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The myth of the “five stages of grief”


We’ve all heard about the five stages of grief, right? Many of us have them memorized, or could name at least two or three of the stages. But, do we know where they came from? Do we know what they are based on? Does it occur to us to question whether or not they are based on actual research? Nine months ago, my answers would have been no, no, and no.

But here I am today, almost nine months after Julian‘s death, with a whole new perspective. As I mentioned in one of my early blog posts, one of the first things I did after I came out of my initial shock was ask a friend, “What are the 5 stages of grief, again?” I wanted a roadmap for my future. I wanted a to-do list. Then, I learned that the theory of “The Five Stages of Grief” — also known as the “Kübler-Ross Model” — is neither based on bereavement nor scientific research. Surprised? I was. So I decided it deserved another blog post.

I wasn’t just surprised, I was disappointed when I learned the facts about Kübler-Ross’s five stages. I was mostly disappointed because I liked the idea of having a map or path through this process, which I could follow and track my progress through a journey that by definition (I assumed) had a beginning, middle, and end. But I was also disappointed to learn that these five stages had become conventional wisdom in the field of psychology and mental health without any scientific research to back it up.

So who was Elisabeth Kübler-Ross, and where did these five stages come from? In the ’60s, she was one of the first psychologists to dedicate her career to working with terminally ill patients. She became a respected lecturer on the topic of how nurses and doctors could/should interact with their terminal patients. Because of the uniqueness of her work and her lectures, she was offered a book deal. It was then — after signing her book deal, and with a deadline looming — that she came up with the stage theory.

She wrote her book based on her work (not “research”) with terminally ill patients (not “bereaved people”). That first book, On Death and Dying, was published in 1969 and was interpreted as fact, and also turned her into a bit of a celebrity. Perhaps it was because of her sudden fame that she didn’t go out of her way to point out that the five stages were simply her “theory,” not proven through research. But in reality, as the introduction to the 40th anniversary edition says, “It is essential to note that … On Death & Dying is not a work of research. It is a popular book of description, observation and reflection based on a series of dialogs with dying people.”

The unfortunate thing for people like me is that the “conventional wisdom” of the five stages has made a negative impact on our experience of grief (as if it weren’t bad enough to be grieving in the first place). One of the most helpful and interesting books I’ve read in this past 6 months, The Truth About Grief by Ruth Davis Konigsberg, confirms what I have experienced: the embrace of the “Kübler-Ross model”…

“…has actually lengthened the expected duration of grief and made us more judgmental of those who stray from the designated path. We have been misled by the concept that grief is a series of steps that ultimately deposit us at a psychological finish line, even while social science increasingly indicates that it’s more of a grab bag of symptoms that come and go and, eventually, simply lift.”

Kübler-Ross, standing on the shoulders of Freud before her, set the foundation for today’s understanding of grief. Unfortunately for all of us, this foundation is fundamentally flawed. To quote The Truth about Grief again:

“a subject that is not supposed to be discussed… is the possibility that grief may be finite. ‘There is no timeline for grief,’ is how the advice books and web sites put it. Even the concept of recovery itself is seen as a misleading elusive goal. Though Kübler-Ross identified acceptance as her final stage, implying some kind of end point, she also said that you could never fully close the chapter on grief. “The reality is that you will grieve forever,” she concluded in On Grief and Grieving. “You will not ‘get over’ the loss of a loved one; you will learn to live with it.” This undoubtedly may be true for many, but the grief movement has taken that statement to mean that no one should ever get over such a loss, although that rule seems to get more strictly applied to women than men.”

Did you catch that last part? That rule seems to get more strictly applied to women than men. For me personally, it’s the judgement of myself and others (real or imagined) that has been hardest part of my grieving process. After those first couple weeks of shock, my instincts told me to focus on moving forward — but I couldn’t stop the voice that would pop up in my head that questioned, “Wouldn’t a ‘good mother’ actually never move forward from losing her child? What does that say about me that I want to survive this? What will this say about me if I’m actually successful?”

