You Should Know

Day 5 of Diabetes Blog Week. The topic: What is one thing you would tell someone who doesn’t have diabetes about living with diabetes?

 

This is a hard one for me. But it shouldn’t be. If you’ve followed my writing at all, you know with what vigor, emotion and honesty I’ve sought to unearth and define for myself—and for others—so many of the deep, troubling aspects of living with diabetes. I’m talking beyond the mechanics of blood sugar checks and carb counting, beyond IVs and Christmases spent in the hospital. Beyond shots and bruises and tender, hurt feelings.

These are things I never understood about myself or about life or creed or my family and the people I love. Tiny outlooks. Perceptions. Conclusions. Sentiments both large and small that arrived not at the end of some long and incredible journey as perhaps I once eluded, but which sank in slowly, over time, in the face of a mountain of resistance and struggles against them, turning them away, begging them leave us—leave her—alone. At some point there is nothing left to do but embrace them because they are all there is in this world and all there ever will be until such time as things change. And they will, one day.

Life is a revolving door. Attitudes come, attitudes go. We, too, change. We learn. We grow. We rise to the call. And I suppose if there is but one thing I would say to someone about what it is like to life with diabetes it would be that. It is a vocation, a duty, an occupation that knows no end, no weekend, no holidays, no worry-free golden years. From others it beseeches consideration, understanding, and for some: devotion, loyalty and a faithfulness that anything in life is possible with love.

Say No More

Today’s topic on Diabetes Blog Week is to write about our Fantasy Diabetes Device. The one item we’d love to see developed to make the care and treatment of diabetes better, easier, simpler, less painful. You name it. The sky’s the limit. Here is my fanciful wish:

 

Say no more

 

Say no more,
Say no more.

These are pretty neat things,
I would say if I’m asked,
And the things that they do
Well…they seem up to the task.

But if I had my way,
I would tell you this much,
I would toss out those names
In one alphabet bunch.

I’d start over from scratch, with every last one.
I’d make it my job… dare I say, my mission
That every last one of those needful devices,
Would get a new name…a kinder edition.

Take Test Strip for instance…just for example,
After a spin through the Name Fixer-Upper,
The word it spits out so cheerfully better.
Now call it a Bodiddly Beandip Whopper?

Or look at this meter and alcohol swab,
Down the word chute they go… now up on the lever
The names that pop up on this dandy Name Namer
Could be Bartle or Bob and a Cootie-free Cleaner.

And who ever heard of an infusion set,
Who didn’t think first and foremost about it,
That an object of such animosity
Would serve us much better if we just called it Mit.

Finally there’s a thing called an Animas Ping—
Wait a minute just now… that’s not really so bad.
But pairing it up with the surname One Touch?
How about we lighten it up with Do-dad.

I hope you see now, it all makes perfect sense,
A machine that names names without any offense.
There is one more item I feel is amiss
Instead of a painfully sharp pointy prick,
I wish lancets would render a butterfly kiss.

Hulk Smash

Yesterday I wrote about Franca and Lia and their strength and indomitable spirit to stare down the maw of diabetes no matter what, any day of the week, standing firm behind the motto: You want a fight? Bring it. For day 3 of Diabetes D-Blog Week the focus shifts to development, a topic for which I will turn the attention to me.

I am by no means a tinkerer. I have no patience for the preciseness it usually requires and would rather do just about anything than spend my time fine-tuning, adjusting, or otherwise engaged in the activity of repair. For me, playing the guitar (if that’s even what I should call it) is about as much experimentation as I care to do. Life, I believe, is to be lived, not calibrated. Besides, my Dad didn’t know how to fix shit and never taught me and so despite my collection of sockets, screwdrivers and power tools, I’d just as soon leave them in the packaging they came in. As it is for the most part, they’re just cluttering up the garage. If something is broken or out of tune, my preference, or should I say, my skills would lend to smash it and start over.

