February 2007
Last Month’s Meeting
Old man winter gave us a break for our first general meeting of 2007. This is fortunate because of all the activities we scheduled for tonight. First, we held our annual elections with Jerry Schinberg presiding over the election and Wayne Kraus performing the installation of officers.
Our main event for the evening was a discussion featuring Eric Kolacinski, one of the principles from Mark Drug Home Health. Eric reviewed the changes made in the ostomy supply business over the past 10 years including the consolation of retailers brought about by changes in Medicare and the insurance companies.
Eric talked about the current trend for retailers to accept assignment of supplies. This means that Medicare and insurance have a set fee they pay for product, which the retailer accepts as payment. To make this even more complicated, they each use special billing codes and pricing that is always changing. For us, we can simply order our supplies and if we are covered by Medicare/Medicaid or insurance; our retailer accepts the payment these organizations make, less deductibles and coinsurance. Quality-of-service now differentiates ostomy supply retailers.
He dramatized how well suited Mark Drug Home Health is to meet the needs of all people with ostomies. Not only can they answer questions about products, they can accommodate individual needs and circumstances. For instance, Rita from Hollister, Inc. mentioned how their customer care department is open until 5:30 PM on Fridays, yet the offices close at 4:45 PM. Many people call at that late hour needing emergency supplies that they have no way of sending those last 45 minutes. Eric said that if he were to receive a call from them, regardless of the date or time, he or his staff have an after-hours number, which he gave us, and that he could ship product for delivery within hours, or even open their store for emergency pick-ups. Now that is customer service! Eric may be reached at erikk@markdrug.com or 847-895-0011.
We would like once again to thank Donna, Mary and Rita from Hollister, Inc. for coming to our meeting, sharing their expertise on ostomy issues and bringing some treats. We would also like to thank Dolores and Renard for helping supply our Hospitality Table. The lucky winner of our 50/50 was our Treasurer, Tim with the consolation prize going to Ken, a multiple winner and a regular at our meetings.
We want to mention the success of our December fundraiser. Our members proved very generous giving us the resources to continue the good work of our ostomy association for 2007. We sincerely thank all of you who donated to our group this past year, including those who gave financially, our loyal volunteers, our industry supporters and our monthly speakers. We can only stay viable if enough of us work together for the benefit of all. With the multiple challenges of 2006 behind us, we are stronger than ever starting 2007.
We are thinking
about moving our monthly meetings to a new location, the faculty lounge at
Grant me the senility to forget the people I never liked anyway, the good fortune to run into the ones I do and the eyesight to tell the difference.
Due to a
power outage, only one paramedic responded to the emergency call. The
house was very dark so the paramedic asked Kathleen, a three-year-old girl to
hold a flashlight high over her mommy so he could see while he helped deliver
the baby. Very diligently, Kathleen did
as she was asked. Heidi pushed and pushed
and after a little while, Oscar was born.
The paramedic lifted him by his little feet and spanked him on his
bottom. Oscar began to cry.
The paramedic then thanked Kathleen for
her help and asked the wide-eyed little girl what she thought about what she
had just witnessed. Kathleen quickly
responded, "He shouldn't have crawled in there in the first place . . . smack
his ass again!"
Coming
Events
February 28—Peg Olsen, a talented holistic nurse from the
Note:
Our Board Meeting starts at 6:00 PM.
All are welcome to attend and see how our Ostomy Association is managed
and operated.
March 28—Mary Jane Wolfe, past president of FOW and
the Secretary of UOAA, will present a slide program showing the good work of
the Youth Rally. It is inspiring to see
the dramatic changes a person can achieve with a little support. This is a program especially designed for
people of all ages who have gone through ostomy surgery.
April 25—Our Anniversary Meeting will feature another
informative presentation by one of the leading researchers and practioners in
the field of ostomy care . . . Jan Colwell, RN, MS, WOCN from the
May 23—Our special friends from Hollister, Inc.,
specifically Mary Rome and a group of customer care specialists, are coming by
to talk to us about the wonderful resources available to us, whenever we have
ostomy issues we cannot solve ourselves.
June 27—Our “Welcome to Summer” meeting
July 25—We are honored to have Madeline Grimm RN, MS,
WOCN from
August 22—Discussions on the successes of the UOAA
Conference held in
September 26—Our “Welcome to Fall” meeting featuring a
favorite of our Association, Connie Kelly, WOC nurse from
October 24—Gail Meyer and Kathy Krenz, WOC nurses from Centegra-Northern
Illinois Medical will come to talk us
about convexity with ostomy skin barriers.