Now, almost nine months later, I don’t ask myself those questions anymore. I know there are people who read this blog, or see me going about my day, and ask those questions in their head. (“How can she work? How can she be functional? How can she be smiling and laughing? If my child died, I wouldn’t be able to do any of those things. She must be in denial.”) These people worry that I’m not grieving correctly, and someday it’s going to finally “hit me.” The reality is, the only “denial” I experienced was Julian’s last day in the hospital. I was in absolute denial that he could die. Until he did. (You can read about that day on his CaringBridge site.)

I believe that the concern about denial and other judgement is primarily based assumptions about the stages of grief, and society’s expectation that no one should get over the loss of a child (especially a mother). But the truth is, both science and my natural instincts tell me that those people (including Kübler-Ross) are wrong.

We all need to re-think and re-discover what grieving really looks like. 

 
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Posted by on December 1, 2011 in the second six months

 

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The six-month milestone.

Here it is. Six months. Some call it an “angelversary.” Or as a wise friend said recently, “I like to think of it as his birthday. His new birthday. The day he was born into whatever comes next.” I like that. Happy six-month new birthday, little one.

For me and my family, it means six months of the “after.” It’s the six-month milestone of “new normal.” In charts and graphs about grief and bereavement, it’s often the first milestone in the timeline, like this one from The Other Side of Sadness by George Bonanno (yellow highlighting is mine):

I first saw this chart, and the book that contains it, around the two-month mark. It meant so much to me to learn that science shows that bereaved people fall into one of three categories — chronic grief, recovery, and resilience. Until that point, I’d only found memoirs and books written by therapists that made it seem that most people were chronic grievers who only reached a sense of “recovery” after years of therapy and support groups (if ever).

Turns out, many of us — perhaps even most of us — fall into the “resilience” category. It’s hard for researchers to know for sure what the percentages are, because these aren’t the people writing memoirs or visiting therapists for years on end, and therefore aren’t on the radar of the therapists and grief counselors who are writing books about their work.

I wrote a lot about The Other Side of Sadness in my two-month blog post, and it seems fitting to revisit it again now. One of the most fascinating details about the scientific research described in this book is that they studied people both before and after their loss. Because of this, the researchers were able to discern the difference between someone who started displaying frequent and prolonged grief symptoms after their loss, vs. someone whose personality and outlook on life was grief-like even before the loss.

The researchers were able to identify personality traits of each group that were apparent before and after their loss. My friends and family would probably agree that the traits observed in “resilient” people sound a lot like me (and my husband, too). The research showed that resilient people are:

  • optimistic
  • flexible (can share AND suppress emotion)
  • can find benefits, and believe that “the world is basically a decent place, and life is good”
  • have a support system of family and friends
  • are “able to evoke comforting memories of the lost loved one”

With six months behind me now, I have a new appreciation for Mr. Bonanno‘s observation that “the human inquiry into the mysteries of life and the nature of the soul is acute during bereavement. When a loved one dies, we have no choice but to face up to nearly imponderable questions…. Many of us discover, in fact, that we have found something quite profound hidden in the experience.”

I’ve now had six months of “facing up to imponderable questions.” I wholeheartedly agree that “the mysteries of life and the nature of the soul is acute during bereavement.” I’ve pondered the imponderable. I’ve inquired into the mysteries of life. I have a new understanding of what it means to be human, and what it means to be alive. If there could possibly be a silver lining to this experience, that’s it.

I’ve survived six months of the after. I’ve spent six months creating new normal. I don’t know where I’ll be in 6, 12, and 18 months from now, but I know I’m resilient. And I know my future will be filled with happiness — because I choose to make it that way.

 
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Posted by on September 3, 2011 in the second six months

 

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It’s time for a new chapter in the American history of death.

