in the market of crude oil.Advertising We will write a custom essay sample on Crude Oil and US Gasoline Market specifically for you for only $16.05 $11/page Learn More It was also reported that political environments in the crude oil producing countries such as â€Å"transitional regimes† also affect the international market of crude oil (Lee and Zyren 101). In the same study, it was realized that â€Å"the petroleum price variance is greater than crude oil variances† (Lee and Zyren 101). The volatility in the prices of crude oil and those of petroleum products was significantly realized across all periods of the research. The volatility between the prices in the markets for gasoline and that of crude oil is closely related, with an inverse response, to the revenues of the two commodities. The volatility can therefore be viewed as a conditional variable being dependent on the turn over rate of the two products. From the research, Lee and Zyre n noted that the price volatility between crude oil and the gasoline in the United States was greatly caused by the regulations in the crude oil market. It was also noted that the volatility in the prices was not significantly dependent on previous markets of either crude oil or gasoline. Similarly, price volatility doesn’t have significant effects on the future markets of the two products. The research generally represented the view that price volatility between crude oil and gasoline in the United States is an independent significant element (Lee and Zyren 111). Pump Prices and Oil Prices Apart from the asymmetry in volatility in the United States market for gasoline and the crude oil market, it has been established that a further asymmetry occurs between prices of the two commodities. Contrary to the business conception that reduced costs of production yields reduced selling price of a particular product, the oligopolistic market of gasoline gives the oil companies an adva ntage to temporarily dictate the retail gasoline price. A disparity is then significantly realized when the price of crude oil falls. When this happens, individual oil companies are always reluctant to lower retail prices as they try to optimize profits before any competing oil company lowers its price as a market strategy. The fall in crude oil prices does not therefore always result to fall in gasoline price (Adilov and Samavati 62). However, Adilov and Samavati still expressed the view that there could be factors that have changed with time to level a direct relationship between the gasoline retail price and the price of crude oil.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More They argue that the asymmetry in the price of the two commodities is not concrete due to the fact that gasoline market is currently invested by increased number of companies. Marketing strategies, according to the two authors is expected to cause price reduction among competing oil companies when crude oil prices fall in a bid to â€Å"undercut competitors† in the oil market (Adilov and Samavati 62). This argument therefore suggests that the prices of the two commodities exhibit some dependence as a result of the competitiveness of the United States oil retail (Adilov and Samavati 63). General opinion has also been expressed that the gasoline prices in the United States are always a factor of the prices of crude oil. The reduction of gasoline prices in the United States during the global recession in 2008 in a way indicated the dependence of the American gasoline prices on the global demand for crude oil. The concept was developed from the observation that gasoline prices wer e high before the period but fell on the onset of the global recession. The reduction of gasoline price was then attributed to the change in demand of the crude oil market as countries reduced their demand for the product (Killian 92). Conclusion There is significant support for the opinion that the price of gasoline in the United States depends more on the internal factors in the United States such as the production facilities and policies among others. It has also been illustrated that there are a number of economic factors that leads to the asymmetry of prices in the two markets. The arguments in view of the dependence of the two markets lack the support of many significant drivers in the gasoline market in the United States. They are isolated arguments that can be easily challenged by the consideration of the internal drivers in the United States. It can therefore be concluded, contrary to other opinions, that to a significant level, the market of gasoline in the United States i s dictated by other factors that are different from the market of crude oil. The gasoline market is actually occasionally asymmetric to the market of crude oil. Adilov, Nodir and Samavati, Hedayeh. â€Å"Pump Prices and Oil Prices: A Tale of Two Directions.† Atlantic Economic Journal 37 (2009): 51-64. Gas. Nation. EBSCO, n.d. Web. www.ejournals.ebsco.com Katel, Peter. Oil Jitters. CQ Researcher, 2008. Web. www.cqpress.com/docs/AffiliationsPDFs/oil.pdf Killian, Lutz. Explaining Fluctuations in Gasoline Prices. A Joint Model of the Global Crude, 2010. Web. www.ideas.repec.org/a/aen/journl/2010v31-02-a04.html Lee, Thomas and Zyren, John. Volatility Relationship between Crude Oil and Petroleum Products. Atlantic Economic Journal 35 (2007): 97-112.

The effects of garbage in the enviroment Annotated Bibliography

The effects of garbage in the enviroment - Annotated Bibliography Example The authors of the piece therefore discuss and analyze the ways in which current and proposed future measures can effect such a goal. This article discusses the way in which under-developed nations take upon themselves a large amount of discarded electronic equipment as a means of reclaiming the nearly 300 tons of gold that are placed into such instruments each and every year. Although this is a lucrative way for developing nations to seek to enhance their own local economies, it has a very high health and safety cost and is only engaged by those least The two approaches that the authors put forward have to do with increasing efficiency of production and seeking to find alternative uses for the waste that is generated. As a means of integrating this idea into the essay, this student will seek not to take one approach over another but rather to seek to include both approaches as a means of reducing the seemingly ever increasing size and heft of waste that the current global system generates. This particular article discusses the ways in which technology offers an ever increasing array of solutions for the levels and toxicity of the waste that the current system produces. Rather than finding ways to reduce the waste per se, the authors hold out something of a modernist approach that claims that the increases in technology that are taking place so rapidly in the world around us will be able to ameliorate many of the issues with waste as they exist within the current system. This article engages the reader with an understanding of how unethical and ultimately unfair the toxic waste trade is. Rather than the industrialized nations seeking to deal with the toxic waste that they generate, it is oftentimes pawned off to poorer countries that are desperate for the influx of FDI that large multinational firms can provide. In this way, a type of econ-slavery