Gail had an exciting presentation last year, and we look forward to the
addition of Kathy this year.
Tired?
Wiped out, but too wired to sleep? Soak in a hot bath 60 to 90 minutes before
bedtime. It brings on sleep even better
than the popular sleeping pill Ambien, according to a recent study presented to
the Association of Professional Sleep Societies. What’s more, unlike pills, the hot soak
increases the amount of time spent in deep sleep, an important factor in
fighting fatigue.
Woman’s World, June
2006
Think like a Guest
By Joseph Rundle, Aurora,
IL Ostomy Support Group
As we prepare for the New Year, let us
think about how we present ourselves to the new person with an ostomy visiting
our group for the first time. As someone
with a new ostomy tries to navigate him/her through the isles of the hospital,
is he/she confused or are we easy for them to find?
Upon entering our meeting room, do they
see a group of friendly members? On the
other hand, do they see a group talking to each other and too busy to stop and
greet them? Is our room friendly,
cheerful, warm and welcoming, or is it just another meeting room that looks and
sounds cold? After the meeting, do we
thank our new visitor for coming and ask him/her if he/she enjoyed him/herself?
Cheerfully greet that new visitor with an
ostomy and direct them . . . no, take them to one our member who has a similar
type of ostomy. Please do not overlook
the fact that a spouse may like to talk to another spouse of an ostomy patient. Do not just leave the visitor with the other
person. Stay around for a little time
until they all feel comfortable in the situation.
These are just a few of all the things
that we, as an ostomy support group, should look to see if we are performing to
a level that exceeds expectations. After
all, we would like to see our first time visitor come back again and even
become an active member of our group. As
we start 2007, let us all do our part to make sure every ostomy visitor feels
welcome. If we start correctly, we
should be able to engage comfortably all our new ostomy visitors throughout the
New Year.
IBD Patient Symposium
On Saturday, March 10, we will once again participate, for the eighth year in a row, in the annual Crohn’s and Colitis Foundation of America’s IBD Patient and Family Symposium, “Knowledge is Power”. We have been invited to set up a booth so that visitors at the show have the opportunity to talk directly to us that experienced inflammatory bowel diseases and have gone through ostomy surgery. Especially relevant are those of us that are former ulcerative colitis patients and are now completely cured of that horrible and humiliating disease. We not only talk to other people who now are going through the same trials as we did and communicate how ostomy surgery changed our lives; but actually seeing that we look like everyone else dramatizes the wonderful future they can choose.
The Symposium starts about 8:00 AM and
runs for most of the day. It is held at
the
You are welcome
to join us on the third Saturday of every other month from 10:00 AM until
12:00 noon. We hold our meetings in
the cafeteria at the world headquarters of Hollister, Inc. in
Bladder Cancer
Advocacy Network
As we see the number of
people with urostomies increase in our ostomy support groups, we also recognize
that we sometimes lack all of the resources available for these folks. In 2005, BCAN was organized. BCAN is a national patient-based public
awareness and educational activities organization for bladder cancer. The website for BCAN is www.bcan.org
or phone at 301-469-6865.
Southwest
Suburban
The Southwest Suburban Chicago Ostomy Support Group is an entirely
volunteer ostomy association dedicated to the mutual aid, education and moral
support of people with ostomies and their families. Meetings are held at 7:30 PM on the third
Monday of each month throughout the year, except July, August, December and
January.
2007
February
19—Little Company of
Potter
Pavilion
2800
March
19—
127th
&
April
16—
May
21—
June
18—Little Company of
Potter
Pavilion
For information regarding this special ostomy group serving
Support Your Ostomy Association
We are now offering free membership to our
Association. To provide for our few
expenses (mainly the publishing of The New Outlook) we need your
assistance. Please send a contribution
to help maintain our group’s viability.