For much of our American history, it was not uncommon for a family to lose a child. Disease, childbirth, war, and lack of hospitals made it unusual for a household *not* to have been touched by death in some way.

Despite the frequency of death, or perhaps because of it, grief was not discussed in those days. Grief was expressed in the appropriate times and places, such as at a funeral, but it was not discussed. Our American ancestors were never urged to go to group therapy to revisit their loss… over, and over, and over.

Then, there were two important changes in our country’s history. First, the medical world made significant advances: hospitals became more accessible and more sanitary, vaccines were discovered and distributed, and diseases became more curable — resulting in fewer deaths. Second, death became a topic of interest among philosophers and psychologists, who suggested that death had become an “unnatural taboo” which caused repression of emotion that would surely cause damage to one’s mental health.

On one end of the pendulum swing, in 1911, an article called “Facing Death” in Harpers Bazaar said, “Grief is self-pity. Perhaps if we were less centered upon our own happiness, grief over the loss of our beloved ones would not be the terrible thing that it is.” On the other end of the pendulum swing, the 1960s and 1970s brought about an emphasis on self-expression, talk therapy, and the overwhelming influence of Elisabeth Kübler-Ross‘s book On Death and Dying* published in 1969. By the late 1990s, it had become a widespread belief that people must “give voice” to their grief, or else it would fester. And now we do get urged to go to group therapy to revisit our loss… over, and over, and over.

In other words, death went from being a frequent occurrence with an expectation of limited outward expression, to being an infrequent occurrence with an expectation of significant outward expression.

Here’s why our culture’s history of death is of interest to me: I believe we must let the pendulum fall closer to the middle. I want us to all be thankful that the death of a child is so uncommon… but I want us to remember that it is not unheard of. I want us to respect those who choose to express their grief outwardly… but not judge or “worry about” those who don’t. I want us to remember that life is a gift… but also remember that death is part of the same cycle. I want us to honor the loved ones we have lost… but not lose ourselves in the process.

It’s time for a new chapter in our American history of death. In this chapter, we don’t expect people to die, and we don’t expect people not to die. We don’t judge people for expressing themselves, and we don’t judge people for not expressing themselves. We mourn the ones we have lost, and we celebrate that we had them in the first place. We remember the loved ones who have died, but we never forget that we are still alive… and we have a lot of living left to do.

* Note: I wrote about this book in one of my first blog posts, and I’ll be writing about it again in one of my next blog posts.
 
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Posted by on August 31, 2011 in month 6

 

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Red sunsets.

I feel like it’s been a long time since I wrote a blog post. Early on, I wrote because it was therapeutic and the writing process created a good structure for me to understand my own thoughts and feelings. Later, I wrote because I was reading books and discovering new things that I wanted to explore. Today, I’m writing just to share what’s going on in my life.

When I wrote my last blog post, I was at a cabin on a beautiful MN lake with my extended family. It was hard to be there without Julian, but it was a wonderful week. The relaxing environment and the beauty of the lake made me feel more peaceful than I’ve been since Julian died.

Almost immediately after leaving the cabin at the end of the week, I longed for more. I instantly missed that peacefulness the lake inspired in me, and I had a whole new appreciation for getting away and having focused family time. John and I talked about it, and we decided to consider buying our own cabin. We started researching our options.

I have now viewed hundreds of cabins online. Both Minnesota and Wisconsin have beautiful lakes within driving distance of our home. We want something small, and certain details are important to us — for me, feature that is most important is that the cabin must be West-facing. I need to be able to see the sunset.

My whole life, I’ve sought out the sunset. I’ve planned vacations specifically to see the sunset over the ocean. I’ve strategized the best reservation time to watch a sunset from a restaurant. My boys would sometime’s tease me about needing to “watch mommy’s sunset.” If we are going to buy a cabin, a beautiful sunset is a must.

