You’re never too old for a field trip

Cartoon of kids in bus with "Field Trip" on side of bus.

I am so excited I hardly slept a wink. Maybe that wasn’t the greatest idea since I have a special day ahead. I’m going on a field trip!

My walking group from the park, now disbanded, will be gathering for a reunion. I don’t know what to call us, since we are in no way Desperate Housewives. We could be the Fabulous Four. First and foremost we are friends. Remember, dogs are the best connectors.

Although these three women knew each other before I came along–two are besties from way back–they kindly let Jelly and me join them on their off-leash walks. The four dogs were a motley crew: the hearing-impaired grande dame, the protective and loving stick shredder, the puppyish overgrown runner, and the howling hound (that’s Jelly). Somehow the dogs all got along, and often three of the four would race through the trees while the grande dame sniffed along, keeping her eye out for us since her ears weren’t much use.

I met these lovely gals and their pooches soon after my leukemia diagnosis. Actually, J. met them first, but as I became strong enough to return to the park, they let me join in. I was trying to adjust to a life without my work and to manage my social isolation, both of which were new challenges for me. These women took me in warmly, providing companionship while also watching over me. I must have been pretty needy back then, as I still am now, but somehow they tolerated that.

The group was physically protective as well. Because they were aware of my bruising capacity, they blocked other dogs from jumping on me and helped me over icy patches so I wouldn’t fall. Even the kind son of one, when I see him, assumed his mother’s caring role in her absence. From these gals, I received offers for help with the dog if I was unwell, which is exceedingly generous given Jelly’s poor behaviour.

Two of these kind lasses have since moved an hour west but we stay in touch through email. We two who were left behind still catch up at the park, perhaps less often but only because I am an unreliable park attendee. All three women continue to follow the blog, which helps me to feel connected with them through the absences.

For some time, I have wanted to drive west to catch up with the two who’ve moved, but have not felt up to managing the highway drive solo. Not only that, but protective J. forbid it, for good reason. She’s seen me on the worst of my stoned-from-medication days. Thankfully, my remaining park compatriot volunteered to chauffeur, so off we go today. The small-town girls will be generously providing lunch and mountain views while we city folk will bring dessert and our engaging personalities (that’s assuming I can stay awake).

Jelly will not be joining us today, however. The only way to ensure she doesn’t steal everyone’s lunches off the table is to leave her at home. Yes, I’m crating for the greater good.


Would it help to know your end date?


Snoopy and Charlie Brown sitting on a dock, Charlie says "Some day we will all die, Snoopy." Snoopy responds: "True, but on all other days we will not."

There’s a new book out that’s getting great reviews but I can’t read it. When Breath Becomes Air is written by Paul Kalanithi, a neurosurgeon who was diagnosed with terminal cancer at age 36. He died the following year. In his book, he wondered how to best use his remaining time since he didn’t know how long he had. His resolution? “Even if I’m dying, until I actually die, I am still living.”

His insights sound compelling and insightful, right up there with Being Mortal by Atul Gawande. Had Kalanithi not died, I might read the book, but I’m too wimpy to stare death in the face. Maybe one of you could read it and tell me what I’m missing.

From what reviewers have written, Kalanithi’s musings were insightful and philosophical. My own thoughts about death are more simple, more concrete, more practical. I’d like to know exactly when I’ll die so I can sort a few things out, such as:

  1. When should I complete that last bit of client filing that’s been in my desk drawer since I was diagnosed with leukemia over three years ago now?
  2. When should I cancel all my library holds, pay off my 50¢ overdue fine and return all my books? I don’t want J. to have to rely on the kindness of librarians after my death. If I knew my due date, I could make sure I end my relationship with the library on good terms.
  3. Need I start on my 2015 taxes? J. too would die, but of a heart attack, soon after I’m gone if she had to address my self-employment filing system, i.e., one big messy pile each year.
  4. Should I schedule coffee with you this week or will I be around next week?
  5. Should I buy those cute new yoga pants or a few new shirts to cover my girth or those snazzy shoes if I’ll barely be able to wear them? I buy few clothes as it is, and they won’t fit J. after I’m gone, now that there are 6 sizes between us. Knowing my end date could make me one of those anti-consumer fanatics.
  6. Toilet paper is on a tremendous markdown this week. How much should I hoard?
  7. Will I have time to finish that $6 cauliflower we bought earlier in the week? Furthermore, how much home-cooked food should I be stocking in the freezer? People often lose their appetites after the death of a loved one (and the dead person doesn’t eat much either). J. eats like a bird at the best of times, so any leftover meals will likely get freezer burn. Although I worry about J.’s not eating through grief–alternatively, she may binge on all the high-sodium foods we’ve kept out of our home–I won’t be here to force feed her. Hey, could you guys could ensure she doesn’t waste away?
  8. Are there any other loose ends I should be cleaning up so they’re not left to my beloved Antiprocrastinator after my demise?

