Thursday, August 7, 2008

Doctor's Office

This picture shows a Doctor's Office. The picture was taken in 1908. My, how things have changed since then.

You see, last week, I had an interesting day. I swore to myself that I would NOT put the story up on the blog. I felt it was unfair to subject my readers to such a tedious story. I was able to restrain myself for about a week, but today I have lost my self control, and am going to have to tell the story. Understand that most of my stories offend about half the people. I am pretty sure this one will offend everyone. Remember, just because I put the story up does not mean you have to read it. In fact, you might should just go up and hit the "back" button right now, and go back to wherever you came from, and save yourself some agony.

OK, you have been warned but have chosen to read on anyway, so here goes. This happened last week, about the same day that I finally got my state-of-the-art, Dual Fuel KitchenAid range fixed, after being broken for 49 days. My wife and I went to bed at the normal time that evening. I drift off to sleep, happy that my new stove is finally working. Then, sometime in the night, I am awoken by a disturbance. My daughter has come stumbling into our room and is crying. My wife jumps up as any good mother would, to see what was wrong. I look up, see my daughter hunched over, holding her back, screaming out in pain, and cursing the day of her birth. My wife asks her what is wrong, and I tell her that Elizabeth has a kidney stone. You see, I would recognize that look of terror anywhere. I had had a kidney stone last year, and knew just what it felt like. Now, if she had just been hunched over grabbing her back and side, and crying out in pain, it might have been gall stones, or maybe appendicitis, but when you throw in that she was cursing the day of her birth, I was pretty sure it was kidney stones (DISCLAIMER- I have no medical background, this should not be considered medical advice. Most of the time I am wrong about things. You should not listen to me, in general, and especially, you should not listen to me about medical issues. This is not medical advice). So, I tell my wife to try and get our daughter ready, and try and make her comfortable, and I will get ready, and take her on in to the doctor.

It does not take me long to get ready, so in no time I am down in the kitchen, fixing myself a piece of toast. Now that the stove is working again, I am looking forward to once again enjoying a piece of toast for breakfast. I decide to make the toast using the "Convection Broil" mode on the stove. I am watching the toast through the little window in the door, and I can see that in about 20 seconds I am going to have what might very well be the finest piece of toast ever made. It was about this time that my wife walks in the kitchen, looks at me with disgust, and says, "WHAT DO YOU THING YOU ARE DOING? ! ! !"

Now, this is a hard question to answer. It is like a question that has no right answer. The response of, "I am making myself a piece of toast," the obvious response ,would no doubt lead to follow on questions. If anyone out there knows how to answer a question like that, please let me know, so I will be prepared next time something like this happens. Anyway, I look in at that perfect piece of toast, and I realize that I have two choices. I can wait 20 seconds for it to be done, and then take it with me, or, I can just walk away right then, and get my daughter loaded in the car. I realize that the only shot I have of ever enjoying another day of domestic tranquility in my life is to just walk away from that piece of toast, and tend to my daughter. So, I make the wise choice and walk away from the toast.

So, I get my daughter loaded into the Toyota out in the garage. I press the garage door opener button on the visor of the car. I hear a loud grinding noise, and then sort of a clanking sound. I look back, and the see that the garage door is not opening. Yes, my new, state-of-the-art, Wayne-Dalton Idrive Torquemaster Plus Model 3726 Garage Door Opening system has failed, yet again. This is the 7th time in the last 6 months that this thing has malfunctioned. Now understand, everything in my house is new, because my house is only six months old. I am not saying this to boast, but just point out that this stuff is all new and should not be breaking like this. Anyway, I get out of the car, and inspect the door to see if I can disengage the opener system from the door, and then open the door manually. No way, it is a catastrophic system failure, and there is no way to disengage and open the door. We are now at Garage Door Def-Con II . . . family with medical emergency trapped in the garage. OK, for a second I thought about calling the service center and telling them that my daughter is about to blow a kidney, and that my garage door is malfunctioning, and how do they suggest I get my daughter to the hospital. I decided now was not the time to poke fun at that garage door opener company, I realize I need to focus on getting my daughter in to town. Now, the truth is, the garage door system had malfunctioned so many times that I had actually worried about getting stuck at home, so I never put both cars in the garage at the same time. I always leave one car outside, for just such an emergency.