Name
& Address: ___________________________
__________________________________________
Send
To:
Ostomy Association of Greater
Mr. Tim Traznik, Treasurer
The
Applications
for Daily Living
Why
the Meditative Practices Work
Thursday, February 22, 5:30 PM
to 7:00 PM
Presenter: Deborah Kronenberger
Ancient
medical practitioners and philosophers told us our minds and bodies are one. Now modern science and research are helping us
understand these connections and their effect on health. Come explore and learn about the mind/body
connections in this experiential workshop. Please wear comfortable clothes. Program offered at no charge. RSVP 847-509-9595. The
Friends of Ostomates Worldwide
Joan Loyd gave us an update of the many challenges facing FOW in 2007. One of the most serious concerns is the need for volunteers to come to the warehouse to help unpack and repack boxes of ostomy supplies as well as assume leadership rolls. Make a resolution to stop by FOW just once this year. After you go there and see the good work that is done, we are sure you will want to return. Give Joan a ring at 847-724-8002.
FOW included a new charity on their list of recipients, which helps them send supplies to some of the world’s poorest and most needy people, Mathew25. This charity was set up to follow the principles laid forth in that verse in the New Testament by which they choose their name. This is the verse where God raises the dead at the resurrection and divides them into groups like that of goats and sheep. He sends the goats away saying that they did not serve him when he was on the earth. He invites the sheep to come with Him to heaven because they did serve Him on earth. When they asked how, He said that those who help the least on the earth serve Him. FOW mission is to fulfill this call made to all of us. God gives every bird its food, but He does not throw it into its nest.
Into the Ring
By Ellen Mills
(Reprinted with permission)
John
Sullivan leads an active professional life as the head of his own production
company (Naked Emperor Productions) and an accomplished editor and
cameraperson, but it was his boxing hobby that led him to Craig Wilson,
Thailand, and his most successful film to date: "Farang Ba (Crazy White
Foreigner)."
Craig
Wilson is a 46-year-old lawyer with an Ivy League education who lives and works
in
"I
met Craig while he was stateside in
"He
wrote to me that he had just fought a former Olympic Silver Medalist and he
only got knocked down three times," relates Sullivan. "He was hoping for a re-match and to only
get knocked down twice." Then in
another e-mail,
"It
was a bare bones shoot," he says, "Just I and another cameraman
[James Weber]." The two men shot on
mini-DV using Canon XL1 cameras. They
spent 12 days in
The
film conveys the familial atmosphere of the amateur boxing world in
"Craig
speaks Thai, he has Thai friends and he has gone places in
Sullivan
also shows unflinching scenes of
Upon
returning to the
When
he was finished, Sullivan had a one-hour documentary about a dynamic man who
has survived cancer, flourished in a foreign culture and become an accomplished
amateur athlete in middle age. Sullivan
took the film on the festival circuit and found that audiences responded
immediately to the story. Personal
stories of triumph have universal appeal and "Farang Ba (Crazy White
Foreigner) is no exception. At the
"Almost
everybody can take something from the film," Sullivan says. "People from 12 to 80 have seen the film
and gotten a lot out of it. It’s highly
inspirational and highly motivational." Distributors saw the appeal of the film too,
and Sullivan sold it to Trio Popular Arts.
Despite
the continued success of this film, Sullivan is practical about his profession,
acknowledging that business can be feast or famine. "It’s a craft," he says, “and
sometimes you have to do other things to pay the bills." For him, this means hiring himself out for his
shooting or editing skills. However,
"Farang Ba (Crazy White Foreigner)" has been one project that has
gone farther than its creator could have hoped it would go. With a production budget of less than $10,000,
"This one’s taken me all over the world," he says. Indeed, at the festivals, Sullivan’s modest
budget has stunned other filmmakers working with budgets three times that size.
"In
Sullivan
began his career as a Production Assistant at ABC News Productions. He did not stay long but the experience
provided good training and the opportunity to get some producing experience. He is a bit of a renaissance man himself as a
published poet, a writer and a member of the Screen Actors Guild. His narrative film, "The Buddha
Hood" won best short at the 1999 Foyle Film Festival in
It is
clear that Sullivan admires
Sullivan
sees his friend and subject as a role model for Americans abroad, citing the
power of individuals to polish the tarnished image that
As
the filmmaker speaks about himself and his subject, neither one seems to be the
type to shy away from a challenge. Sullivan
inspires other filmmakers by making meaningful films on a modest budget, and
For more information
about John Sullivan and his film, visit www.thenakedemperor.com.