I could go on.

I won’t know my end date until it arrives since no one does. In the meantime, I’ll try, like Dr. Kalanithi, to keep living until I die. Waiting to die is the alternative, and what’s the fun in that?

Around the world in 24 hours

Person's hand holding a miniature globe

It seems I worried some of you with last Friday’s post. Well, after a full weekend of keeping my swollen finger elevated on my softest feather pillow and scanning my arm regularly for the return of those ominous red streaks, I seem to be fine. You don’t really think I’d sit around elevating my finger, do you?

To the disbelievers: how could you take me for the drama queen type? I never exaggerate. A real drama queen would have barged into the doctor’s office at the first sign of the scratch. I didn’t do that; I waited until the infection spread to my lymph nodes. When I went to the doctor, I apologized for bothering her over a scratch while she chastised me for not coming sooner. I’d say the doctor was the drama queen.

Rather than sitting around nursing my miniature wound this weekend, I went travelling. I completed my home yoga practice–hello India!–while watching Giada’s new show on Food Network. I don’t like the show much but it’s filmed on the Amalfi coast so the scenery is grand.

Then J. and I went to Brooklyn, the movie that is, which took place in…wait for it…Brooklyn, and a small town in Ireland. (As a completely unrelated aside, Brooklyn was much better than Carol, which I was supposed to like since I’m gay. It was a “nothing ever happens” movie, and the characters were not very likeable. Also, every shot was filmed through a rainy window. What a downer. The critics gave it 5 stars, but I took off one for each time I fell asleep, which brought my rating down to 0.) Brooklyn deserved its rave reviews, and by the end of two hours, I had crossed the Atlantic.

If a scratch puts me at risk of sepsis, Montezuma would surely intrude on any trip to Mexico. Why not bring Mexico here instead? So we ate Mexican for dinner, tasty bean tostadas with fresh salsa verde, chipotle sour cream, and jalapeño cheese. Sweet and spicy and crunchy and fibrous all in one. The meal was pretty yummy, if I might say.

Right after dinner, Downton Abbey was on–good thing I’d done yoga earlier or I’d have seized up from all the sitting–so back to the UK we went. To get in the spirit, I had bought some Cadbury caramel biscuits which J. and I enjoyed for dessert. You know where the real Cadbury factory is, right? But did you know Cadbury chocolate tastes better in England?

This morning, since J. was not working and the sun was shining, we had planned to head to Antarctica with the Calgary Zoo’s Penguin Stroll. J., ever the pragmatist, said that if we were going to pay for zoo entry, we’d better traverse a few more continents while we were there. I agreed with the plan.

Alas, we were a bit late heading out because Jelly and I tarried at the off-leash park. We both met up with good friends–it’s great when both members of the human-dog couple get along. And, despite all my adventures, on this most beautiful of days, I realized I’m pretty lucky to be right where I am.

Although I am looking forward to dinner of Thai stir fry with $6 cauliflower. It’d better be good.

Calling all Germinators!

I’ve decided to write a blog post so I can burn enough calories to earn dessert after dinner. I’ll let you know how it goes. If it doesn’t work, maybe next time I’ll go for a walk instead.

I want you to think back to those high school parties. (I was too busy studying to attend, so I’m using my imagination.) There were the friends who came early to help set up, brought food, and stayed late to clean up. Then there were the others who sent out the invitation on Facebook, lazed around with all the party crashers, spilled drinks on the carpet, and moved on to the next house, leaving destruction in their wake.

Picture of 5 female superheroes flyingThis is the difference between your white blood cells and mine. We all need white blood cells to fight infection, and I have 3 or 4 times as many as you healthy folk. With such an abundance of infection fighters, you’d think I’d be healthy as a horse, but in fact I’m immunocompromised. My white cells are the ones who show up at the party with their hoards of friends but don’t do much to help when I need them. I’m calling them Germinators, even though mine don’t really deserve the superhero moniker.