Well, I get my daughter out of the Toyota, and take her out to the Ford Ranger parked out front. As I am walking through the kitchen, my wife is watching me like a hawk, making sure I don't try and get that piece of toast as I walk by the oven. I get my daughter into the Ranger, and even though it is a Ford, it did start on this particular morning. It did start, but I could not be sure whether I had enough gas to get to town or not. You see, about 2 months ago, the gas gauge went out on the pick up. It reads empty all the time, even if you just filled it up. I had taken it in to see about getting it fixed. I was told that the little gas tank "sender" unit, a 25 cent component had gone out, but the sender unit is built into the fuel pump, so if I want the gas gauge to work, I have to have the gas tank taken out, taken apart, and the entire fuel pump replaced. And we wonder why all the American auto manufacturers are going bankrupt. Anyway, I refuse to pay the $850 to fix it, and decide to live without the gas gauge.

But I have digressed . . . back to my daughter. So, I get the car started, and start in to town. I live about 35 miles from town, so it is going to take a little time to get her in for help. The trip goes relatively smoothly, other than her screaming in agony the entire way. We get to the medical facility, and I breathe a sigh of relief. We go in the front door, and start heading back towards the Doctor's office. I make it about 20 feet, and all of the sudden, I feel someone grabbing me from behind. Focused on trying to get my daughter to the Doctor's office, I struggle to break free from whoever is grabbing me. Well, that was a mistake. I turn around, and there is this woman who was a former German SS Gestapo officer, and she is trying to restrain me. Now I don't know for a fact that she is a former Gestapo agent, but I am pretty sure if she was not that at a minimum she was one of the Hitler Youth. I try again to break free, and this time she picks me up, and body slams me to the ground. She gets me in a choke hold, and I become fearful that she is about to give me the Pile Driver. Well, I realize I better stop struggling, and see what the problem is. I stop struggling, and she explains that I have to go to the front desk, and "Sign In" before going back to the doctor. You see, I had thought the priority was to get medical attention for my daughter, but in fact, I learn, the priority is to sign in at the registration desk. Once I understood this, I was happy to comply. The lady releases the choke hold she has on me, and I get this tingly feeling as oxygen returns to my brain.

Well, she escorts me over to the Registration Desk. Real quick I learn that "Signing In" is code speak for "They are going to get all your money before you see the Doctor". So, she takes her position behind the desk, and she looks at me sternly, and asks, "Do you have insurance?" I whip out my handy-dandy Blue Cross, Blue Shield of Texas Card. It is a lovely card, with my name embossed in gold lettering. She sees the card, and a magical transformation occurs. Her face lights up, she smiles at me, happy music starts coming from her workstation, and little butterflies start circling her work area. Yes, she sees I am somebody. I have insurance. I am in the circle, the few, the proud, the insured.

Well, she takes my card, and she types some numbers into the computer. All the sudden, her head sort of bobs back, she has a perplexed look on her face, and she types the numbers in again, this time slower and more deliberately. Her demeanor darkens once again. The happy music turns to ominous music. The little butterflies disappear, and she once again looks like a Gestapo agent. She looks at me with disgust and says, "Sir, your insurance has a $10,000 per year deductible. This year you have met $4.87 of that deductible. How do you plan on paying for the medical services today?"

Well, I could not resist, and asked her the following question, "Ma'am, what do you do with 18 year old girls who come in with kidney stones who don't happen to have a father kind enough to be willing to pay for medical treatment?" It took her no time to answer . . . "Kidney stones will pass in time. We tell them to drink lots of water and send them out". You know, the lady had me completely convinced that if I were to try and just abandon my daughter at their facility, that they would in fact throw her out on the street with no medical attention.

Anyway, I look over and see my daughter still flailing around on the floor in agony, and realize I better quit fooling around with the lady, and pay her and get things moving. I had left home without my check book, but I have a Discover card. The lady swipes the card, and tells me I can go back to the Doctor's office.

So, my daughter and I walk on back. We are in. We are entering the inner sanctum, the Holy of Holies, yes, we will be able to see . . . The Doctor. Well, when I get back to the Doctor's Office, his nurses and receptionists are very kind, helpful, and concerned. Seeing my daughter is such agony, they take us right back into the examination room.

