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Michael Detsky Profile
Michael Detsky

@michael_detsky

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father, husband, pats fan, ICU physician and researcher

Toronto, Ontario
Joined January 2017
Don't wanna be here? Send us removal request.
@michael_detsky
Michael Detsky
3 years
I deleted twitter off my phone because I was going on clinical service for 3 out of 4 weeks in the ICU. I found it was a negative distraction. However, after the Ontario government’s latest restrictions to curb transmission of COVID-19, I had to see what people were posting. 1/10
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@michael_detsky
Michael Detsky
3 years
After coming off a week of service in the ICU, I had many observations that I want to share but I’m going to focus on commenting on three separate, yet equal groups that I interacted with. 1/15
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@michael_detsky
Michael Detsky
3 years
These announced restrictions seem to have unified every voice on my twitter feed. People are angry about restricting low risk outdoor behaviours while doing nothing to mitigate the higher risk situations related to occupational exposures for essential front line workers. 2/10
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@michael_detsky
Michael Detsky
3 years
But yesterday’s announcements and failures in the past year have just crushed the public and it’s trust in our elected leaders. 4/10
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@michael_detsky
Michael Detsky
3 years
It is only to highlight that the theme of helping was seen in all three of the groups mentioned above. And it is this desire to help that can make such a difference! 15/15
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@michael_detsky
Michael Detsky
3 years
And I know that this will eventually get better, but it is going to get a lot worse before that happens. 10/10
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@michael_detsky
Michael Detsky
3 years
All that being said, I’m going back on service in the ICU on Monday. Despite the overwhelming fatigue of this pandemic, with clinical work, months of home schooling for my kids, restrictions on the usual activities that provide joy in life, I will give it my all. 7/10
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@michael_detsky
Michael Detsky
7 months
Jewish parents across this city (and the world) are having conversations about whether to send their children to school tomorrow. What has become of this world?
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@michael_detsky
Michael Detsky
3 years
I have been largely silent in criticizing the provincial government because I think it’s an impossible job but this approach seems misguided and the government has likely lost whatever credibility they had. 6/10
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@michael_detsky
Michael Detsky
3 years
I believe there are some elements of this pandemic that we cannot fully control. We need to have some humility about that, especially early on when we knew less than we know today. 3/10
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@michael_detsky
Michael Detsky
3 years
I will try to be a cheerleader to the clinical team in our ICU who has worked so hard and maintained a commitment to excellent critical care in the face of difficult circumstances. There efforts have been an inspiration. 9/10
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@michael_detsky
Michael Detsky
3 years
I don’t know if the public can truly appreciate how extraordinary it is that this ICU has committed to helping out their adult ICU colleagues. 7/15
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@michael_detsky
Michael Detsky
3 years
I don’t know what everyone is going through internally. What I can see is that these people are doing their absolute best, keeping the unit running and providing the best care possible. 3/15
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@michael_detsky
Michael Detsky
3 years
While the current policies seem eerily similar to those a year ago and should help get COVID-19 numbers down, a more targeted approach may have achieved more success while asking the people of society to sacrifice less. 5/10
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@michael_detsky
Michael Detsky
3 years
I will learn the stories of the patient’s in the ICU. I will diagnose, treat, prognosticate and communicate with the frightened families at home. 8/10
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@michael_detsky
Michael Detsky
3 years
As one pediatric intensivist said to me; “we just wanted to help.” The physician and non-physician clinicians in the pediatric ICU are doing an incredible job and these daily interactions were a real highlight for me. 8/15
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@michael_detsky
Michael Detsky
3 years
Despite this, they came to work each day with a positive attitude and commitment to work hard. The trainees this past week are smart, kind and funny. 11/15
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@michael_detsky
Michael Detsky
3 years
Part B is the pediatric ICU physicians at Sick Kids who have taken on the job of looking after adults. This included daily in person conversations in an ICU I had never been to before. 6/15
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@michael_detsky
Michael Detsky
3 years
The first group is the non-physician clinicians that work in our ICU. This includes nurses, respiratory therapists, pharmacists, social workers, spiritual care workers, physiotherapists, porters, ward clerks. 2/15
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@michael_detsky
Michael Detsky
3 years
These discussions provided moments of human connection and levity that may serve as the best intervention to help provide wellness to clinicians. 13/15
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@michael_detsky
Michael Detsky
3 years
The third group is our physician trainees. These are medical school graduates who are doing their specialty training in internal medicine, anesthesia and plastic surgery. 9/15
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@michael_detsky
Michael Detsky
3 years
This is the group I probably interacted the most with in the past week. These young men and women have had their personal and professional lives completely interrupted. 10/15
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@michael_detsky
Michael Detsky
3 years
The second group is my physician colleagues that will be highlighted in two parts. Part A are specifically the obstetricians and palliative care physicians who I had conversations with multiple times a day. 4/15
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@michael_detsky
Michael Detsky
7 months
To the non-Jews reading this; if you have Jewish people in your life and you are thinking about them, let them know. You won’t regret it and they will probably appreciate it.