And so we arrive at the events of the past week. It starts with my scratching my finger. Dumb, dumb Annie. It was a superficial scratch since I’m a shallow person, the skin barely broken, but the darned thing wouldn’t heal. Germinators crowded the scene, but they were just hanging out rather than helping clean up.

Within a week, I was in such pain that I called the doctor. Despite what you might think, I don’t call the doctor very often. So when I do call, I really need to get in. Unfortunately, Dr. Family didn’t have time to see me for another two days. Because I am a loyal patient and didn’t want to attend a walk-in clinic–I’d need an hour to provide my medical history–I waited it out.

This, folks, was a mistake. While I was waiting, and my Germinators were lazing around, I developed weird red streaks up my arm. Yes, my Germinators extended the party to my lymph nodes. Lymph node infection can result in bloodstream infection. Last time my bloodstream came to the party, I ended up in the ICU for 13 days.

But not this time. My Germinators finally got off their arses and started cleaning up, the inflammation in my arm settled, and day by day my finger is healing. Unsure whether to keep my doctor’s appointment, I decided to go so for guidance in the event of another life-threatening scratch.

When I arrived at the office, I apologized for wasting Dr. Family’s time. Her response? “OMG (or something like that)! A few more days and…. Next time, get thee to my office forthwith. Oh, and do you realize that every time you visit, you apologize for wasting my time? I just ignore you.” No wonder I adore Dr. Family.

Next time my Germinators bail on me, I’ll go directly to the doctor. I will not pass go and I will not collect $200. Oh, and I will not apologize.

Anything I can do to help

I’m awfully fond of the CBC, as you know, and I’m not talking about the blood test here. It’s amazing that our national station has survived despite all the cuts it has endured in recent years. Every so often it even creates a gem.

I was getting bored of Border Security reruns–how many times can you watch a disgusted customs officer pull a rotting snake out of a jar?–so I happened upon another airport show created by our national station. It’s called Hello Goodbye and it’s a reality series that takes place in the ginormous Toronto Pearson airport.

A nice fellow who describes himself as a psychotherapist wanders up to people who are Helloing or Goodbyeing and asks them all sorts of intrusive questions about their relationship. Within minutes, these strangers are sharing intimate details of their lives for the camera. The interviews are edited so these conversations go from 0 to 100 in intimacy within seconds, to be broadcast later for public consumption. We feel like we are eavesdropping on their private lives.

Why do I like this show? The person who came up with the premise of the show is brilliant. There is so much intense emotion with all the comings and goings at the airport. No wonder it always makes me cry. The stories are so moving, the people so loving and open and so brave to share their stories publicly.

But the intensity of their expressed emotion makes me nervous. Is anyone following up with these poor folks after they bear their souls? It feels like a one-shot psychotherapy session with no plans for future contact. Let’s expose all those vulnerable issues and leave you to sort them out yourself.

I’m recalling a particularly compelling spot between a loving father and his adult daughter, who was about to return to work in another city on the other side of the country. The closeness between the two was obvious, and both of them were quick to tears through the interview. She’d never told her father that she was planning on resettling in her new location until that day on camera. After his daughter left for her flight, the camera followed the dad to a bench, where he sat down and started weeping.

This is very tender and all, but the poor guy looked absolutely devastated by his daughter’s departure. Is anyone going to be there to help him work through these feelings, or is he going to be crying in the car all the way home? If you’ve ever driven the highways near Toronto, and Highway 401 in particular, you’ll know why crying while driving is contraindicated. Evoking this kind of emotion without follow-up support is irresponsible, at least in my view.

Creative thinker that I am, I’ve come up with the perfect solution: As these devastated interviewees are leaving the scene, overwhelmed with emotion, hand them my card. I’d be glad to help them resolve all those issues the interview raised. Heck, I could use a few new cases; I’ve got time on my hands since my doctors don’t want much to do with me lately. Sometimes I’m so altruistic, I can’t stand it.

Two women in teary embrace at airport

Forgive me, Doctor, for I have sinned

Picture of whole and part grapefruit

What if Adam had eaten this forbidden fruit?