In about 2 minutes the doctor comes in. He sees my daughter in misery, and asks what the problem is. I tell him that she has a kidney stone. Oops, that was a faux pas. I knew it the minute I said it. If you could have seen the look on the Doctor's face . . . I really can not describe it, but it was a look of disgust. You see, when he asked the question, he was not asking for my medical opinion, or my diagnosis . . . he was asking for what her symptoms were. So, I try to recover as best I can and tell him that at about 4:00 AM she started having severe back and side pains. She did not have a fever, and had some blood in her urine.

Well, he makes a few notes, and says that he is going to send her over to radiology for some x-rays. I gasp. You see, they charge about $200 for x-rays. That is not the worst of it either. If you get an x-ray, in addition to the charge for the x-ray, about two months later you get the "mystery bill". The mystery bill is from the "Radiologist". The Radiologist is a doctor you never see, and you never asked for his service. He is not the person that takes the x-ray. He is a person who somehow intercepts the x-rays somewhere between the x-ray machine, and your doctor. He looks at the x-rays, and then sends you a bill for $250. I cringe, but realize that my daughter is in pain, and we will just have to go down and get the x-rays done.

So, I take her down to radiology, and the people there are real nice. They get her right in, and she gets out in under 5 minutes. We go back to the doctors office, and he already has the x-rays up on his fancy little monitor. He shows us the x-rays, and says that it looks to him like she might have a kidney stone. I use good judgement this time, and bite my lip, and do not say, "Do ya think?"

Anyway, he can not be sure from the x-ray, so he decides to send her back down to radiology for a CT scan. I gasp, and try to steady myself against the wall, as I feel I am about to pass out. You see, I have no idea how much a CT scan is going to cost, but I figure it is going to be a lot more than an x-ray. What scares me even worse is I figure that the radiologist is going to figure out some way to get his grimy little fingers on the CT scan, and charge me for looking at the scans. Then what really scares me is that I figure that they probably have the Junior Radiologists look at the x-rays, and probably the really expensive Senior Radiologists look at the CT scans. Yes sir, there is probably some Grand Dragon or Imperial Potentate of Radiologists who is held back just to look at CT scans. Any hope I had of eating red meat this year disappears . . . I realize I am going to be eating pinto beans and cornbread for the rest of the year.

Well, I take her back to radiology, they do the CT scans, we go back to the doctor, and he has the CT scans up on the screen. He looks at them and says he is pretty sure she has a kidney stone. He then tells me that he can do the surgery first thing in the morning. He then tells me that he is going to go ahead now and check her into the hospital (Cha-Ching), and keep her there today (Cha-Ching) and tonight (Cha-Ching), and put her on an I-V pain drip (Cha-Ching) so she can control the pain until the surgery in the morning.

Now at this point I could not control myself any more. I see my life savings slowly slipping through my fingers, so I just come out and ask him, "Are you putting her in the hospital for safety or health reasons, or are you putting her in the hospital for her comfort?" Well, he says that it is a comfort issue, not a safety or health issue. I mention to him that when I was a kid they use to have a big hypodermic needle that they would use to give you a big shot in the rear that would sort of numb your whole lower body for about 8 hours. I told him that it was not a nice pretty little syringe, but a huge ugly hypodermic needle. I told him that it looked like something you would use to put a race horse out of his misery with. I told him that the orderlies would bring the shot in on a tray, and as a courtesy they would have it covered with a little towel so as to not throw the patient into shock by seeing it. But you could see the bulge under the towel that looked the size of a baseball bat, and you knew you were fixing to get the Shot from Hell. So I ask him if they had anything like that anymore. He said he could probably find one. I ask him how much that would cost. He said $25. I asked him if there would be any additional medical risk of that strategy. He said no.

So, I tell him that we will take door number 2 . . . the $25 shot.