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@michael_detsky
Michael Detsky
3 years
It is helpful colleagues to bounce ideas off of and ensure we are on the same page. I’ve learned a lot from these discussions. 5/15
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@michael_detsky
Michael Detsky
2 years
Reading the tweets directed against those who work in public service makes me question who would want to subject themselves (or their families) to this public abuse by accepting these jobs in the future.
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@michael_detsky
Michael Detsky
3 years
We had opportunities to engage in conversations about non-clinical topics (ourselves, our interests, our thoughts on the state of the world). 12/15
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@michael_detsky
Michael Detsky
3 years
None of this is meant to dismiss the horrific situation our province is facing, that people are struggling, that people are dying or facing prolonged states of morbidity. 14/15
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@michael_detsky
Michael Detsky
10 months
July 1st in academic medicine in Canada is an exciting time of transition. To old friends who are finishing, congratulations and best wishes as you enter the work force as independent docs! To new friends starting residency tomorrow, welcome to the start of something amazing!
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@michael_detsky
Michael Detsky
2 years
This is the current reality in Ontario in 2022.
@CP24
CP24
2 years
Toronto police advise hospital workers not to wear scrubs to work this weekend ahead of planned anti-vaccine trucker protest in downtown
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@michael_detsky
Michael Detsky
3 years
Came home from hospital to find our pet gecko had died. Drove to the pet store with my eldest to get a new one while listening to “Follow you into the dark” by Death Cab for Cutie while he was bawling in the back seat. Tough way to finish a week of service in the ICU.
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@michael_detsky
Michael Detsky
4 years
This letter of appreciating was written last week by my son. Appreciating #respiratorytherapists this week (and every week).
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@michael_detsky
Michael Detsky
7 months
The unspeakable horrors that took place on Oct 7 are mentioned as a “situation”. As a Jew, I can’t imagine reaching out to this office. I’m embarassed to be affiliated with this university.
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@michael_detsky
Michael Detsky
3 years
@Barbara_Haas_ @SharkawyMD @VatsalTrivediMD @ccmtoronto I have worked with @VatsalTrivediMD He’s a dedicated clinician who has been on service in ICUs across this city from the start of this pandemic until the present day.
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@michael_detsky
Michael Detsky
4 years
#COVID19 in Canada. A lot to be proud of but still opportunity to improve and not undo early success, especially as we enter the crucial period of fall and the start of the academic year for Canadian children. @ADetsky @BogochIsaac
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@michael_detsky
Michael Detsky
2 years
Thanks to @Michael_Harhay from @PAIRCenter for his great rounds to @ccmtoronto about the challenges and opportunities to measure long-term ICU outcomes. Important to learn how great thinkers evolve ideas over time. So touched to hear my own (tiny) role in his incredible career!
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@michael_detsky
Michael Detsky
4 years
Start in service covering both ICU and rapid response for next week after family vacation with wife’s family (n=24). I think service will be more relaxing than “vacation”.
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@michael_detsky
Michael Detsky
3 years
Imagine being that attention-seeking MD reading this tweet and not realizing their own behavior
@Sonjalovesbikes
Sonja B
3 years
Imagine being given a devastating diagnosis only to open Twitter to see the same attention-seeking MD reflecting on your specific case on the same day This is a subtweet
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Michael Detsky
2 years
The challenge in Ontario right now is that three important metrics (ICU/ward/ED capacity based on available work force) are dynamic and difficult to measure. Contributors to work force attrition include, but are not limited to, school closures, covid exposures at home.
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@michael_detsky
Michael Detsky
5 months
This is really tough to watch…but people should see this. I imagine that calling for the death of any other religious or ethnic group would be met with a different response but we don’t live in that counter factual. We live in a world where calling for death to Jews is accepted.