But if anything taking control of diabetes requires a good bit of routine and extra fine-tuning, let’s call it D-regulation (don’t say I never reach across the aisle). The things that can and should be governed are as confusing as they must sound to someone unfamiliar with diabetes. Total Daily Dose. Insulin to Carb Ratio. Correction Factor. Twenty-four hour basals. Insulin on Board. And so on and so forth. Each of these  elements weighs heavily on just how effective we are at managing Lia’s blood sugars. Changing the settings of just one of them could mean the difference between this (thereabouts):

______________________________

or this:

Engineering all those factors to obtain level blood sugars depends upon the precise application of tiny little tweaks, not smashing. You make one little change to just one of those elements (not six), wait a few days and see what happens. Didn’t get the results you wanted or expected? Make another little tweak, wait some more. It should feel like you’ve gone back in time and are trying to tune in a television station by ever so slightly adjusting the antennae rabbit years, not banging the crap out of the side of the box.

With diabetes I’ve got to change my attitude and techniques. Lia is ten now. Next year she wants to do cross country. Then her teen years are fast approaching. Smashing won’t work. Smashing will work against us. It’s time the Hulk in me developed a little more patience.

Delightful Survivors

The rigid person is a disciple of death;
The soft, supple and delicate are lovers of life.
                                –Tao Te Ching

 

For Diabetes D-Blog Week Day 2 the topic is to tell about one diabetes thing that we do especially well. So rather than go this one alone, I enlisted some help over dinner last night and what we came up with were a number of things we felt pretty safe bragging about—making good food choices, checking blood sugars regularly, working to understand her diabetes better—but all of us agreed at the tip-pity top of the totem pole is Lia’s own self control.

She has her mother to thank for that. I am much better at keeping my cool in a dire emergency, but Franca—and by pedigree, Lia—have true survivor mentalities. They are humble, gracious and love to laugh. They believe in themselves and live in the present. The decisions they make are simultaneously bold and cautious.

Diabetes is hard on a little kid. No, that’s not quite right. Hard is something you do, like sprinting or moving a piano. Putting up tobacco, now that’s hard. Living with diabetes is galaxies beyond hard. The word hasn’t been invented yet to describe this disease for a little person. Arduous. Demanding. Complicated. These simply don’t stand up to the job.

In fact, hard is the word I’d use to describe Lia, not diabetes. Hard as in: firm in her convictions, whose spirit is not easily broken. Someone who meets each day head on with humor, diligence and earnest. That’s Lia. The one who is able to come home from school not in tears, but smiling incredulously with a story to tell of her teacher who in passing out bars of chocolate to the students came to her and said, “I know you can’t have this, but maybe your sister can enjoy it.” Or who during a critical moment of a pump site change on her derriere says to her mom, who is kneeled down behind her about to release the needle, “Wait, can you move your face away a minute” because she has to fart.

Managing diabetes is an enormous, endless task, like cutting tobacco every day of your life, but it is really no match for a will and personality that are as strong and delightful as that of my lovely daughter and her stoic mother.

D-Blog Week: A New Friend

Honestly, D-blog week caught me by a bit of surprise today. I’ve been so wrapped up in… well, let’s just say other stuff. When a friend reminded me and I went out to Karen’s blog, Bitter-Sweet, to take a look at this year’s topics I knew then I had no choice NOT to get on board. This event was such a moving experience last year. It turned writing about Lia and our family and diabetes into something else, something more than just me talking at a computer screen, it was me talking with friends. Which makes today’s topic so much more apropos:

It seems the most popular thing about Diabetes Blog Week is that it helps us find blogs we weren’t reading yet and connect with some new blog friends.  With that in mind, let’s kick off Diabetes Blog Week by making some new connections.  Think about the d-blogs you read that you think we may not know about and introduce us to one that you love!!  Let’s all find a new friend today!

I can’t recall exactly where or when I first met Tim Brand, writer, poet and author of the blog, Bleedingfinger. I know though that he reached out to me, which I think says a lot about a person. To be sure, Tim goes out of his way to make room in his own life to welcome others touched by diabetes, especially dads, and yields nothing whatsoever to the condition that affects two of this three young daughters. In addition to his blog, he created a popular group on Facebook called, D-Dad: A group for dads battling diabetes, and can be found there regularly posting research highlights, bits of encouragement, and friendly remarks. In fact, there is little you can count 100% of the time on when living with diabetes, but a kind word from Tim at just the right moment is one of them.

A Tribute, of sorts

Franca and I work very hard and with much thought to not let Lia’s diabetes bring her down. There are good days and there are bad days and sometimes we have to work much harder and be much more creative than others. But the human spirit is resilient and we’ve found that sometimes all we have to do is let parenting get out of the way. It’s never easy to see this from just Lia’s perspective, but in most cases, Lia’s perspective is truly all that matters.

