What do I say when Mom says "I want to die"?
My mother, who's 86 years old and in generally failing health, has always been a happy, optimistic person. But for the past few months, her health problems -- which have included a series of compression fractures in her spine -- have gotten worse, and she's been in a lot of pain. She keeps saying, "I just want to die." We're doing everything we can to ease her pain. But what's the right way to respond when she says she wants to die (and seems to mean it)?
The right way to respond involves more than what to say to her. We're fortunate that we live during a time when pharmacologic advances are such that no one should have to live with severe pain. Therefore it's critical that a physician with expertise in the treatment of pain evaluate the medication she's taking and work with her to make her as comfortable as possible.
Physicians, nurses, psychologists, and other healthcare providers can choose to develop expertise in treating pain. In order to find such a person locally, ask your own primary care physician to whom he or she goes with questions about how to manage pain. Several national organizations also promote effective pain management and have directories of healthcare professionals with expertise in treating pain. These include the American Pain Foundation and the American Academy of Pain Management.
It's also important to have a psychiatrist evaluate your mother. If her hopelessness is caused by a significant depression, which is likely the case, treatment of the depression will dramatically improve her quality of life. Unfortunately, healthcare professionals often fail to properly diagnose depression in older people. They may assume your mother has reason to be unhappy -- after all, she's had compression fractures and is in pain, and she has likely also lost some physical function. While that all may be true, the stress may have triggered a depression, and the hopelessness that can result can in fact be treated. This means her optimism can return, despite the compression fracture.
Ideally, treatment should include a combination of talk therapy, to help her gain perspective, and antidepressant medication. There's a feedback loop between pain and depression. Interestingly, antidepressants -- even in someone who is not depressed -- can decrease the perception of pain. In your mother's case, an antidepressant might help her with both the depression and the pain. It's also important that her physician evaluate whether she's taking any other medication that's contributing to her apparent depressed mood.
An experienced clinician -- probably a psychiatrist, given the combination of emotional and medical issues -- should also carefully evaluate your mother's safety. When someone is feeling so terrible that she expresses a desire to die, her words must be taken seriously. Even if she doesn't specifically say she has considered taking her own life, the hopelessness she has expressed means she needs a comprehensive assessment regarding her risk for a suicide attempt. It would be tragic if she made a permanent decision about a temporary problem that could be treated.
In the meantime, let her talk about how she's feeling and feel free to ask her if she's considering suicide. This won't put ideas in her head, as many people fear; rather, it will give her a chance to talk about her feelings and thereby feel less alone. The feeling of being alone and hopeless is a dangerous combination. When she's talking to you about how she's feeling, she's no longer alone, and her risk for suicide decreases.
But also know that while talking to you will likely help her, it doesn't diminish the critical need to have her evaluated by a mental health professional.
MY 86 year old Mother would have none of the "let's go talk to someone" answer. She was married for 33 years to my Father who died of cancer, then was married another 26 years to a man who died of cancer. She's wealthy beyond belief, and is in her own home. My sister does her grocery shopping, delivers her medicine, takes her to get her hair and nails done, and her grandchildren and great granchildren visit her almost every weekend. I am in another state and my visits are limited to a few a year. But my Mom is at the stage where she's given up driving, her eyes are going so she gave her checkbook to my sister, she's under 100 pounds soaking wet, she has to use a cane and a walker to get around, and she generally just feels she's had a good life and wants to die. She's on anti depressents, and now when I call she's just in a hurry to get off the phone. She doesn't want to be at home, but she doesn't want to go anywhere. I feel for her but am at a loss as to what to say. She's a Christian so I know she truly knows she can't control when she dies, but I'm afraid she'll starve herself and think that's OK. What can one possibly say to her?
My mother suffered from bipolar disorder for many years, having frequent episodes of severe depression. She was evaluated by her psychiatrist at regular intervals, with several trials of medication changes.
About 6 months before her 78th birthday, following a 6-week bout of severe depression, she told me that she didn't want to live any more because she couldn't handle the suffering she experienced with each depressive phase. She called this experience
After that incident, she began to show increasing symptoms of dementia. She became more physically and verbally aggressive. The psychiatrist made additional med changes, to no avail.
One day, she became so violent that her spouse had to call the EMTs and police because she had knocked him down. She was hospitalized and sedated. She refused to eat or drink. I knew that her living will instructed that she not be given IV's or feeding tubes. She passed away one week later.