@Elad_Si
Elad Simchayoff
5 months
Watch this. Two presidents of IVY league universities were asked if calling for the genocide of Jews goes against the school’s rules. You won’t believe their answers.
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@michael_detsky
Michael Detsky
4 years
Hat tip to @laveenamunshi and @efan75 for their leadership and efforts on making @CCCForum happen in 2020! I am lucky to be their colleague. I was on service but look forward to catching the presentations online.
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@michael_detsky
Michael Detsky
4 years
Shana Tova! May this new year bring health and happiness to the masses!
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@michael_detsky
Michael Detsky
3 years
How was this only a year ago? Same message applies, health and happiness to all!
@michael_detsky
Michael Detsky
4 years
Shana Tova! May this new year bring health and happiness to the masses!
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@michael_detsky
Michael Detsky
7 months
The unspeakable horrors these responders encountered when entering the homes after the attack. To listen to this while seeing videos of people in the West tearing down pictures of the hostages who survived the same attack; it shows how much hate people have in their hearts.
@sumlenny
Sergej Sumlenny, LL.M
7 months
Israel rescue team: “We found bodies of an executed Jewish family. Parents and kids with tied hands, shot in the head, in one room. Both tortured before death: eyes carved out, fingers cut off. Were the parents forced to watch? Or the kids?”
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@michael_detsky
Michael Detsky
3 years
@imgrund @kwadwo777 Your comment about @kwadwo777 is totally inappropriate. He might be providing care to patients in the ICU right now. It’s one thing to have cordial discussion about the merits of a study and if data is missing (which it looks like it isn’t). it’s another to make it personal.
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@michael_detsky
Michael Detsky
4 years
This is excellent advice. This isn’t a diagnostic dilemma. Be sensible and ask “how will the results of this test change my management?”
@ogi_gajic
Ognjen Gajic
4 years
Excessive #POCUS scanning, CT scanning, PCT, troponin, God forbid bronchoscopy/BAL, or ANY other non-essential, minimally actionable activity will have to increase the transmission from patient to patient & clinician no matter how careful you clean it. DON'T DO IT! #CommonSense
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@michael_detsky
Michael Detsky
4 years
@theresaboyle @dmrider Masks indoors should be implemented across the province now! The effect size and safety profile of masks highlights that this is a no-brainer. I have yet to hear any compelling argument to the contrary. The longer we delay, the more likely we start seeing more outbreaks!
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@michael_detsky
Michael Detsky
4 years
People who don’t take this pandemic seriously need to spend the 30 seconds it takes to read this blog post to understand the impact covid-19 is having on our fellow humans.
@AndreasLaupacis
Andreas Laupacis
4 years
Often the most moving blogs are the shortest. Thanks to Ed Etchells for this one via @CMAJBlogs @picardonhealth @theresaboyle @DavidJuurlink @SeemaMarwahaMD
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@michael_detsky
Michael Detsky
3 years
@imgrund This is a research letter that has primary data in it. To say it is just a “letter” is misleading. This is irrespective of whatever issues you may have with the data presented and what data may or may not have been withheld.
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@michael_detsky
Michael Detsky
1 year
@EM_RESUS Coding on induction may have less to do with under resuscitation and more to do with over use of induction medications. Judicious use of sedation and analgesia is essential to a safe intubation.
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@michael_detsky
Michael Detsky
7 months
This short article really resonates with me and is well worth your time. My children are descendants of holocaust survivors. They were one trigger happy Nazi away from not existing. These days are a stark reminder that evil persists and good people must stand up to it.
@missmayim
Mayim Bialik
7 months
I am resisting the desire to post everything I want everyone to know all of the time. This Bari Weiss article from The Free Press says a lot of what needs to be said. Please read and beware people celebrating right now.
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@michael_detsky
Michael Detsky
5 years
Check out this great up to date review on intubation critically ill patients first author the inimitable mike sklar
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@michael_detsky
Michael Detsky
4 years
@ADetsky That’s me! I wasn’t as cute as the next generation
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@michael_detsky
Michael Detsky
1 year
Amazing piece highlighting physician longitudinal relationships with their patients. A reminder to acute care physicians the potential value in communicating with patient’s “main doctor.” So many challenges to improve this but it’s a challenge worth taking on.