Two weeks ago, we rented a cabin that is also for sale. It had wonderful ’70s modern architecture that reminded John and I of our own house… but most importantly, it had what the owners describe as an “Aloha sunset.” We were only there for 2 nights, and I was so disappointed when the first night was cloudy. I could see a glow in the distance where the sunset would have been, but not the real deal.

The second night was beautiful. It was, indeed, an “Aloha sunset.” As I sat there on the shoreline, I watched John and Oscar fishing right off the dock (and actually catching fish!). It reminded me of the times when Julian was John’s fishing buddy, as shown in this cute photo, and this one too.

I was entranced as I watched the sky change from blue to purple to orange and red. When the red tones came out, it hit me. THIS is why sunsets are important to me. The red sky, the beauty of nature, the cycle of sunrise to sunset, the cycle of birth to death. THIS is where I feel close to Julian’s spirit. His favorite color, red, is what makes a sunset beautiful.

From now on, every time I see a sunset, I will think of my sweet boy and the beautiful things he contributed to my life. Hopefully, soon, we will own a cabin with a sunset of our own. Until then, all I have to do is look at the photos I took (like the one shown above), and I feel peace.

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UPDATE ON 8/10/11: This week we made an offer on the cabin I mentioned in this post, and it was accepted! Now we will own that sunset — and the sweet little cabin that looks out over the lake. We look forward to creating wonderful family memories there.

 
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Posted by on August 8, 2011 in month 5

 

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Julian + Daddy.

Today is Father’s Day. Today I’m remembering and appreciating how Julian’s too-short life was filled to the brim with love and attention from his daddy.

I wanted to share some photos that offer just a glimpse of the special connection they had. Sadly, I never caught a photo of them in the kitchen together (Julian loved to watch John cook) — but the ones of them fishing together are some of my favorites…

S L I D E S H O W

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G A L L E R Y
 
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Posted by on June 19, 2011 in month 4

 

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How do you plan a child’s funeral?

Let me start by stating the obvious: No one wants to talk, read, or think about a topic like planning a child’s funeral. But this blog is all about addressing the unthinkable, and that’s what I’m writing about today. So, how did we do it? How do you design an event to commemorate your worst fear? The first thing we did was eliminate the word “funeral.” Instead we called it a Celebration of Life. That was 3 months ago today.

As I think back on that day, exactly 3 months ago, I remember that the feelings of love and support were overwhelming (in a good way). Hundreds of people came. Family, friends, clients, acquaintances, and total strangers from Minnesota — plus family and friends flew in from California, New York, Connecticut, Ohio, and Colorado. One of John’s best friends even used a year’s worth of vacation days to drive up from Kentucky. The event itself was exactly what we wanted it to be.

We were comforted by positive feedback from the guests as well. Last week I had lunch with a friend who attended Julian’s Celebration, and she also had recently attended a funeral for her cousin’s son. She shared with me some of the differences between the two services: Julian’s Celebration was uplifting and healing for her, the other one was painful. Julian’s service made her feel as if she knew who Julian was (even though she had only met him a couple of times), the other service didn’t reveal much about who the child was.

My friend encouraged me to share some details about Julian’s Celebration so other bereaved parents, like her cousin, might find inspiration and assistance when they have to do the impossible: plan their own child’s funeral. I’ve been wanting to capture some of those memories anyway, so I started thinking about it.

Let me start by telling you a few things my husband and I did NOT do:

  • We didn’t call it a funeral. Right from the beginning, we called it his Celebration of Life. “The Celebration” for short.
  • We didn’t rush into it. Some people follow a specific schedule for the events surrounding a death, based on their religious beliefs and family traditions. We didn’t feel obligated to follow any specific schedule, so we took our time and planned the event for the date that felt right to us: his 4th birthday. It was nine days after his death.
  • We didn’t have an open casket. In fact, we didn’t have a casket at all. We had him cremated, but didn’t have the ashes at the ceremony. I agree with C.S. Louis when he said,  “You don’t have a soul. You are a Soul. You have a body.” Julian’s body was the container for his Soul, and he didn’t need it anymore. It didn’t need to play a role in the Celebration, in any form.
  • We didn’t let anyone take over. At the time of the planning process, we were surrounded by people who wanted to help us any way they could. It would have been easy to find some sort of template or find someone to plan the funeral on our behalf, and in many ways would have been easier. But nothing was easy in those first days. Everything was hard. Given the choice between not-easy Celebration planning, or not-easy anything else, I chose to focus on the planning. And I’m glad I did, because the things that initially seemed hard ended up being surprisingly therapeutic.