Dear Doctor:

It has been over 52 years since my last confession. Remember, I’m Jewish, and Jews don’t do the whole confession thing. Our Day of Atonement is months off, so I hope you won’t mind my beseeching you now. My sin is weighing heavily upon me.

Every winter, as citrus season arrives, I make do with the usual tasty but inferior navel oranges while J. enjoys her daily grapefruit. When I am buying groceries, I make sure my beloved spouse is in good supply of such fruit when in season. I miss grapefruit terribly, the smell, the taste, the whole experience, and I’ll admit I have long coveted J.’s stash. It pains me to have this most delectable of fruit in our home because, for many years now, grapefruit has been verboten for me.

This past weekend, as I sat in the living room watching (what else?) Border Security, I could hear J. in the kitchen peeling her grapefruit. Soon the smell was wafting my way. When she sat down beside me, I asked her ever so sweetly whether I might have one segment. Just one. She shot me the evil eye while searching her bowl for the smallest piece. I ate it slowly and lusciously, openly defying my lifetime ban.

Why am I not allowed grapefruit? Because grapefruit has a compound that interferes with the elimination of my chemotherapy, allowing excess amounts of the drug to build up in my bloodstream. This excess may cause heart arrhythmias or even a heart attack.

How do I know this? Now we get to my other, more grievous sin: I looked this information up on the internet, after I had consumed the grapefruit section. So often I have warned my readers not to seek medical information on line, but I did not heed my own warning that day. I recklessly sought an answer to my query. Thankfully, my searching did not raise my anxiety, as it often has in the past, but it confirmed for me that the prohibition against consuming grapefruit is valid and important.

Still, I figured one segment on one occasion wouldn’t hurt. And it didn’t, I hope–no heart attack yet–although the effects of these evil compounds can interfere for some time after consumption. If I look like I have really bad leukemia today, it is indeed because of my sins of the weekend.

I do not know what penance you will decide upon, but I’d appreciate your leaving out the Our Fathers and Hail Marys. I am Jewish, after all. Perhaps I could do some public service, such as educating people on the importance of heeding all written warnings on their prescription bottles. I also hope you’ll absolve me of the sin of my internet search; I didn’t want to burden the unfortunate pharmacists working the weekend shift.

When you determine my penance, please factor in my bravely confronting my wine gums addiction today. I walked toward the bulk bins, stopped at the wine gums, and proceeded to the till with nary a purchase. I am trying, Doctor, I really am.

Your devoted patient,


What I learned from the humble fruit fly

Picture of fruit fly

I have so much to learn from you, drosophila.

[Note to self: Never commit to blog post topic without a written draft. Drosophila? What was I thinking?!]

Imagine being the only one in a room who does not know what a drosophila is. That was me a few weeks back. Oh, I was so ashamed. But I got over it.

Yes, I was hanging with Drs. Hound and a few of their neuroscientist friends–there were a lot of IQ points in one room–and the topic of fruit flies arose. I had not realized how much one can learn from this tiny being. Turns out because their life spans are so short–approximately 2 weeks if I heard correctly–they are perfect subjects for all sorts of important research.

I learned, for example, that approximately 20% of fruit flies’ energy is consumed by their teeny tiny brains. Although it is a far reach to assume the same is true for humans, let’s assume so for the sake of argument. If indeed 20% of my caloric intake is consumed by my brain, it is no wonder that: a) I was ravenous the day following our media event on Monday; and that b) I could barely move for a few days after, I was so wiped.

I doubt you’re wondering why I was hungry. I’m always hungry. But I was all the more famished, I know now, because I had used so much energy to think. Yes, I had to construct coherent answers to insightful questions on the spot while I made sure to look at the camera, tried not to say anything utterly inappropriate as is my nature, and fretted about how much I looked like I had leukemia that day. After the recording was over, I spent the rest of the day thinking about how I might have answered the questions more incisively. No wonder I was ravenous the next day. Imagine all the calories I had burned thinking.

My thought-induced caloric deficit surely explains my exhaustion the next few days. I was catatonic on my couch most of that time watching Food Network reruns. (Border Security was not on.) I did not go anywhere or do anything. I was even too tired to nap.

But there’s more. On that fateful night, surrounded by really smart people, I also learned that fruit flies who are bred to be smarter do not live as long. Yes, dumber flies live longer.