@DianaToubassi
Diana Toubassi
1 year
An essay about how we (family docs) feel when we're not able to take proper leave of our dearest patients - a sadly common experience... @CFPJournal
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@michael_detsky
Michael Detsky
2 years
Great thread highlighting some of the challenges in the current “healthcare system” in Ontario. Covid isn’t going anywhere in the foreseeable future so policy changes and plans should take this into account
@petrosoniak
Andrew Petrosoniak
2 years
As a fellow emerg doc, I'm extremely disappointed to see this inaccurate focus on COVID related illness as the main cause for incr ED wait times and staff shortages. Rather the link to COVID is that it exposed a system that has always been non functional, but now just more so.🧵
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@michael_detsky
Michael Detsky
6 years
Me: med student on gen sx. Him: 34M w/metastatic colon CA in hospital. Us: lamenting how the leafs weren’t going to make the playoffs that year. Him: dying before the NHL season finished and never finding out that our leafs prediction would be correct. #ShareAStoryInOneTweet
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@michael_detsky
Michael Detsky
4 years
@ADetsky Doesn’t acknowledge his own flesh and blood being quoted in this article!?!?
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@michael_detsky
Michael Detsky
5 years
Thanks for highlighting this! Systematically collecting this information can help inform clinicians about what patients were like before coming to the ICU @PAIRCenter
@DrMeganHoseyPhD
Megan Hosey
5 years
Learn about patients so you can help them survive AND live. Patients’ primary activities prior to critical illness: how well do clinicians know them and how likely are patients to return to them? H/T @vitaincerta . work by @michael_detsky and colleagues
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@michael_detsky
Michael Detsky
4 months
The statement that doctors and nurses who believe in a concept (i.e, Jews living in their indigenous homeland after thousands of years of persecution) would be incapable of providing compassionate care to patients from different religious and ethnic backgrounds is an affront.
@sairasameerarao
saira rao 🍉
4 months
Realizing how many American doctors and nurses are Zionists and genuinely terrified for Palestinian, Arab, Muslim, South Asian and Black patients — even more than usual. And usually it’s bad.
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@michael_detsky
Michael Detsky
6 months
There is no mincing words here. These people are calling for a one state solution that does not include an Israel. It's difficult to have a conversation on achieving peace with people who hold this opinion.
@HaMeturgeman
Eli Steinberg
6 months
New York City, 2023 “We don't want no Jew State, we want all of it!”
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@michael_detsky
Michael Detsky
7 months
Most jews murdered in a single day since the holocaust. Women and children taken hostage. Rape used as a weapon. These students blame Israel. Consider how these statements make you feel. If it’s anything but disgust and horror, let’s have a chat on why you feel that way.
@yaelbt
Yael Bar tur 🎗️
7 months
This is the final crack in my broken heart - a joint statement from @Harvard students. I could be sitting in class with these students, watching children brutally murdered, raped, kidnapped and their mutated bodies torn apart by a jeering crowd - and hear why it’s justified.
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@michael_detsky
Michael Detsky
3 years
He was well loved and I don’t mean this as a joke because the death of a pet is tough but “may his memory be a blessing”
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@michael_detsky
Michael Detsky
3 years
@efan75 @UHN @SinaiHealth @SickKidsNews I’m comforted knowing you are on service across the street. Thankful for all the great colleagues out there!
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@michael_detsky
Michael Detsky
3 years
Data like this is not particularly helpful because of the specifics of how the question was asked. Would be more helpful to know if these visits were indoors vs outdoors, masks vs no masks, eating together (which would be most high risk).
@CP24
CP24
3 years
Nearly 50 per cent Canadians visited with family, friends outside household over holidays: poll
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@michael_detsky
Michael Detsky
6 years
@adamcifu Daily ekg on icu patients to check qt length for patients on antipsychotics
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@michael_detsky
Michael Detsky
6 months
Violence against Jews is escalating daily in North America. The non-specific language of this MP in response to a shooting of a Jewish school in Montreal is ironic considering his statement explicitly states 'words matter.' Very discouraging.
@OmarAlghabra
Omar Alghabra
6 months
This is troubling. We all have a responsibility to lower the temperature. Words matter and could lead to radicalization which could lead to violence. Everyone has the right to free speech but we must be careful not to directly or indirectly promote resentment of each other
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@michael_detsky
Michael Detsky
7 months
I don’t have words to explain the mental gymnastics this medical student goes through in answering these basic questions. She does ultimately state the words “I support Hamas”. Can you see why Jewish people don’t feel safe right now?