Global Marketing Strategy Essay Example | Topics and Well Written Essays - 2000 words

Global Marketing Strategy - Essay Example The induction and diffusion of the effects of globalization in various parts of the world has been fast forwarded in a tremendous manner by the easy availability of high speed internet connectivity in every corner of the world. The easy availability of information in the various forms of virtual media like the online media forums, social networking sites and blogs have significantly contributed to the faster dispersion of the effects related to globalization. This has brought into play, a significant and constant process of change in the macro and micro environmental factors related to the development of business opportunities in the established as well as the developing economies of the world. As a positive impact of globalization, there has been a significant increase in the opening up of economies around the world. As a result of opening up of economies of various emerging and developing countries, new markets are emerging from various corners of the globe. The steady rise in the opening up of new markets around the world is leading to a tremendous increase in competition in the global marketplace. Talking on this note, it can be said that the process of opening up of markets around the world is allowing organizations located in various parts and corners of the world to look for opportunities related to market expansion by applying various strategy-based methodologies and action plans. This approach of entering new markets, by various international firms, is leading to the rise of business practices in the domain and arena of international business practices. Theoretical framework: International business Talking about international business, if we wish to define it, it can be said that the international business or international trade comprises of various business activities that are undertaken by business organizations around the world to develop new markets for the purpose of gaining significant growth opportunities by catering to the demands arising from the new markets. In an effort to do so, the international firms focus on the process related to generating, communicating, delivering as well as capturing of value for the customers of the new markets while customizing the product or service features as per their needs and requirements (Dlabay & Scott, 2011, p. 8). The concept of international business is also highly applicable and relevant in the case of various business firms who look forward to tapping significant amount of business opportunities by providing their services and products to various remotely located clients and customers who dwell in different countries. In the context of various business to business scenarios, international business represents the process of conduction of business between various business organizations through the mass conduction of import and export of goods and services. For the process of conduction of international business, opening up of economies as well as setting up of various investment f riendly policies and tax laws in the new and developing economies is very essential. It is highly important to mention in this case that the flexibility in multiple government outlined policies and regular evaluation

Narcotics and Capitalism Essay Example | Topics and Well Written Essays - 750 words

Narcotics and Capitalism - Essay Example The author says that in the dynamic style of the modern age, people are so busy in their schedules that they can not make up time for their personal leisure and relaxation. All of the time is used up in work, shopping, cultivating relationships or childcare. In such circumstances, drug use provides an individual with instant comfort that he/she longs for. Besides, in the very busy schedule, people are not used to free time and thus free time may put many in distress. Many people experience depression and yet can not locate a reason for the same. Dope addiction provides them with the reason to be distressed as they long to re-experience the first feel of consuming heroin. Modern capitalist society is categorized by time, and drug use enables the individual to break free of the chain of time. Dope addicts are conventionally stereotyped as money-centered and greedy people, but the author suggests that the reverse is true i.e. greedy and money-centered people become dope addicts rather t han dope addicts becoming greedy or money-centered. The author thinks that people whose behavior is perfectly consistent with the requirements of the capitalist society are the biggest and most serious addicts of dope. They generally maintain a bossy, hustling and dominating image in front of the society but from within, they feel ashamed of their ruthless attitude. Their obsession inculcates a deep desire in them to change their identity for good, and dope addiction helps them achieve that. The author connects the reason for buying dope with the intrinsic desire of humans to be cool. When they can not identify smarter or more intelligible means of being cool, they resolve to buy dope because this is one thing they know would cool them down for sure. The author says that despite the fact that dope may be considered as a hipster buy, it is essentially a deal between a seller and a buyer whereby all is said and done. The author sees little difference between loving copping and loving shopping. To him, it is the same activity but in different aesthetic. The author also connects dope addiction with the desire for commodities. The author says that he loved cars because they provided him with an isolated space in which he could find out answers to ultimate questions in complete mental and physical peace. Same is allowed by dope addiction as it disconnects an individual from the world, and he/she becomes lost in an imaginary world where the past, present and future lose their significance. Another important linkage between narcotics and money comes from the fact that consuming narcotics make an individual look rich. Heroin is extremely expensive. I pound of heroin can cost thousands of dollars. This property of heroin as well as most of the narcotics makes their consumption a game of the rich people. Presenting ourselves as rich is one of the most fundamental elements of a capitalist society. In a capitalist society, money is power. The more money an individual has, the more respected he/she is. Thus, dope addicts perceive this habit as a quick and easy way to look rich and be in the league that most people of our society long to be in. In addition to making themselves look rich, they also look stylish. Spending up to $2100 on heroin in just a week, they surprise the richest people around. In everyday life, we spend money wisely and thoughtfully no matter how much money we have. We remain cautious not to waste money, but dope