Back when she had made the pronouncement that she wanted to die, I listened to what she had to say, but did not try to convince her to see her physician again. I knew that she meant what she said and was desiring that her suffering come to end.
Dr. Robbins' article is okay, but it only presents one alternative in dealing with the wish to die. Every person deserves the opportunity to explore his own way of dealing with the end of his life, utilizing the kind support of family and friends.
Pierre Lavedan MD Palliative Care and Hospice Care Omaha, Nebraska Dr. Robbins has given a very good discussion of how to respond to "I want to die" statements. You could seek out a Palliative Care physician in your area. The physical pain needs to be treated to a level that is tolerable for your loved one. Depression should also be treated. Other types of pain should also be considered. Social pain- the loss of our social functions in society. In the dying process we gradually withdraw from our community and freinds. Then we withdraw from extended family and finally immediate family. A psychologist or social worker might be helpful. Spiritual pain- are there any spiritual issues involved? Seek out your loved one's spiritual advisor. If all aspects of the suffering are being addressed the request to die should be relieved. We want to restore hope. When we are dying, hope transforms from the hope of cure to the hope of relief of suffering and finally the hope of a peacefull death. Not only should we ask "why do you want to die?" but also "What is causing your suffering?"
Dr. Robbins article does have some good advice in it, however it is very plain to see he is a psychiatrist. Why is it sir, that someone whom is perfectly rational, can't have the right to choose their way and time of death? I, for one, believe an individual whom has not decompensated emotionally, does have the right to choose the time and manner of their ascension to the spiritual plain. Especially the people who have no quality of life left, despite all of the pain management and neuroleptic drugs we as MHP's encourage them to take, and quess what? A lot of tmes all these wonder drugs do is possibly nothing except to get bigger and more expensive meals and office supplies, (ie: advertizing materials for the prescribing physician's office, allegedly). I do agree with you that if a person is not of being of a rational mfind when they talk about wanting to die, a psychosocial intervention should be initisted. However if the person is rational, then I strongly believe they have the righ to die with dignity, and the family does need to be there to listen to them, ask questions about family history, and in general tie uo loose ends on all sides before the loved one goes to join with the creator,
I would ask, "If we got your pain under control, would you still feel this way?" If she answers no, then make some serious efforts to control her pain with her Primary care physician. That person may refer her to a pain specialist. If her answer was yes, I would have her assessed for depression. If depression is not a factor, then an evaluation by a hospice agency may benefit her. Hospice care specializes in pain management at the end of life.
Of course, I don't have much medical history on her so I'm saying hospice may be a treatment option if she is refusing medical treatment and is ready to die. The hospice team could educate and support you during this time. I strongly believe, also, that a person has the right to die with dignity and comfort. Also, please look into Advanced Directives (power of attorney, Medical Durable power of attorney, living will, and out of hospital do not resuscitate).
I personally don't believe in pushing our loved ones to do anything especailly if they are up there in age, I've seen way to much suffering in my family and the 2 nurising homes I worked in...never force or threaten them, that is not very nice and does not help them. just one persons opinion.
My great-grandmother who died at 92 told me that it was no fun being the last leaf on the tree. I understood then. All her contemporaries were gone. There was no one who could understand the life she had led or the changes she had seen. Her statement made it easier to let her go.
I agree with Dr. Robbins. I'm a Psychologist and I know how important it is to manage pain and to evaluate depression symptoms. Frequently, when someone says "I want to dye", she means "help me, please" and "I need love". As Dr Robbins says, " It would be tragic if she made a permanent decision about a temporary problem that could be treated". Specially if it isn't a temporary problem, love is always an answer and it makes miracles. If you'd like to share with the suffering person on how valuable it is to offer the own suffering as a prayer for someone else who is suffering as well, you will give peace in the midst of suffering.
I am middle aged and in constant pain.I have an incurable disease that robs me slowly and painfully. I do not understand why anyone would make someone go to therapy and all that crap. If you are suffering and really want to die, what is the big deal? Dying is part of life. Why can't people just accept that and let the ones who want to die just go ahead and die without trying to talk them out of it. You know, life can just lose it's appeal when you hurt and cannot do anything. I just take up space at this point and suffer every moment. I think death sounds wonderful.