He looks sort of disgusted with me, and he goes out and in a few minutes the nurse comes in with the shot, and gives it to my daughter. They did not even try to hide it under a little towel. Sure enough, in about 3 minutes the pain goes away. The shot is one of those that numbs the pain, but does not make you goofy in the head, or groggy. So, my daughter is thinking clearly, and not in pain, so I tell her as I see it we have three options. The first is, we can sit out in the waiting room all day. That way, if the pain comes back, we are right there, and she can ask for another shot. The downside is it will be a pretty boring day. The second option is I can take her home. It would be better to be at home, but if the pain comes back, she will have a long ride back into the doctors office. Now, there is a third option, and in the interest of full disclosure, I felt it only fair to present the option to her. You see, she is taking classes this summer at the university to get a jump on her freshman year that starts this fall. She is taking Physiology. In the summer they cram the entire semester into one month, so if you miss one day of class in the summer, it is like missing a week and a half during the normal semester. I realize that if she misses today, and tomorrow (due to the surgery), there is going to be no way for her to successfully complete the class. Now, I already paid the $1,200 for the tuition, and if she does not complete the class, I will have to re-pay for her to take it again in the fall. So, I tell her the third option . . . I could drive her over to school, and she could sit in class for the afternoon. She picks option three. I breathe a sigh of relief.

OK, so I drive her over to the university, and I walk her to class. I sit outside the class, so in case she has any trouble, I can drive back over to the doctor. She makes it through the class with no trouble. We get in the pickup and drive home. Also, I picked up the pain pills the doctor had prescribed.

Anyway, we get home and get settled in. I realize that the shot is going to wear off in about the next half hour. The pain pills he prescribed are the kind that make you goofy in the head, so I realized that I only had about five minutes to speak to her while she is still pain free and clear headed. There was something real important I needed to talk to her about, and I only had about 5 minutes to do it.

Now, you need to understand that in my career, I have been sent to many different management training classes. I have been to crisis management training, Malcolm Baldridge Quality training, managing for success training, and even paper shredder safety training. I mean if there is a management training class that you have heard of, I have probably been sent to it. I always felt like someday all that training would come in handy, and today was that day. You see, if I were to sum up 25 years of management training into one brief summary, it would be this: First, you need to make sure the person understands the objective. Second, you need to make sure they understand why the objective is important. Third, you need to make sure they understand what the incentive is for them to achieve the objective.

So, I have about five minutes to explain the situation to my daughter. I sit her down, and tell her that I need to speak to her about an important matter. She sat down, and I felt I had her full attention. I explained to her that her surgery in the morning was going to cost me $10,000. She nodded, and indicated she understood. I told her that I was counting on that money for things like groceries, heart worm medicine for the dogs, and college tuition. She said she understood. I told her that if she passed that kidney stone tonight, that we would not have to have surgery in the morning. Now, for the kicker, I told her that if she passed the kidney stone tonight, I would give her $500 cash to do with as she pleased. She said she understood, and did not appear to be offended by the offer.

Now I fully realize that there is no way to deliberately pass a kidney stone. I made the offer in the faint hope that there was perhaps some yet to be discovered synaptic connection between the old, primordial region of the cortex of the brain and the plumbing system. I was hoping that perhaps the right incentive could somehow stimulate this yet undiscovered nerve pathway, and that with the proper incentive the cortex could somehow stimulate the plumbing system to relax or fluctuate in just the right manner to release that kidney stone. I knew it was a long shot, but it was the only shot I had.

So, sure enough in about 5 minutes the pain shot starts wearing off, and she starts screaming in agony, once again cursing the day of her birth. She takes the pain pills but they do not help much. I settle in at the computer for what I anticipate is going to be a long night. Not having anything better to do, I email my brother, who works in the medical field. I tell him my theory that there could be an undiscovered path between the brain and plumbing systems. I told him about the $500 offer. He thought it was pretty funny. In fact he thought it was so funny he told his wife. His wife did not think it was that funny, so she calls my wife and tells her. Well, it was about five seconds later that my wife comes in and says, "WHAT WERE YOU THINKING? !!!!"

That is another one of those questions that is hard to answer. She says, "YOU OFFERED OUR ONLY DAUGHTER $500 IF SHE WOULD NOT GET THIS SURGERY DONE? ! ! !"

Well, you can see the story got distorted somewhere along the way. I was not offering her money to not get the surgery, I was offering her money to pass the kidney stone, which is an entirely different matter. Anyway, I start trying to explain the whole deal to my wife, while at the same time my daughter is in the next room, screaming her lungs out. Well, as I am trying to explain my way out of things with my wife, suddenly my daughter stops scremaing. About 30 seconds later she walks in, she has a little zip lock bag with a little rock in it about the size of a BB. She hands me the little zip lock bag, and tells me I owe her $500. Well alrighty then.