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@michael_detsky
Michael Detsky
2 years
I should also point out that “capacity” is not a dichotomous outcome. There may be beds for patients but if the personnel are stretched thin, the care delivered will be suboptimal.
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Michael Detsky
3 years
This is so disturbing
@verboom
Ben Verboom 🍉
3 years
This should horrify all of us.
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@michael_detsky
Michael Detsky
6 years
@DrSamuelBrown @HainesKimberley @DrMeganHoseyPhD @EveCorner @major_mel Yes, when we asked survivors how they rated their QOL, 1/3rd said it was better than prior to their critical illness (1/3 the same, 1/3 worse). Results surprised me.
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@michael_detsky
Michael Detsky
6 years
@EveCorner @major_mel @DrMeganHoseyPhD @DrSamuelBrown @HainesKimberley When we asked patients why they rated their QOL as better, even though their function was worse, they would say things like “I no longer have substance abuse issues” or “I’ve reconnected with family.” None of this could have been predicted when they were in ICU.
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@michael_detsky
Michael Detsky
1 year
@shanxonline Don’t worry, the corporations pay for those seats. And the cost is passed on to (check notes…) the public who uses said corporations.
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@michael_detsky
Michael Detsky
3 years
@nataliexdean @kmfiest Agreed!. 1. The numbers report the vaccines efficacy at preventing disease, not preventing mortality. 2. The long term impacts of Covid-19 are still not known and many who survive may endure long term sequelae from the initial infection.
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@michael_detsky
Michael Detsky
4 years
I’m willing to volunteer to discuss values/preferences and engage in shared decision making for at risk patients re; utility of receiving mechanical ventilation. We don’t want to intubate patients prior to making an informed choice
@doctor_oxford
Dr Rachel Clarke
4 years
It isn't easy to contemplate our own mortality. But every medical intervention has cons as well as pros. There's never been a more urgent time to discuss with your loved ones your views on advance care planning. Please have that conversation ❤️ #COVID19
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@michael_detsky
Michael Detsky
3 years
@BogochIsaac @michaelmina_lab It makes sense that the effectiveness of vaccines in the real world would be lower than the efficacy in the trials. People enrolled in vaccine trials believe in science. They are probably more cautious in their behavior relative to the general public who received the vaccine.
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@michael_detsky
Michael Detsky
4 years
@AdinaWeinerman @GIMtoronto One of the all time greats! Feel so lucky to have been on third year clerk on red team!
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@michael_detsky
Michael Detsky
5 years
@ADetsky @GIMtoronto @uoftmedicine Thanks to @StephenLap for covering me and allowing me to attend!
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@michael_detsky
Michael Detsky
5 months
This suggests that leaders who support Jewish people feel intimidated to do so. How do you think Jews feel?
@zach_kessel
Zach Kessel
5 months
Brown University president Christina Paxson planned to say "every student, faculty and staff member should be able to proudly wear a Star of David or don a keffiyeh on the Brown campus, or to cover their head with a hijab or yarmulke." After pro-Palestinian protesters heckled…
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@michael_detsky
Michael Detsky
4 years
@DrDaleNeedham @ICU_Recovery And predicting self reported QOL is really challenging. Would be interested to see in settings that have post ICU care follow up
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@michael_detsky
Michael Detsky
4 years
Very nice piece by two great thinkers ( @AmolAVerma @DrFahadRazak ) who know what they are talking about in part because they study hospital based care while also delivering hospital based clinical service. Great ideas! Wish I knew what existing allied health capacity is.
@AmolAVerma
Amol Verma
4 years
Based on our clinical and research experience, @DrFahadRazak and I share some ideas about how Canadian hospitals can find capacity for #COVID19 ? @Globe_Health
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@michael_detsky
Michael Detsky
5 years
@DrKaliBarrett @JAMA_current How many readers were biting their upper lip when reading the results?
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@michael_detsky
Michael Detsky
7 months
Dark days ahead in the world of academia
@TPostMillennial
The Post Millennial
7 months
This is an actual tweet from a union representing university professors in Canada. Today.