Death of a Parent Essay Example for Free

Death of a Parent Essay I believe we are defined by events that happen throughout our lives both passivity and negatively. Most of the events that change people’s paths often happen suddenly in their life and sometimes have long term effects. Whether it is a personal, religious, life style, or even a career change the fact still remains the cause for change was caused by the event. The statements above are true for my life; my life was about to change forever. This is the day I found out my mother had only six months to live, I was only 19 years old. I was picking my mother up from a routine follow-up appointment she had at Keesler Air force Base Hospital in Biloxi Mississippi, on the afternoon of 3 March 1997. I was walking up the steps of the hospital when I saw her walking out her face was pale I asked her if she was ok, her response was no. At this point in time everything went silent she asked me to sit down on the steps but I couldn’t I just wanted to know what was wrong. My mother while holding my hands then told me the results of the test and that she had liver cancer and it was untreatable. I was frozen not knowing what to say I just grab her and held her close and begun to cry. She told me to stop crying because she was going to need me to be strong for her and my brothers, that she wanted her last six months to be happy memories not sad ones. Let’s step back for a moment so I can explain the relationship I had with my mother because it was not your normal one. My mother was so much more to me than just a mom, she was my best friend I told her everything and she told me everything. We spent many late nights talking about everything in life from how our day went to what life would hold for us in the future. My mother was one of those people who never wanted or asked for anything for herself but was one who gave everything and would do anything for her children. When I say her children I don’t just mean her biological ones, she took care and provide for so many more, whether it was local neighbor hood, friends, family, co-workers and sometime even complete strangers who just need help. I remember many nights sitting at the kitchen table with people eating dinner with us who I did not know and many of them I would never see again after that night. My mom would always say we don’t have much but what we do have is sometimes way more than what others have. My mother was the strongest person I ever known, who also had the biggest heart. Two years before we found out she only had six months to live my mother kicked breast cancers ass. At least so we thought until the cancer showed back up in her liver and the doctors only gave her six months to live. At first nothing changed for her life or mine after finding out the bad news in fact she made me promise not to tell my brothers or anyone else. She continued working up to about the last two months. That is when things started to fall apart. The first thing to go for my mother was her memory. I can remember coming home from work and my mother talking to me about going camping like I was five years old. Not knowing how to handle it I just played along with the conversation, it seemed to make her happy. This went on and off for about two weeks and then things really started heading down hill pretty quick. I had to get help from hospice care, to have help taking care of her, because she was basically bedridden and unable to care for herself. Hospice came into our home and set up a medical bed and other medical equipment in our formal living area, this was the open area in our house. At this point I quit my job to take care of her because hospice care was only coming to the house like twice a day the rest was up to me. I had made a promise to her not to let her die in a hospital and I was trying to keep that promise. As the days went on the care became more and more demanding not really physical but mentally. I was doing everything thing for her, from bathing, changing her clothes, and bed pan to forcing her to take the meds she still need to take for pain control. At this point she was no longer able to speak, it seemed like her mind was completely gone just a blank stare. My breaking point was met, I was unable to care for my mother at home anymore she had pretty much slipped into a coma. I had to have my mother moved to the hospital, I couldn’t keep that promise I made her and still to this day I beg for forgiveness from her. She was only in the hospital for three nights before she passed. My brothers and I took turns at night staying with her and my night was night three. That night was a special night, it was her birthday. On the night she passed away we got her a birthday cake and song happy birthday to our mother for the last time. After singing happy birthday and blowing out the candles we each gave her a hug. When it became my turn to give her a hug I told her it was ok for her to go, that we will be ok and I love you. It wasn’t long after that she passed away at the age of 40. Not long after my mother died my life begun to fall apart. I could not deal with people always asking me if I was ok or if I needed anything. I started pushing everyone away and shutting out the ones I love. I needed to make a positive change in my life because my mother would not want me to live this way. So I joined to U. S. Army and left home and everybody I loved. I didn’t really have a plan I just knew I needed my space and this was the only way I was going to get it. In fact I wrote a letter to my girlfriend breaking up with her on my flight to Germany, after I had completed all my initial training. I was completely alone for the first time after my mother died. Not a day goes by that I do not think about my mother and how her passing changed my life. Today I live my life the way I believe she would have wanted me to, with an open mind, trying to see the positives in every situation I find myself in. There are things I wish I would have handled differently when it comes to my love ones I left behind when I joined the Army. My mother’s passing away changed my life in so many ways and has dad a major impact on the way I raise my kids, I do not take the time I have with them for granted. You never know when your time is up, so I say make the most of it and never wait until tomorrow to tell someone you love them.