Infertility Risk with IPAA
Reuters Health
Women with severe ulcerative colitis (UC)
who undergo colectemy with ileal pouch anal anastomosis (IPAA) have a threefold
increased risk of infertility compared with patients who receive drug therapy,
new research shows.
The findings "may influence
physicians to more strongly consider potentially hazardous rescue therapies,
including cyclosporine and infliximab, in young women with severe UC before
committing to a colectemy with IPAA," Dr. P. D. R. Higgins, from the
University of Michigan in Ann Arbor, and colleagues note.
As reported in the November issue of Gut,
the researchers searched MEDLINE, EMBASE and other medical databases for
studies looking at fertility outcomes in ulcerative colitis patients. Eight studies were identified, although one,
which had very high preoperative infertility (38%), caused significant heterogeneity
for the meta-analysis and was later excluded.
Analysis of data from the remaining seven
studies linked IPAA with a relative risk of infertility of 3.17 with
non-significant heterogeneity between the studies.
The weighted average infertility rates for
medically and IPAA-treated UC were 15% and 48%, respectively. No procedural variables were identified that
affected the infertility risk associated with IPAA, the investigators note.
"Additional research is needed to
identify modifiable procedure related risks and to determine whether
interventions to reduce scarring of the fallopian tubes may have an
ameliorative effect," they add.
Gut 2006;
55:1575-1580. Date Posted: December 1,
2006
Origins of Ostomy Surgery
By Keryln Carvill, RN,
BSc, Silver Chain Nursing Assn,
"And Ehud put forth his left hand,
and took the dagger from his right thigh and thrust it into his belly. And the haft also went in after the blade: and
the fat closed upon the blade, so that he could not draw the dagger out of his
belly: and the dirt came out" Judges 3:21-22 (King James Version). Ehud's mortal attack on King Eglon of
The origins of ostomy surgery are
entrenched in the antiquity of surgery. The
earliest reports of openings into the gastrointestinal system described rupture
or perforation because of trauma rather than surgery. This is not difficult to comprehend when one
considers the history of violence and wars that has accompanied man's journey
down through the ages.
It is appropriate that the word 'stoma'
has its origins in the ancient Greek language for they were often at war and
appeared to have had considerable experience in perforating injuries of the
abdomen. Ancient Greek physicians such
as Hippocrates (460-377BC) and Celsus (53BC-7AD) wrote that wounds of the large
intestine were not deadly where as wounds of the small intestine and bladder
resulted in death (
Another ancient medical figure was Galen
(130 - 200AD), who was surgeon to the Emperor Marcus Aurelius and the Roman
gladiators, and one presumes very experienced in traumatic perforations of the
abdomen. In his prolific writings, he
discussed surgical management of the large intestine and abdominal wall
following penetrating injuries; however, he believed little could be done to
save the person with a rupture of the small intestine (Haeger 1989).
Throughout
the ages, military surgeons have been presented with great challenges in caring
for traumatic wounds. These challenges
were exacerbated from the 14th century onwards, for it was in 1346 at
Acute bowel obstructions and perforations
occurred not only within the realm of the military but royalty has been sorely affected.
King Stephen of
The first recorded royal, though not the
last, who had an ostomy was Queen Caroline, wife of George II, who died in 1736
from a strangulated umbilical hernia. She
endured seven days of suffering before her gut ruptured, but alas to no avail,
for she died three days later (Leavesley 1996).
William Cheselden (1688-1752), a British
surgeon, had a 73-year-old patient, Margaret White, who ruptured her abdominal
wall following severe vomiting. Cheselden
removed the gangrenous portion of prolapsed gut and left the sound portion,
thought to be small intestine, hanging through her umbilicus (
Surgeons of that period were reluctant to
operate on the bowel for fear of peritonitis and inevitable death to the
patient. This was not only harmful to a
surgeon's reputation but the major stimulus for what is considered today, some
bizarre medical practices. These
included purging with laxatives and enemas, attempted dilatation via the anus, bloodletting
and the consumption of large amounts of mercury in the hope that the heavy
weight of the substance would push through the obstruction. Death due to mercury poisoning was a common side
effect (Leach 1986).
Thomas Sydenham, a noted London physician
during the mid-1800's, recommended horseback riding as a means to assist the
passage of stool through obstructed gut and his treatment for paralytic ileus
was to keep a kitten on the distended abdomen, presumably for the warmth (Leavesley
1996). Failed treatments such as these
usually resulted in the death of the patient.