For instance:

One morning not long ago, my work was interrupted by a visit from Krista, our teenage daughter. Though I was very busy, I stopped what I was doing and gave her my attention.

Can you believe it? she said with excitement. It’s here, it’s here. It’s finally here.

What’s here? I asked.

The Hunger Games! she exclaimed.

Oh, right. I turned back to my work.

Aren’t you excited? she asked.

Very, I said. Maybe now you’ll stop obsessing so much over it.

Never, she answered and she smiled broadly and then skipped happily out of the office.

It’s true. She had been planning for the movie’s opening day for some time, had bought her ticket a month in advance and gotten her hands on every article of licensed clothing she could, every magazine, every photo. Now that the hour was almost upon her, her joy was simply too much to contain. For certain, it seemed to have the will and energy to last forever.

A couple of hours later, I was still in my office going over my notes for a research presentation I was providing to my local chapter of the JDRF later that night. The subject was the Artificial Pancreas Project and I was looking over the slide deck, when Lia came strolling in. What’s that? she asked, pointing to a picture of a small, handheld device.

That, I said, enables a continuous glucose monitor to talk to a pump to help manage blood sugars better. I scrolled back a couple of slides, to show her how the three things worked.

You mean they talk?

It’s like talking, I said. The CGM sends blood sugars to that smart phone-looking thing and it tells the pump how much insulin to give, or not give, as may be the case.

Lia’s face lit up. How cool is that!

Right, I know.

Can I see that first picture again?

I clicked back to it and I watched her face and she was smiling still and I could see her mind working through what that might possibly mean for her and I was surprised by her excitement and at thoughts that might be at that moment soaring through her head as she imagined the difference such a small, complicated thing would have on her every day life. And then I remembered back to earlier in the day and compared her joy to that of my oldest and the premiere of The Hunger Games.

Two children. Both thrilled. Each by something different.

Was it sad? Yes, to me it was sad as it highlighted something we struggle with everyday, keeping diabetes in its place, not letting it have free rein over everything else in life.

But after I thought about it, it proved something else to me, too, about diabetes, and especially about Lia. It proved that inspiration flows both ways. After all, even The Hunger Games can’t compete with a smooth-talking artificial pancreas.

 

The Wild Blue Yonder

How do you manage? This is one question in relation to Lia’s diabetes that Franca and I hardly ever get asked. I can’t remember the last time in fact, which is both bizarre and at the same time understandable, because caring for type 1 diabetes is one of those things where looks are not only deceiving, they can outright cloak and camouflage the real dangers and challenges, making it feel like you’re piloting the Stealth bomber of incurable diseases. It’s a ton of commanding work, fraught with great risk, but one no one ever notices, until something crashes.

Helping in this is the fact that Lia is truly a champ. She does what she has to and rarely if ever bitches about it. Certainly, she doesn’t complain to anyone else. Only to us, and that is just how it is because we are her parents and parents know when their children are hurting and denying them a voice doesn’t do anyone good. I don’t care how tough you are. Diabetes hurts. A lot. And often.

As a result, however, what everyone else sees is just this kind, happy kid who sometimes has to prick her finger, give a little extra thought to her food, and fiddle with some contraption she wears around her middle. Big deal. Isn’t she handling it nicely? (Don’t you ever want to say to them: Yes, of course, she is handling it nicely. What choice does she have? She has a job to do, just like everyone else, and that job is to grow and become her own person, with or without a stupid pancreas.)

So on that hand I get it. People see Lia at her best, taking care of herself, growing, learning, further defining her person. And from that I can also deduce why no one would give a second thought to the effect diabetes is having on Franca and I. Honestly, we don’t even give it much thought ourselves. The weight is just something that’s there, we own it. Call it worry. Stress. Whatever. It’s heavy and it’s permanent, like a steel wire cable suspended from the base of your skull and rooted into the earth. You drag it dutifully wherever you go, over and about the landscape, through whatever muck, mire or meadows you find yourself.