This information raises many additional questions. How the heck do scientists measure a fruit fly’s intelligence? I’ve done a lot of IQ testing in my time, and I can’t imagine testing materials small enough for a fruit fly to manipulate. Also, I don’t speak fruit fly. Kudos to the scientists for overcoming these barriers.

If we put the measurement challenges aside, the theory does enlighten me about my own experience. Recall my recent treatise about how unsmart I am according to current IQ protocols. Perhaps I needn’t worry about dying young after all. Yes, I could be here for a while yet.

There are two lessons to be learned from this post. First, for those of you trying to lose weight in the New Year, don’t restrict your eating, just increase your thinking. And second, only the bright die young, so don’t think too much.


ICU, U C me, but I don’t C me

So much for picking up groceries today. I managed to forget both my wallet and my phone when I went out. No money, and no way to text J. incessantly for her input. Oh well. The grocery store will be there tomorrow.

Further to my last post, I spent 13 days checking out the facilities in Calgary’s state-of-the-art ICU. Except there are no facilities, or at least not for the inpatients.

Yes, one of the first things I noticed upon my arrival to the Unit was that my room had no washroom. This perplexed me. Where would I go when I had to go? It turned out I would have to go in bed, with assistance of course. Catheters, diapers, and bedpans are ICU staples. Thank goodness for that little red call bell.

J. explained why I wouldn’t be getting out of bed when she spotted the hard-to-miss Octopus (her term), a multi-armed IV stand. The usual spindly IV stand in a regular hospital room, a.k.a. The Skinny Bitch, would be dwarfed by this monster. My Octopus held numerous bags of medication, fluids, and nutrition to keep me alive. Yay, no hospital food!

So, you see, the reason there are no facilities in these rooms is that ICU patients are so enmeshed with their Octopi (of course I had to look that plural up) and other medical equipment that they cannot get out of bed. For the same reason, inpatient yoga classes are not offered to help ICU patients manage the stress of being in hospital.

The other thing missing from my ICU room was privacy. The wall facing into the Unit was all windows. That allowed all the “smart kids” (defined in previous post) to watch over me day and night. My nurse’s station–yes, I even had my own nurse–looked into my room. Thankfully, curtains could be drawn when I was being changed (interpret “changed” as you will). I would have changed myself but recall The Octopus, above.

Beagle looking in small mirrorTo this day, I am grateful there was no mirror in my room. Had I been able to see what my medical crisis was doing to my body, I might have died for real. Once I was transferred back to a regular unit, I was horrified when I first caught my reflection. I did not recognize this person, with my distended belly, spindly legs and arms, and jaundice. The washroom fixtures were mustard yellow–call it “midcentury outdated”–a highly insensitive choice of colour for the jaundiced among us.

I pray you are never in the ICU as a patient or visitor, but if you are, you’ll know now what to expect. Be sure to bring your own diapers, to ask for the blinds to be drawn as needed, and to leave your compact at home.

I realize these last two posts have been intense. Don’t worry, dear followers, Friday is coming, and Friday is fish for you and levity for me. I’m gearing up to talk about the drosophila (please don’t ask me the plural of that one). You now have 24 hours to look the word up if you, like me, don’t use it often in a sentence.


That which did not kill me made us stronger

I know, I know, I let you down yesterday. Had I not given up apologizing, I’d tell you I’m so sorry. You’ll just have to trust that I was conducting important volunteer business.

While you were anxiously awaiting my words of wisdom, J. and I were participating in a video that will be used for ICU training. The multitalented communications guy/videographer, the kind and supportive manager of the ICU, and Jess, my Cancer Centre volunteer “boss”, congregated at our house for the event. I baked, of course. I couldn’t help myself.

I jumped at the chance to participate in this venture when Jess raised it a few months back, but I needed J.’s involvement too. Really, we were both in the ICU for 13 days, even if I was the only one with a bed. J. also recalls that time much better than I since I was a wee bit looney tunes, for lack of a better term.

If we can do anything to make someone else’s health-care experience easier, why wouldn’t we? My body’s a lemon but I can still make lemonade, at least sometimes.

As we told the crew, J. and I thought we were experts in hospitals and doctors until I landed in the ICU. J. believes the “smart kids” work there, and I concur. Those “kids” kept me alive. J. likes to say that I was too stubborn to give up the fight. (FYI: J. doesn’t often consider my stubbornness a positive attribute.)