So, I look at it and it looks like a kidney stone. My daughter tells me she is completely pain free. I call the doctors office, and they tell me to go ahead and bring her in in the morning, and the will check things out.

So, I take her back to the doctor in the morning. This time I was careful to check in at the registration desk. He comes in and asks what the situation is. I started to say,"she passed her kidney stone last night and we can cancel the surgery", but I remembered my Faux Pas from the day before and I bite my tounge. I tell him, "She went to the rest room last night, and this little rock came out. After that, she has been completely pain free". He looks at it, and says "I-n-t-e-r-e-s-t-i-n-g." In fact, he finds it so interesting that he wants to send her back down to radiology (Cha-Ching) for more x-rays (Cha-Ching). So, I take her back down to radiaology, and they are all happy to see her feeling so much better. We get the x-rays, and go back to the doctor. He looks at them, and then says that it looks like the kidney stone might have passed, but he can not be sure. He wants to send her back to radiology (Cha-Ching) for some CT scans (Cha-Ching) to get a closer look (Cha-Ching). I start to ask him why we continue to take all this expensive data only for him to ignore the data once it is taken. I refrain from saying anything, and take her back to radiology. We come back, he looks at the scans, and says that as near as he can tell, that the stone has passed, and that little rock we have in the zip lock bag might in fact be the stone. He takes the bag, and says that he can not be sure, and wants to get it tested (Cha-Ching) and that we need to come back in two weeks (Cha-Ching).

Anyway, I hope you all have better insurance than I do. What you find is that if you are self-employed, or if you work for a small company, it is almost impossible to get health insurance, and if you can get it, it is extrememely expensive, and not very good.


  1. I just love your stories!!
    Once again I had to share this one with all of my friends! I'm glad your daughter is better.
    Thanks for not holding back the story! :)

  2. The best time I have had for weeks!

    I started to show it to the wife, but luckly thought a second or two before calling her. Like your trying to answer your wife's questions early in the story, I determined that no good could come to me for having your plight and responses shown to her. The vast majority of wives think in the same path, so I assumed her unhappyness with you would transfer to me by association.

    Great story. Keep them coming!

  3. I'll swear, this is the best one yet!
    I have laughed myself silly.
    Do you have more incidents in your life than the rest of us, or is it that you just know how to put the word to the paper. Ohmygosh, loved it!

  4. I would have been more inclined to behave like you rather than like your wife. I am glad she is feeling better, but I have to say, it is stories like this that make me sooooo glad I live in Canada.

  5. Very nice! You were joking about a 10,000 dollar deductible, though, right? Seriously, there has got to be a better system. My friend waited to have her tooth pulled until she was on vacation in Holland!

    Love your blog, love the pictures. I teach 8th grade U.S. History and use your page every day on the overhead for a little intro to class.

    Keep it going:)

  6. While the story is told in a "Colorful" way, the part about the deductible is absolutely true. My Blue Cross/Blue Shield insurance plan has a $10,000 per year deductible. I pay 100% out of pocket all expenses, every year up to $10,000. This means it really hurts when they do "defensive" medicine and order to many tests. I am very serious when I say that the system is seriously broken. I will keep you posted on how much this trip to the Dr. cost me, even though nothing was done, but a shot and some tests.

  7. Ya. You couldn't pay me $500, $10,000, or any amount to live in the states. Private health care is just plain immoral.

  8. Many thanks for sharing another bittersweet experience from your life.
    As far as your wife's response about the toast, well obviously she could see what you were doing, it is just that she couldn't believe it. Neither can I when I see the relentless logic in some of my husband's actions.
    But I saw nothing wrong in the incentive you offered to your daughter- my daughter was 3 years old when she had to have her ears pierced ( done with a needle back then and without freezing ). We told her she would have two of the biggest chocolates available if only she would let the doctor pierce both ears. Pluck to the backbone, she howled her way through the piercings and gleefully ate up her reward and bragged about it to her friends.
    Please keep on sharing other such incidents.
    Best wishes,
    Sakuntala Basu