What has been important for us is that we have been there for one another, because each other is all who we have—I say this not wonting for sympathy or to sound dramatic, it’s just the way it is for parents of children with diabetes, for the reasons I’ve mentioned above—and the days when we could leave Lia at someone’s house, anyone’s house who doesn’t just think she is handling it nicely but is fully aware of every special nuance, so that we might enjoy time alone, and not brood and toss and turn and wait for the liberating call the next morning, are a thing of the past. Lord only knows how you handle sending them off to college—we will when the time comes, I know, and fortunately we’ve got a few more years to prepare—because parenting is difficult, no matter the objectionable add-ons.

But that’s not what I wanted to write about, further making my point, I now see. People don’t ask how we are doing because they don’t understand diabetes. They don’t know how mentally, intellectually and emotionally time-consuming it can be, they don’t understand how the technology and the treatment, how the very disease itself—you can’t see it, you can’t touch it, hell, most people can’t even define it—how all of it adds up and makes caring for diabetes look easy.

It’s not, but somehow, like so many other parents and people with diabetes, we manage. We suck it up, we cope. We cram it into our schedules like a trip to the DMV, we treat it like a pilot treats their flight plan, just part of the routine, and we carry it with us wherever we go and we do it without too much griping because that is our job. We’re her parents and parents help kids learn to fly on their own.

Asking someone how they manage something so invisible as type 1 diabetes certainly may not cross anyone’s mind, it may even feel oddly unwarranted in a so-you-think-you-have-it-bad kind of way—to be sure there are plenty who suffer from worse—but if you’re reading this and you know a parent out there who is caring for someone with diabetes, do them a favor and ask them how they are handling it. They will probably feed you a lie and say: Oh, it’s just swell, thanks for asking.

But even a pilot with one of the most deceptively, undetectable roles in the world deserves the chance to brag every once in a while.

Come What Come May

Any parent of a child with type 1 diabetes knows the importance of living in the present. To live any other way is to focus too much on those things that lie beyond our control. Better treatments. Soaring costs. A cure. But what about that other member of the family, the sibling?

For Krista, who’s smack dab in the midst of her teen years, awareness of Lia’s diabetes isn’t enough to keep her up nights with worry, or preoccupied with how to pay for health care, or the whereabouts and funding of research. What she observes and retains is much more immediate: frequent finger pricks, food scales and carb counting, painful repetitive procedures that appear, rightly so, to get in the way of the normal, untroubled life every teenager (and everyone else for that matter) most yearn.

So what happens when Krista gets sick, or more precisely when the symptoms of her illness mock those of what Lia experienced just before her diagnosis?

Worry, that’s what.

Worry about what might be, not what is.

“Come what come may,” said Macbeth to himself after meeting the witches, those secretariats of blind ambition, oracles foretelling the future. “Time and the hour runs through the roughest day.”

I thought of this simple yet legendary line recently when Krista experienced one such medical crisis. She’d been complaining of dehydration and of frequent trips to the bathroom and fearing an infection, or worse, had been taken to see the doctor. They tested her urine for a disorder and found nothing unusual, but a trace amount of ketones. She was sent home and we were told to monitor the situation. Nothing was said about diabetes, her blood glucose level was not checked, there was no hasty rush to the ER. But that didn’t matter. Much like the throne to Macbeth by those witches, the idea had been sufficiently sown: What if?

Later that day we did check her blood and when she wasn’t feeling better the day after that we checked it again. Both times we found it normal. So it was not—or is not yet—diabetes, but the whole thing raised the question: yes, precisely, what if?

What if diabetes struck again?

There are two answers of course to that question. There is the parental answer: We know what diabetes is and we know how to treat it. We’ll deal with it. If ever there was a motto for the parent of a child with type 1 it is “Come what come may.” If it happens, it happens. We’ll manage.

Then there is the child’s answer, which is not an answer at all but more questions: How? Why? What now?

To be sure there are answers to these, just as there were answers when we learned of Lia’s diabetes two years ago. But answers take time to arrive and telling a young person the secret to a happy life is learning to endure is like telling an ambitious but dithering brave warrior of a prophecy he would be king. The reality takes some getting used to. But as Shakespeare understood, even the worst of days come to an end.

Unless, of course, you’re Macbeth.

 

 * * * * * *

A Special Announcement

In honor of my wife and daughters and the pursuit of a healthy lifestyle by women everywhere, we are pleased to announce that beginning this week, some excerpts of the best and more memorable posts from our family’s journey of living with diabetes will appear on Lifescript.com, one of the most dedicated and respected women’s health portals on the internet.