Despite the exemplary care I received, I unfortunately only have bad memories. I was scared and disoriented, and I didn’t understand why I was there. I could not tell day from night because all my windows faced indoors. I had visual hallucinations from the drugs I was on. The experience was traumatic for me, but my disorientation buffered me from the worst of it.

Although I thought I knew everything there was to know about J.’s experience of that time, I was further enlightened yesterday. For example, I learned J. was reluctant to leave me alone because, however disoriented I was, I started fussing whenever she let go of my hand. I believe the ICU was much harder on J. than me because she had to watch me struggling. Half-full-cup gal or not, at times she feared the worst.

I also described the short- and long-term physical, emotional, and cognitive consequences of my ICU stay. Ever heard of PTSD? Did you know it’s a common consequence of time in the ICU? Immediately following my discharge, I had nightmares and heightened anxiety. To this day, my motor skills are impaired–I’m always heading for a fall–and my ability to handle stress is poorer. I cannot think on my feet as well as I once could, and my attention span is shorter. I am more impatient and easily frustrated.

I appreciated the opportunity to talk about the experience with others who understood, despite having to revisit the trauma. (Of course I’d say that; I’m a psychologist.) Yes, our discussion was upsetting, but it was also healing.

J. and I have grown closer since this time, but, sadly, she’s never again commended me for being stubborn. She’s pulled out her hair, maybe, but never praised me. Oh well, I can’t expect her to appreciate all my finer attributes.

Quote: Being stubborn can be a good thing. Being stubborn can be a bad thing. It just depends how you use it."

Mittens Anonymous, anyone?

6 wine gums of different colours

The purple ones are the best.

Did you know that people are more likely to follow through with commitments they share with others? This so-called public commitment theory is used in programs like Weight Watchers–group shaming after an overindulgent week, anyone?–and Alcoholics Anonymous. It’s also the reason I share my self-improvement resolutions with you. If I blow it, I’m accountable not just to myself but to the world.

Of course, this theory presumes I care what others think of me, which I do. Anxious people care about all sorts of things that unanxious people don’t give a second thought to. (Yes, I realize “unanxious” isn’t a word, but it works, doesn’t it?)

And so I confess my relapse on the wine gum front yesterday. I resumed my filthy habit of grabbing a bag when I passed the bulk bins, choosing 6 wine gums, and adding them to my other groceries. (No, I didn’t write out the bin’s code because I’ve memorized it.) Yes, I bought and immediately consumed 33 grams of sin (after paying, of course, since anxious people never steal from the bulk bins). I feel such shame. But today is a new day. On a positive note, I did manage to pass by this bin on several previous occasions without indulging, and during my relapse, I took fewer candies than I had of late. But we all know one cigarette with friends over drinks quickly progresses to a pack-a-day habit.

In contrast, my home-based yoga program has been proceeding brilliantly thus far. I’ve used the extra mat time to focus on poses that are challenging for me, even throwing in a bit of Pilates for good measure. Some part of my body is stiff almost all the time, but it’s a good stiff. I’ve even made some progress on a few poses. Soon I will be flying like a crow without giving myself a concussion, I’m sure. That’s if Jelly stops trying to play Twister with me.

But there’s one resolution I neglected to share with the group for fear of failure. No wonder I’ve already blown it repeatedly; I did not allow for group censure. It’s time I come clean. Now that winter is truly here, I thought I might recommit to my outerwear. For years now, on the coldest of days, I’ve taken to carrying my mittens between the car and my destination rather than putting them on my hands. In no time, my fingers turn blue from the cold and take hours to warm back up. For those of you who don’t know, mittens lose their effectiveness if they are not worn on hands.

The other day, I reluctantly shared my dirty little secret resolution with J. The public shaming came fast and furious, especially when we headed outdoors shortly thereafter, my mittens grasped firmly in my hands. I realize I deserved the verbal spanking I received.

I feel like such a loser, but I’ll keep trying. You never know what might inspire me to change. Perhaps an unrelenting cold spell, or shovelling, or a little frostbite. If I can floss even on vacation, I can do anything. Come to think of it, wearing those mittens would lessen the pain of holding the wine gum bag when it’s -30° C. If that isn’t motivation, what is?