  9. The time I had a kidney stone, my wife drove me to the doctor 6 miles away. However, our driveway was 1.5 miles of herk-jerky-bumpy private dirt road. I was riding in the back of our van, lying on my stomach on the back seat, passing out continually while on the driveway. By the time we got to the doctor's office, I thought I was feeling better. Or maybe it was just the pain cycle at its minimum. We went inside, got x-rayed after waiting 30 minutes for my turn with the doctor. No one else was waiting and no one was with him, but I had to wait my turn. I began to suspect that the stone had passed. (Yes, we also self-diagnosed. Probably why I had to wait my turn.) He had his own xray equipment, so as to avoid any radiologist skims. He got it all. We had to wait about an hour before he came out to say that the xray showed the stone in the bladder. It had passed.! 'Course he had to have the stone when I passed it, so as to have it analyzed which would allow for proper prescription of treatment to avoid future K-stones. My wife took it to him after I captured it in the strainer the doc supplied. We waited a month for the report, but when we inquired, "it was lost 'at the lab'". The next month Doc was arrested for misuse of drugs (on himself). We saved the CTScan cost but paid for the 2 visits, the xrays, the prescription for the never used pain killer, and the lab costs for a stone lost at the lab and therefore no report. I drank a measured gallon of water every day for many, many moons. Down to 1/2 gallon a day today. Never had another stuck stone since, 15 years later.

  10. Excellent example of why I'm glad I no longer live in America. What finished me was when a hospital handed me a $70,000 bill for my son's five day stay at the hospital when he was diagnosed with juvenile diabetes. No surgery, no x-rays, no CT scans, no MRIs, just monitoring and education on how to use insulin. A few blood tests.

    For seventy grand, I could have checked him into a five star hotel, had round the clock private nurses that would actually take care of him, unlike the harridans at the hospital, all food brought in from a five star restaurant, and probably would still have been able to hire the Rockettes to come in to entertain him.

    At the time I didn't have insurance because my husband lost his job two days before the diabetes diagnosis came in. We could have continued on the COBRA plan for the low low price of $700 - a month.

    America's health care system and insurance coverage sucketh.

  11. Anon,
    In all seriousness, the health care system here is seriousely broken.

    If you have catastrophic insurance, a Doctor can cavalerely send you down for one more "test" that will break you.

    I live about 95 miles from Mexico. I have friends that literally drive to Mexico in order to get affordable health care.

  12. Here 'Down Under' Australia, our health insurance system doesn't rack up unreasonable charges. My family health insurance costs about AU$2500 pa and provides premium cover in private hospitals with minimal out of pocket gap.
    Whilst I have great admiration of USA as the Nation that undoubtedly preserved our way of life during WW2, perhaps some of your administrators should take a close look at our system with a view to implimenting something similar in the States.
    Last Friday I underwent angioplasty with stent (femoral) and my total out of pocket expense amounted to AU$120 for the anethetist.

  13. All the stuff in your house seems to be "made with pride in the US of A"

  14. "If anyone out there knows how to answer a question like that, please let me know, so I will be prepared next time something like this happens."

    Would have been better to tell her you were making HER some toast...

  15. In answer to some readers, there are other solutions to the Health Care crisis in the US better than socialized medicine such as they have in Canada if our Congress would even consider suggestions made by *thinking* members. Most of them want to institute more government control of American lives. There are plenty of cases of people coming down to the US from Canada for medical care because the wait to see a doctor is dangerously long, people coming here to have their babies, etc.

    I love your stories, too. You are indeed a funny guy. I like the idea as a female, of one reader who said you should have made a piece of toast for your wife, too. What is a 20 second wait, anyway?
    Hope you got that garage door fixed. I guess you'll have to move out of the USA where products are so much more superior to ours. LOL

  16. It's funny because my wife was mad at me for a very similar situation. But instead of kidney stones, it was gall stones. And instead of our daughter, it was my wife that had them. The money issue is definitely a legitamate concern but boy was she mad at me for talking about it. She never swore at me during the birth of our children like you see in the movies, but she made up for it that day I'll tell you.

  17. You're a great writer ^.^

  18. This is one of the funniest things I've ever read! Oh, do, please, keep them coming!

  19. Great story .Glade your daughter pasted it .

    If you still haven't fixed your guage and you want to fix it yourself ,send me an email of the year and model .So I can look it up and send you the vehical repair guide . I had to the same thing a few years ago when I was 15.

    - Rob

  20. I read this 2 years later, but I love your story! I would have ask you the same questions your wife did!! :-) (in the matter of fact I did it while I was reading) But I understand your reasons.
    I really can't believe the medical system you have in US...
    (perdón por mi inglés)