Franca and I are honored to have this opportunity to spread awareness of Type 1 Diabetes and share with others the challenges, the small and large victories that parents, caregivers and people with diabetes demonstrate everyday to live life to fullest.

Click here to check out WOE at Lifescript


A Special Request

Hi there —

I’d like to make a special request/ offer to the readers of Without Envy. As you know, I’ve recently published my first novel, called A Lovely, Indecent Departure.

www.stevenleegilbert.com
by Steven Lee Gilbert

It is a story about a young mother who kidnaps her five year old son from his emotionally-abusive father and flees the country to her native Italy. It is, if you know me personally and/or perhaps if I’ve written this blog with enough intimacy that allows you to read between the lines, a story, first and foremost, of love, and second, of a testament to what we as parents are willing to sacrifice for our children. Attributes with which each of you out there now reading this are exceptionally quite familiar.

The book is a culmination of nearly a decade of research and writing, an endeavor of heart and talent and yes, struggle. Writing it brought me much pleasure, but the act of publishing and marketing it has opened my eyes to a part of the process I’d not ever given much thought to. For certain, self-publishing a book is an enormous, individual marketing challenge—okay, so was writing it—but it was something I sought on my own, preferring to bypass traditional publishing methods. As a result, I am caught between sharing this wonderful, exciting news to the world and talking about it so much I come off sounding like a shameless fairground carny.

Step right up! Get your good read right here!
Hey you, wanna really impress her? Try reading a book!

Trust me, that is not my intention (though it would make for an interesting character, a kind of dickensian Gary Busey).

Part of what makes it so difficult is that when I think of who the book’s audience is—unlike a carny, it can’t just be everyone—my answer will probably not surprise you: There’s me, and then there is Franca. Those two are my audience for pretty much everything I write, because there are few things better for you and more satisfying than expressing oneself clearly to oneself (and who better to tell you if your idea of expression is correct, or appropriate, than a spouse). Through expression we learn to know what we think, which brings me to you: Without Envy readers, the community.

Many of you have been with me these past twenty-plus months. You know me. You have listened to me as I’ve shared my gripes, my hopes and my worries. You understand more than most parents what it means to feel out of control and especially of the sacrifices we make everyday to keep our children safe. You get it. So, I’d like to ask for your help and in return give you a token of appreciation.

The novel is currently being distributed through whatever means books are distributed to all sorts of booksellers. Eventually, it is my hope especially that I might walk into my library even and find it. To do that requires it get noticed (this is where that audience thing works against you). Toward that goal, I would like to offer to any of you who are willing one free copy of the book in return for an honest review on Amazon, Goodreads, Shelfari, or wherever else readers congregate. The review doesn’t have to be all positive, just honest. If you’re interested send me an email and we’ll get started with either the paperback copy or a free download from Smashwords.

Writing has always been a huge part of my life. It has felt at times, especially over the last two years, as if it were the only thing keeping me sane. Through it all, your companionship has been invaluable, your comments uplifting. As far as I’m concerned if I saw any of you walking down the runway, I’d give you the book AND the big stuffed animal. I wouldn’t even ask to guess your weight or age.

 

Lending to a Wounded Hand

I’ve been thinking of what to write for this post for some time, going all the way back to last summer when I first began to see for myself the dangers of what I will call over-volunteering. It sounds strange to me even now, all these months later, quantifying the effort I applied to finding a cure for type 1 diabetes like it was some sort of muscle I’d worked to the point of straining. As if I—or anyone else—could do too much to bring an end to it. I can’t. There is nothing I wouldn’t do or give to heal Lia. Period.

But last summer I started to realize something important, something more critical to her care—and my own well-being—than fundraising, research and to a certain extent brotherhood: you must first make time for the present and learn what it means to live with diabetes in the now.

Staying fixed in a tragic moment is hard for any parent, and so very hard for a father who wants only good things for his children. You find yourself always looking ahead for the way out. When the truth is, there is no escaping this.

Our first introduction to the Juvenile Diabetes Research Foundation was at a family retreat we attended one month after Lia’s diagnosis. I can remember quite vividly sitting through the various seminars feeling like I was lost, and I was, like some naive countryman having stumbled upon someone else’s battlefield. I had no idea even what kind of war we were waging. Still later while writing about it, my focus was not on the daily onus of survival but on a clinical trial that afforded me some genetic and vaguely-understood glimpse into the future, a worthwhile effort to be sure, that might help us see if the same thing could happen elsewhere in our family, because even as children we know that monsters can’t hide behind doors that don’t remain closed.