Colostomy Surgery
History records but a few pioneering
surgeons who were brave enough to experiment with attempts to create an
artificial anus when medical treatments failed. The first planned colostomy procedure was
performed in 1776 when a French surgeon, M. Pilore, operated on an M. Morel. Surgery was seen as a last resort when other
aggressive non-surgical treatments such as purgatives, dilatation and the consumption
of two pounds of mercury had failed to clear his malignant bowel obstruction. An opening was made into the caecum and the
bowel was sutured to the skin. A sponge
held in situ with an elastic bandage was used to control the effluent between
regular enemas. All went well for two
weeks until the patient died two weeks later. An autopsy attributed the cause of death not
to surgery but to a gangrenous small bowel, from which was retrieved the two
pounds of mercury (Cromar 1968).
A French surgeon, Duret, performed the
first successful left inguinal colostomy recorded in 1793 on an infant who was
born without a rectum. Although the
infant was close to death prior to surgery, he recovered to live for 45 years (
Other European surgeons who added their
names to the list of pioneers were Professor Fine, from
A Danish surgeon, Hendrik Callisen
(1740-1824) described in his surgical textbook, a surgical lumbar approach for
performing a colostomy, this he claimed would reduce the risk of damage to the
peritoneum and thus reduce the risk of peritonitis. However, his colleagues of the day disagreed
with his technique stating that the increased benefits did not outweigh the
increased difficulty to perform such a technique (
The first British surgeon to perform a
colostomy was George Freer who in 1815 operated on an infant with imperforate
anus and in 1817 on a 47-year-old farmer with rectal obstruction (Cromar 1968).
Both patients lived but weeks, an excess
of therapeutic zeal no doubt assisted the farmer’s demise post-operatively, for
daily purgatives and numerous enemas via the stoma resulted in a ruptured
caecum.
The second surgeon to perform colostomy
surgery was Daniel Pring, who operated in 1820 on a patient who was quite
coincidentally named Mrs. White. Pring
described in detail the formation of a sigmoid colostomy and Mrs. White's
complicated recovery. It is perhaps the
first record of post-operative stoma complications such as skin ulceration and prolapse,
and discussions of ostomy appliances. It
appears that Mrs. White found what appeared to be an elaborate truss-like
appliance not as effective as a pad and binder in containing her two stools per
day (
Pring's comments highlight the necessity
even in 1820, of providing expert stomal therapy care and choice of appropriate
appliances for stoma management. Pring
thought the colostomy was a great benefit for it was his belief that the
colostomy: "has afforded her a moral, as well as a physical advantage; for
she is now at a no loss for an interest, and is provided with something to
think of for the rest of her life" (Richardson 1973, p18).
Generally, few surgeons of the day were
courageous enough to perform bowel surgery for they feared to enter the
peritoneum for risk of causing mortal sepsis. Knowledge of bacteria, antiseptics and the
importance of asepsis were yet to be gained. Jean Amussat (AD 1796-1856), a French surgeon,
believed that the ignorance of his colleagues was also compounded with the fear
of compromising one's reputation if the patient should die.
Amussat carried out a retrospective review
of all published surgical colostomy procedures. He found that between 1716 and 1839 there were
27 cases listed but only six people had survived (
Ileostomy Surgery
The first recorded operative ileostomy was
in 1879 by Baum, a German surgeon from
Maydi reported a successful recovery in a
patient following an ileostomy procedure from
Ileostomies carried with them unacceptably
high morbidity and mortality rates up until the 1950's. The high mortality rate was often due to the
critical, often moribund condition of the patient following acute or lengthy
episodes of ulcerative colitis or Crohn’s disease. There was still much to be learnt in the care
of the patients with a spectrum of conditions broadly termed inflammatory bowel
disease. During the first half of this
century, an ileostomy stoma was made by a small prolapsed section of ileum and
allowed to heal to the skin surface. Ileal
dysfunction, a complication attributed to obstruction of the stoma and
characterized by cramps and excessive loss of ileal fluid, dehydration and
electrolyte disturbance, resulted.