Unfortunately... too many areas do not offer palliative care doctors/nurses. After providing in my home care for my mother (Alzhiemer's, wet macular degeneration, colostomy and incontinent) for nearly 6 years, I learned a great deal about what daily life is like for someone who just wants to be done with life. I truly wish there was a legal recourse for people who want to end their own life on their own terms. Mother was a Christian and begged for God to let her die. I tried everything I could to keep her engaged and physically able, but a dramatic downturn in her abilities, causing 2 falls and hospitalization, led the way to her entering a nursing home, something I had promised I would not let happen if there was any way to avoid it. Despite all her problems, she was physically strong, but weakened by the practice that the hospital and nursing homes forced on all their patients... and that was to be forced to stay in a wheelchair (due to potential fall liability). This practice WEAKENS the person dramatically (even if they DO have a few minutes of "REHAB" daily). My mother was also forced to wear a diaper and they would not assist her in going to the bathroom (she had always used the toilet and was incensed that she was forced to "pee her pants"). Mother suffered terribly both the hospital and nursing homes. You cannot complain or your loved one is tossed out on the street. FACT! Mother would much rather have been able to die than to live that last 6 months in a nursing home. I know she suffered and I suffered, as a result. LET US LET OUR BELOVED FAMILY MEMBER CHOSE THEIR TIIME OF DEATH... we are better to our pets than we are to our humans.
dear anonymous, I know how you feel and agree 100% My poor mother suffered the same fate as your Mom, after years of caring for her at home her overall health and a fall causing a broken hip did her in, I also promised my Mom no nursing homes while I was alive to care for her, I tried will all my power to get services at home to help me but the best I got was 15 hours a week, what the hell is that when someone needs 24/7 care?? she ended up in a nursing home, mostly in bed as thier phyisical therepy was a sham and passed from pnuemonia over a year later at the hospital..my heart still breaks and it is over a year now :-(..I feel your pain and agree that things have to change for end of life care and dicisions**
Reading so many similar situations, helps, but does not make it any easier. My dad also just wants to die. He is 85, living in assisted living because I could no longer take care of him. My mom died over 3 years ago and that is the day he wanted to go too. He has severe hearing loss, severe macular degeneration, is very confused and forgetful. He has no joy in life anymore, even when he is with our family. He does not want to partake in any of the activities offered in the home. I get it, I would not want to be in his situation either. He has to take medicine for his "quality of life'. I don't see a quality of life. I don't think he is ready for hospice, but I would like to consider it because I feel he has "failure to thrive" which I just read about, but that is it. He will not thrive anywhere, he is just tired of life. he lived a long, good life and he is done. It breaks my heart to see him this way and I just want to see his suffering end. and agree that end of life decisions need to be changed. We cannot just feed people medicine to keep them "living" indefinitely just because it is available. We need to treat our beloved family humanely the same way we treat our beloved pets. As an aside, this is also why our country is going bankrupt, hospitals, families paying for care, etc, keeping people alive longer than they would naturally is unethical and expensive. thank you for having this forum to discuss issues like this.
I am currently taking care of my mother in the end stages of cancer and congestive heart disease. After a series of small heart attack and knowing that we couldn't risk any more chemo without damaging the heart muscle any more mom made the decision to go with hospice. It was her decision and I have her medical power of attorney and I believe I would have made these same decisions for her. I think the most important part of all of this is to make these decisions BEFORE something happens. TALK with your family no matter how uncomfortable it is about all the WHAT IF's in life and know what they all would want and need to happen in their lives. Believe me this has been the hardest thing in my life to do. Sitting and watching my mother wasting away and dying and knowing the only thing I can do is try and make her comfortable. Sometimes I feel that I need my anti-depressant changed as I am having a hard time managing my life with 2 young children and raising my young grandson as well. But with a loving husband and wonderful friends we are doing it. With a lot of help with God. Mom is not afraid. She is only 67 MUCH MUCH TOO YOUNG.
I think that the answer is comprehensive and definitely includes what you need to consider in terms of physical and mental health. It's possible that, as many have added, this mom - like others - make not be amenable to psych. intervention, and her wish may not be either a sign of depression or unreasonable. I would add then - having a mom who is not suicidal, not religious, and frustrated after a long time in a nursing home setting, sometimes you first have to let the person know you are listening, and even encourage her to speak about her psychic pain. It's hard for us who want to make things better - sometimes we can't - and sometimes we may have to face that we do not have a pill or activity or anything that can counter that person's feelings of loss. You also have to consider if this is a really different expression of her personality - or pretty ordinary.behavior.