I discovered too there were others like us and it was comforting to know them and to hear their stories and the stories behind the volunteer army that had staged this special event. I was inspired by their mission and especially by their commitment. And so after the retreat I did what anyone might do, I signed up.

One month later I wrote about that lattice work community and how I felt strong and invigorated, compelled by the burden of everything that is good about fatherhood to join the cause and fight to deliver a cure. How could I not? It was my daughter, my Lia who stood to benefit. Just point me, I said, in the right direction.

I was warned at the time that like a cellular organism victory rested not with one individual but on the unified strength of an entire community, and I knew from my own experience that was true of any war. But this was no ordinary war, and the analogy was wrong. Only last summer did I finally start to piece together why.

First, let me say something about a cure. I believe in it. I believe in science and I have faith in the work being done to rid the world of this disease. I support it and will always. I don’t think this way because I have no other choice. I do. Just as Lia will have a choice of her own to make when it’s time. But it is my right as her father and parent to believe that one day there will be a cure for type 1 because I want the best for my daughter and that means living without diabetes.

I believe also in volunteering. Before Lia had diabetes, we worked every summer for the Special Olympics and our time spent there was as rewarding and as special as the name implies. Volunteering, caring for others, caring about others is one of those things that separates us from every other animal on the planet. But we all, myself included, need to aspire to give back as a way of life, not an occasion.

But having diabetes, I now see, is not like any other war, so much so that I’d like never to use that analogy again. This, what we do day in and day out to treat this disease is not a war. War implies two sides and when that person hunkered down on the opposite end of the battlefield is your own body, well, you can see, the comparison just doesn’t fit, and therefore, neither does the role of a volunteer army.

We are, each of us, first individuals and what I had failed to see was what Lia needed most from me was not a hero, not someone larger than life swooping in, giving  their time and their energy to rid her of this awful, invisible thing. What she needed from me was just to be by her side, to help her and hug her and hold her hand, to love and stay close to her here in the present.

She tried to tell me that in many ways. Every time I got dressed up to go to a board meeting or attend some event. I thought it was just her innocence talking or her not liking that daddy was leaving the house. I thought I could do both, be a caretaker and also a knight. Now I believe you cannot. Before you can swing a sword, you have to know how to sharpen it, and that is the point of this:

Learning to care for someone with diabetes takes time, it takes patience and paying close attention. There isn’t the benefit of knowing firsthand what it feels like for your blood sugar to drop, or go high, or your thoughts turn angry by this thing that is such a part of you and at the same time so utterly out of your control. I don’t know what it is like to carry diabetes inside you, other than as a worry, which is why even now I still feel implored to connect this metaphorically to an epic conflict, as if it were Me against Them. It is not. It is Me, and then it is Lia. It is All of Us. Individuals.

Within weeks of that first visit to JDRF, I was mentioned to chair the Walk Committee, then asked to join in another leadership role and was invited to serve on the executive board. By summer, I had become a regular presence in the office, both figuratively and literally. To an outsider, it surely must have looked, as some have mentioned, as if I had drunk from the proverbial Kool aid (an even poorer analogy, if you ask me.)

But then, in the middle of last year I began to see things more clearly and I came to the conclusion that it was a mistake to jump like a general headfirst (and headstrong, I might add) into the foray of finding a cure. I decided it was best to take baby steps, even if that meant backing up, so I could spend whatever amount of time was necessary to learn more about diabetes and what entails taking care of it today, not tomorrow, not for the someday there comes a cure. This moment. Right now.

I do still volunteer with the JDRF, but in a slightly lesser role, and the chapter, I’m encouraged to hear, is working on developing a more effective volunteer program that benefits everyone, not just fundraising. It’s a tricky situation when someone with passion and goodwill comes strolling into your office. You’d be a fool to turn them away. But also I think, and more importantly I believe my chapter thinks, at least in theory, that there is an obligation as well—to borrow from a past U.S. President—to ask not what they can do for you, but what you can do for them, because diabetes is that kind of disease. Where everyone could use a helping hand.