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@michael_detsky
Michael Detsky
2 years
Great thread! The Ontario PC party is writing the handbook on how to lose the trust of its constituents. Inconsistent messaging from when the leadership puts the CMOH on the podium days ago. What metric will be used to determine in person school?
@DocDominik
Dominik Mertz
2 years
This is heading into the wrong direction, no question, and I stay true to what I have been saying all along: healthcare strain is what should be the metric to watch in an largely immune population. But closing schools for an arbitrary number of weeks? A few thoughts...
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@michael_detsky
Michael Detsky
3 years
@janinemccready @BogochIsaac @ShadyAshamalla @NathanielBasen Our community is lucky to have such smart and committed people like @janinemccready doing such important work
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@michael_detsky
Michael Detsky
6 years
Great piece that incorporates the elements that go into decision making, specifically around deciding which patients should be admitted, especially those that fall in the “grey zone”
@NEJM
NEJM
6 years
Perspective: Questionable Admissions by Raphael Rush, MD.
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@michael_detsky
Michael Detsky
2 years
Wordle 211 3/6 ⬜🟩⬜⬜🟨 🟨⬜🟨⬜⬜ 🟩🟩🟩🟩🟩
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@michael_detsky
Michael Detsky
6 years
@tony_breu @tony_breu these are all great, but this one in particularly is exceptional!
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@michael_detsky
Michael Detsky
3 years
@imgrund @kwadwo777 But that data is reported in the supplement, it’s not missing
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@michael_detsky
Michael Detsky
10 months
Ditto when it comes critical care. As time goes by, the number of patients I encounter my age or younger increases. Continuous exposure to tragic stories creates grief and forces healthcare workers to face their own mortality. This trauma puts our healthcare workforce at risk.
@heinrich_kat
Kathrin Heinrich
10 months
As oncologist I am familiar with pain, loss and grief. But losing patients my own age to metastatic #cancer is just unbearable. To quote @marklewismd : Patients don’t fail treatments. Treatment fails patients. Honestly, sometimes that feels like we fail our patients.
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@michael_detsky
Michael Detsky
4 years
@laveenamunshi @SinaiHealth Best team I’ve ever been a part of!
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@michael_detsky
Michael Detsky
4 years
Important to recognize that changes made today won’t be seen for weeks. Need to be aggressive with social isolation measures now while patient when observing the impact. Cases today are result of transmission days to weeks ago.
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@michael_detsky
Michael Detsky
4 years
This image has the potential to have a greater impact than the data that is slowly evolving. Thanks @Yarnell_CJ and the patient for sharing this message.
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@michael_detsky
Michael Detsky
4 years
@ADetsky Ok, boomer
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@michael_detsky
Michael Detsky
4 years
Amplifying the words of my former classmate and esteemed colleague. Important words to read and consider how we can all do better. Thanks @husam247 for sharing
@husam247
Husam Abdel-Qadir
4 years
/Thread/ I did not participate in #BlackOutTuesday . While the spirit underlying it is commendable, I do not think you can enhance your awareness of such a complex and difficult issue by sharing a black screen.
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@michael_detsky
Michael Detsky
2 years
If they spent a chunk of the weekend completing these mandatory modules, I have a sense of how they will respond to this query of “how their weekend was?”
@ADetsky
Allan Detsky MD PhD CM
2 years
For now I am not how much more I know about fire safety or privacy than I knew before doing the modules, but I did learn from the module created by @uoftmedicine that I MUST ask people I work with if they enjoyed their weekend.
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@michael_detsky
Michael Detsky
3 years
Have we hit our peak for this wave? Probably not but this is the first time in this wave that the number of COVID patients in ICU were less than the day before. The overall icu census is over 2k, which is troubling given the census we have seen during this pandemic.
Tweet media one
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@michael_detsky
Michael Detsky
3 years
This captures the emotional roller coaster of dealing with a family member with covid. Also highlights that some people may be risk averse and get unlucky. Others may engage in risky behavior and avoid being exposed because of a mix of privilege and pure, dumb luck!
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@michael_detsky
Michael Detsky
4 years
Thanks @drmwarner . Nice primer for the public on what intensivists do and what we (ie I) am worried about.
@drmwarner
Michael Warner
4 years
@michael_detsky introducing the public to the next battlefront in the war on #COVID19 ...the ICU. This is going to happen very quickly. The reason intensivists are ringing the alarm bell so loudly is because we see what is coming.
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