So actively listen - let her know you hear her pain, and this may may things livable.She doesn't have to be a hero, she needs a place where she can express her feelings bluntly even if they aren't "acceptable." But anyone filling this role needs support, too, It takes courage and strength to be present when someone is in pain of any kind.
Anonymous caregiver - please find help for you. Tomorrow my sister-in-law will be "unplugged." She has decided it's time. Unplugged in her case means declining to be hydrated, which has been done solely intravenously for about three weeks. [Some details, if you want them, so far as I can give them are that her kidneys are clogged with cancer, she had a small bowel obstruction, and anything she takes in by mouth flows out of her stomach drain]
Some times it is time. She has been in an extraordinary place of approaching death for a long time, having all of her wits, and having family and friends close. Last Friday, she had her last dinner with neighborhood friends over. Her pain has been completely controlled so far - a true blessing. Two weeks ago her daughters moved her from hospital to home(one is an RN, and an expert in pain management, which is another blessing). Unrelenting pain - the prospect of it going on and on - is a curse which separates many people from living far before death comes.
She pursued good and innovative treatments, had fine doctors, and has lived, not just survived, for the past 5+ years with metastasized breast cancer. But now she has is out of energy, and options, and and having had a good life, is sad, but ready to let go.
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I worked ads a live-in for a wonderful Family caring for their 89 year old Mother she was scary smart she held a Masters in education, she was a WWII Vet, and a Mother of 8, she also had Rheumatoid Arthritis that had crippled her,. She had bouts of depression where she would tell deveryone she wanted to die, she meant it and would try to starve herself. She was used to the pain you could hear her little bones grinding when she tried to move her arms. She was so hard of hearing she was deaf. Reading was her only outlet she had at least 20 magazine subscriptions and monthly book clubs and would occaisionally order cases of books and she would read them all. We don't know for certain but we think she had a mini stroke that took her sight she told her Dr. she didn't want to investigate she just wanted comfort care he referred us to Hospice and she was gone within a week She died surrounded by her children peacefully at home she had a wink and a smile for all of us her last days she was so happy. Hospice is wonderful they can help bring a peaceful end for your loved ones. She couldn't understand why she had to suffer through when she was dying anyway, she felt as though no one was listening to her cries for help. We communicated by writing on a dry erase board but after she lost her sight we could only hope she understood us We herd her and in the end she was so happy.
Well... It's shockingly to me, now been over a year since mom finally passed. And I am still not recovered. People are so mindless and thoughtless! I have been shaken to my core by the complete lack of compassion shown by my church (member 16 years), and my own family. But, then, they were not there for mother or me for the final 7 years of her life, when I sacrificed everything in order to care for her in our home. She was the one that suffered from Alzheimer's, had a colostomy (those 2 combined were a disaster at times), wet macular degeneration, and incontinent... Yet, would use the toilet (thought the custom diapers I did were underwear). Upon entering the hospital, then a series of ever worsening nursing homes was a nightmare of epic proportions. The fact that I could have been admitted to the hospital at the same time she was, due to damage done to my back trying to keep her from hitting the ground when she fell twice, that last day she was home.... No one cared about. That I am still in a world of unrelenting physical pain, no one cares. That what mother endured at the hands of HORRIBLE people at the nursing homes... No one cares. Not really. That one family member showed up at the last minute and made a total fiasco of things (force feeding mother after she'd been diagnosed with having list the ability to swallow)... And then leaving town, not returning until the funeral... Which, immediately prior to... She pitched a royal fit and refused to allow our pastor to include ANY references to God or a salvation message. She allowed The Lord's Prayer. That daughter was the eldest daughter; and she'd "taken" mother, it was discovered, financially over the years (she and her daughter). Like I said.... It's been a year. And I have not heard from anyone... Except my aunt, married to my mother's brother. When my sister realized there was nothing for her to inherit (she'd already taken EVERTHING from mother's home when mother moved in with me... Even though it was halfway across the continent). She managed to do that, but only managed to come see mother once while she was with me and she only lives 7 hrs away by car. Interestingly enough, the only time I've heard from my sister since mother died was when father's brother died and she wanted to know what was in HIS will. Well, a niece on THAT side if the family stole everything and there was nothing to be done. This business of family squabbling over a dying person (or a dying person's estate or even a simple item)... Is so repugnant. Especially for a longterm caregiver that has sacrificed in order to BE THERE FOR THEIR LOVED ONE. If I had it to do all over, again?? I would have fought HARDER to allow mother her expressed desire and that was to control the ending of her own life... With a shred a dignity. Even if it meant me going to jail? I'd rather be in jail than a nursing home!!! I dare every one of you to go to busting homes in your area. Show up at dinner hour. Ask to see where one would "shower". That is the torture chamber. Imagine you are naked and freezing. Get to know the night workers. Yeah, that'll happen. Never.