And now for the things my husband and I DID do:

  • We were inspired by a Dr. Seuss quote. Someday* I’ll write more about how the quote presented itself to me in the first place, but the short story is that I came across a quote that said, “Don’t cry because it’s over… Smile because it happened.” The fact that it was a quote from Dr. Seuss made it even more perfect, and we decided to make it the theme of the Celebration. Not because we didn’t believe that crying is an important part of processing emotions, but because we wanted the Celebration itself to be focused on what a wonderful gift he was to us. We wanted to remember his life, and we wanted to smile.
    *NOTE: I wrote more about this in a later blog post.
  • We designed the experience. John and I both have a background in design, and our business is focused on designing experiences. Even though each element took effort, I was grateful for the opportunity to apply the skills and strengths that I have as a creative professional to design the details of the event. Everything I created — posters, program, slideshow, and a keepsake photo we gave the guests — was designed with common elements: the Dr. Seuss quote, the little spaceman illustration from the pajamas he was given in the hospital, and the color red (Julian’s favorite color).
  • We asked people to wear red. We wanted the event to be lively and celebratory. It was so perfect that Julian’s favorite color was red (despite the fact that by the age of 3, almost all boys will tell you their favorite color is blue). The whole church was a sea of red, because in every announcement of the event we included this sentence: “Guests are encouraged to wear red, Julian’s favorite color.” What didn’t need to be said was, “Don’t wear black.”
  • We used music throughout the service. Overall, the music was amazing. We stayed away from sad, melancholy songs (perhaps with the exception of the song I chose for the photo slideshow — a track from Julian’s favorite CD of lullabies). The musical highlight was a song written and performed by Molly Dean Anderson, who also lead us all in singing “Happy Birthday” at the end of the service.
  • We chose speakers who knew and loved Julian, starting with my husband. When John announced that he wanted to speak at the Celebration, I tried to talk him out of it. But it was important to him, and he wrote a beautiful message. When it came time to share his message, he had Oscar join him as he spoke about bravery and what it means to be a hero. My two brothers and John’s sister also shared touching, beautiful messages about Julian.
  • We really, truly celebrated his life. The Celebration was held in a church, but the service was intentionally non-churchy. It was important to us that the Celebration was focused on our son, not on religious tradition. In addition to Julian’s dad, uncles, and aunt, we asked two long-time family friends to participate in the service. First, Georgann Fuller offered beautiful words of wisdom from her own experience of losing her husband many years ago, and she read a poem that has become deeply meaningful to me. Later, the “sermon” part of the service (the Meditation) was delivered by Don Portwood, who has known me since I was young, officiated our wedding, was with us at the hospital as Julian went in for surgery the day after his diagnosis, and was at the hospital with us the day Julian died. Don included a poem by Rumi in his meditation, and it was perfect. Everyone who participated in the service was clearly filled with love for Julian and our whole family. The service was truly a “Celebration of Life.”

Planning an event to honor a child’s death is not something anyone ever wants to do. And it’s certainly not anything anyone wants to be good at. But I followed my instincts, and found solace in the “work” of it. I wanted the event to be focused on sweet Julian’s short life, but also on love and gratitude for life in general. It was exactly what we wanted. And I wouldn’t have changed a thing.