It was not until 1952 that Professor Bryan
Brooke from
In an attempt to eliminate the need for
wearing an appliance, a Swedish surgeon named Nils Kock developed a continent
ileostomy in the 1960's. An internal
pouch or reservoir was made from lengths of ileum and the patient taught to
empty regularly using a catheter. Leakage
remained a problem however, and in 1972, he overcame the problem by designing
an intussuscepted valve in the ileal outlet, which provided a leak-proof
mechanism (Kock 1976). The Kock pouch
offered another choice for some people but it was still very different from the
normal means of defaecation.
Rudolph Nissen, a Berliner, successfully
performed an ileo-anal anastomosis in 1933 in a patient following the removal
of the large intestine. However,
diarrhoea complicated quality of life for many people and few were satisfied.
In order to reduce the degree of diarrhoea
experienced by a patient with an ileo-anal anastomosis, Peck in 1971, created
an ileo reservoir or artificial rectum (McGarity 1993). This surgery became known as restorative
proctocolectomy and various surgeons went on to describe individual techniques
which are identified by an ileal pouch alphabet such as J, S, W and H that we
know today (Tjandra & Fazio 1993).
Urinary Diversion Surgery
The first record of diverting urine from
the ureters into the rectum was performed in a child with congenital
abnormalities in 1851 but the child died (
Verhoogen and de Graeuwe fashioned a
pseudo-bladder from caecum and created an appendicostomy in 1909 similar to the
urinary pouches of the 1980's. Coffey in
1911, devised a procedure where he implanted the ureters into the sigmoid colon
and thus urine and faeces were evacuated via the anus but this method was
abandoned because of electrolyte disturbance (Brooke 1980).
Successful urinary diversions were not
achieved until 1950 when an American surgeon, Eugene Bricker, described a
procedure using a small section of terminal ileum, as a conduit to deliver
urine from the ureters to the abdominal wall, and for fashioning a urinary
stoma (Turnbull 1994). Since the
fifties, Bricker's ileal conduit procedure has remained the most commonly used
technique for urinary diversion.
References:
Brooke, B. (1952). The Management of an
Ileostomy Including Its Complications.
The Lancet, 2, 102 –
104 Brooke, B. (1980). A History of
Stomas: From King Stephen to Dr Turnbull.
The Newsletter of the
World Council of Enterostomal Therapists, 1(2), 1-3 Cromar, C. (1968). The Evolution of Colostomy. Diseases of Colon & Rectum, 11, 256-280,
367-390, 423-446
Haegar, K. (1988). The Illustrated History of Surgery,
King James Version of
the Holy Bible,
Present Status of the
Continent Ileostomy: Surgical Revision of the Malfunctioning Ileostomy. Diseases of
Historical Aspects of
Colostomy. Australian Association of
Stomal Therapy Nurses, Summer 20-21
Leavesley, j. (1995). Stomata History. The Journal of Stomal Therapy
McGarity, W. (1992). Salute to ET Nurses, Journal of Enterostomal
therapy, 19(2), 40-41
McGarity, W. (1992). In Hampton B & Bryant R. Ostomies and
Continent Diversions, St Louis: Mosby Year Book McGarity, W. (1993).
The Evolution of
Continence Following Total Colectemy. Journal
of World Council of Enterostomal Therapists, 13 (4), 10-16
The Abdominal Stoma: A
Historical Survey of the Artificial Anus.
Status of Ileoanal
Reservoirs. Journal of Enterostomal
Therapy, 20(2), 56-62 Turnbull, G. (1994).
Guest editorial. Journal of World Council of Enterostomal
Therapists. 14(2), 6-9
Psychological
Issues
Here are some of the types of people who fare better after ostomy
surgery.
·
Those who think of others
before themselves
·
Those who look outward
and upward
·
Those who are busy and
active
·
Those who are interested
in life
·
Those who are always
inquiring and learning
·
Those who are not bogged
down in grief
The four L’s of the ostomy patient are
Learn—through your local ostomy association
Lean—on each other
Laugh—through troubles with a positive outlook
Lead—others through your good example
Hypnotist’s Slip of
the Tongue
It was entertainment night
at the
He began to swing the watch gently
bank and forth while quietly chanting, "Watch the watch, watch the watch,
watch the watch . . ..”
The crowd became mesmerized
as the watch swayed back and forth, light gleaming off its polished
surface. Hundreds of pairs of eyes
followed the swaying watch, until, suddenly, it slipped from the hypnotist's
fingers and fell to the floor, breaking into a hundred pieces.
"Shit!" said the
hypnotist. It took three days to clean
up the senior center!