This answer is probably not very helpful because it's REAL. And the reality your loved one faces is dark if confined to a nursing home. Now that mother has passed, I have heard so many horror stories from people that didn't want to speak up sooner. Why not!? This political climate with people fighting against the right for everyone to have affordable healthcare is horrendous. Change MUST HAPPEN! My family knows beyond a shadow of a doubt that I am to DIE by any means necessary if I am in such a state as to require a nursing home. I so wish I had honored my own mother's wishes. I will NEVER be able to forget how she suffered. If only she could have died at peace at home in her own bed as she wished.
To Still Anonymous, My heart hurts for you, I am so sorry and I care :-( My poor Mom ended up in a Nursing home the last year and a half after I care for her in her home and mine for the prior 10 yrs. It was just to much physically for me at that point with pretty much no help except my hubby and brother on weekneds but mostly for visits which of course is nice but I needed overall help. I hear you I worked in 2 nursing homes and they all suck no matter how nice but forget it if you are on medicaid or poor and don't have a choice then you get stuck in a horrible dingy place and even worse care. My heart is also still broken and I am haunted by the last year of Mom's life as you are with your Mom end. I made the same promise and my Mom wanted to die even with demeita, she had a host of health issues, COPD, broke her hip that last year, osteperosisi, shingles, artierial sclrosis, the list goes on believe me, just know that your feelings are normal, the gulit and all..do know that you did your best and the leaches come out to feed when all is said and done, we had them in my family too, where were they when we needed their help with our Moms?? So anyway you are in my thoughts and prayers, hope you feel better.. God Bless xo xo
When people tell their loved ones that they wish to die - hello?! They mean it! Why the heck don't people learn to fricken listen? Or HEAR what they are saying! Hold their hands if they express this. Grant them the psychological oxygen to express themselves, and for god's sake - bloody well empathise - don't PATRONIZE just because you are frightened!
Why the need to pass the buck and say 'we suggest they talk to a psychiatrist/psychologist! What a fricken cop-out!
Let them express their desire to die. What are you so afraid of? People fear death! It's pathetic. Rather than becoming knowledgeable on the subject and realising that a soul is passing/transcending the human body into another dimension - people grow scared. Educate yourselves!
I'm glad I'm taking my own death into my hands. I've already expressed my desire to die (and NO I'm NOT depressed/suicidal blah blah). I'm incurably ill, have been for 15 years! Get it? I've learnt to be happy on my own during this time, during my hardships. I've grown through all this.
And I see that everyone around me is plain scared - or bullying me into living and fighting, working harder on my diet, seeing this counsellor/doctor blah blah blah. I've had enough of all this money down the drain on therapists who couldn't help me. And I no longer want health supplements or diets or any more green smoothies/juices.
I want to die! And I'm relieved to take matters into my own hands in the very near future. I'm enjoying the last days of my life, have picked my favourite flowers, have enjoyed time with my pets (who I've already organised new loving owners for), have enjoyed sitting in the sun, looking into the clear water of the ocean, my favourite meals etc.
This is the love I give to myself, as no one else knows how to give it. I love myself enough to nurture me at the end of my life.
When people who wish to die say it - just hear them out and say nothing if you've got nothing good to say. Spare them the lecture or how much better off they are than starving children in Africa. Sometimes you just need to hear them and give them your permission. That is what they are instinctively seeking.
As I am writing this, my mom is here in bed in a skilled nursing facility. She suffered a massive stroke over 40 days ago. I am a family physician, and neither me nor her numerous specialists expected her to survive the stroke. She did. She cannot swallow, and has had a gastric feeding tube surgically placed for hydration and nutrition. She is alert, aware and can talk some, but has movement only in her head, neck and one arm. Yesterday she vomited and aspirated her stomach contents into her lungs. She will likely develop a chemical and then a bacterial pneumonia as a result. I am struggling, trying to come to terms with the impending loss of my beloved mother, and trying to encourage my wonderful father, who despite being in poor health himself, spends 12-18 hours a day here with her. She has directly asked me to end her life several times. I reply that I cannot do that, but I will be here with her as much as I can, and be her advocate to make sure she does not suffer any unnecessary pain.
What I am most frustrated and baffled about is that most other family members and friends do not come to visit her. Many are local, and all are within an 8 hour drive or a 1.5 hour flight, none of them are so poor they could not afford the travel. When I speak with them most make excuses about being "too busy". One of her siblings flatly stated that they "did not want to see her in this condition". Others promise to come and then don't.
Please don't avoid people who are ill and dying! We may all be in my mom's position someday. The saddest part of this process is the detachment I see in people she has actively loved and cared for for 80 years. The fear of death makes many people retreat into denial, and makes it so much harder for the loved one and those of us who are caring for them.
Many of these stories refer to people in pain. My tale has a different twist. My 93 y.o. MIL moved in 8 mos ago. She has some mild dementia - not alzheimers - just short term memory problems. Otherwise she is basically healthy and pretty fit. She does not act depressed (she gets up every day, has a good appetite, exercises, cares about appearance, etc.). But almost daily she talks about wanting to die - saying she has just lived too long. She doesn't talk about it obsessively and never with her hired caregivers. We discuss it openly. She is not suffering, she just sees no purpose to life and feels she contributes little. She doesn't want drugs or therapy, religion or spiritual counseling, nor is she interested in making new friends. She is just tired of waiting to die and wishes there was some way we could make it happen for her (but understands we can't - we've been through that discussion too). What suggestions do you have?
My mom, terminally I'll with stage 4 breast cancer is coming to terms with her situation and has asked me or my aunt to "help" I'm sure it has nothing to do with suicidal tendencies, or depression for that matter. She's hoping to speed up the process. I really can't say I blame her, the constant pain, among other things, would probably make anyone start to wonder if and when an end can be seen in sight. They've continually upped moms pain patches and meds, but the relief is short lived at best. She was baptized in the Church of Christ here where I attend just before she was hospitalized and when she starts to doubt that relief will come I remind her of her willingness to obey Gods perfect plan of Salvation. I tell her He will not leave her to face this alone, and it won't be long until He calls her into an eternal peace. I think reassurance, especially letting them know they're not as alone as they might think can sometimes make all the difference.
I am 46, live in chronic pain due to mold poisoning. I feel the same way many times. I want to die. This is not worth living. However, pain can be managed. Don't let her go out in pain. Don't worry about addiction. The most over-used word in the world of pain. Who cares? Really? I'm on pain medication and probably will be until I die. I'm dependent on it, and I'm fine with that. I still work as an engineer. So please, do it. Make sure she is comfortable. If that means opiates, then so be it. It will certainly help her to feel less like she wishes for death.
I think it all depends on the individual who is suffering. Listening to them would be the first thing to do. Ask questions; talk. But don't be condescending or make them feel bad for what they've said. I just had a cousin tell me she was ready to go. She has lived a great life and has family around on a regular basis, but her body is just giving out, slowly. I didn't know what to say, so I just listened, smiled and held her hand. I'm going to go back to see her and I'll be sure to say "Well when you do go, I will miss you, but I understand. And when you get to heaven, be sure to "look up" my Mama and Daddy, and y'all get together for a party. Now I realize that may not be how heaven works, but my family does sort of joke about that kind of thing. It's nice to think that all those who have already passed away are just sitting up there as guardian angels, but also having one magnificent family reunion. Anyway, I do think you should make sure their pain is taken care of, and at least mention their concerns to their physician. when it comes my time for this sort of thing, I really wouldn't want someone to make a big deal about whether my mental status is okay. Get me checked out, fine. But damn it, if I'm ready to go, I'm ready. And there shouldn't be anything wrong with that.