And now for some special thanks:
  • Don Portwood — for delivering the perfect message in the service, and for being so much more than a friend-slash-pastor.
  • John, Dan, Alex, and Jennifer — for so eloquently writing and speaking about their memories of Julian.
  • Georgann Fuller — for traveling from California and contributing such a wise and important message of survival and love.
  • Molly Dean Anderson — for writing a song specifically for the event, and performing it like an angel (and the other songs, too).
  • Jeff Lindsay, Anne-Marie Finsaas, and all at Colonial Church of Edina — for your contributions to the service, and providing such a beautiful and welcoming environment for the event.
  • Lili Korbuly — for capturing the event in beautiful photographs.
  • Bastian Skoog & Queen of Cakes — for the beautiful flowers at the front of the church, and the delicious birthday cake served after the ceremony.
  • Everyone who sent flowers — because even though we said we’d prefer a donation to Julian’s fund, the abundance of red floral arrangements was breathtaking.
  • Friends and family — for folding programs, stuffing envelopes, hanging balloons, serving cake, and keeping us sane.
  • Everyone who flew in for the event — especially my cousin Sarah, who has always been like a sister to me.
  • Every single person who attended, and those who couldn’t attend — because your love and positive energy made the event a true Celebration.
  • Last but not least: Julian — for being my inspiration and motivation, not only for the Celebration, but for the rest of my life.
 
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Posted by on June 12, 2011 in month 4

 

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The circle of life in our back yard.

Spring has finally arrived in Minnesota. All around us we see signs of rebirth. But this year, I’m also painfully aware of the flip side… we can’t appreciate new life without acknowledging the inevitability and significance of death.

This circle of life is literally on display in my back yard. About four years ago, we noticed that a pair of foxes would appear in our yard from time to time. When the snow started to melt, we realized they had created a den under the trees and brush.

Daddy Fox near the entrance of the den.

A couple of months after the foxes moved in, they had babies! We had seen a lot of wildlife in our wooded neighborhood, but never anything as cute as this. Our whole family was excited to see the little “kits” grow from little balls of fluff to the size of a small dog. As the weather got warmer and the grass and brush started to grow in, the babies would come out to play.

We were delighted when the foxes returned the next year, and the next. The boys loved to watch them from the kitchen windows:

Click to see video of last year’s fox babies.

But this winter, I didn’t see the foxes like I had in the past. I worried that they had decided not to come back to us this year.

But then I finally saw the daddy fox. He appeared the morning after Julian died. Somehow, he looked both confident and carefree as he trotted through the yard. He reminded me of my strong, sweet little Julian.

During those first days of the “after,” I’d often look out the kitchen window toward the fox den. Through my fog of shock and grief, I admired this pair of faithful, committed fox parents. I felt honored that they had picked our yard as the safe place to give birth and raise their little ones, especially this year.

As the snow melted, I’d search for signs of babies. I was surprised I hadn’t seen them yet. Did they pick a different den this year? Did they not have babies this year? Something seemed off. And then on Easter morning, I saw a little mound of brown fluff moving around. A fox baby! I felt relieved. Nature had once again come full circle. And how fitting to have the first sighting on Easter.

I only saw one baby on Easter, but I assumed there must be more. In past years, we had always seen at least 3 or 4 kits. But I kept seeing only one at a time, never a group playing games and tackling each other like in the video from last year. And then just this week, it hit me: there is only one baby this year.

The fox mama that had raised her family in my yard year after year, the creature that I somehow felt kinship with, had ONE BABY. One. She most likely gave birth to at least one more, but only one made it. One. Just like me. There used to be more, but now there is one.

I wondered if this “only child” fox baby would be different, growing up without brothers and sisters to play with. But this week I saw something amazing. I was standing in my kitchen, and something caught my eye outside. A small pack of deer were eating their way through our yard (this is not an uncommon occurrence). But then I noticed something else: the fox baby was “hunting” one of the fawns. It was a showdown between baby fox and baby deer. The kit clearly had developed his instinct to hunt, but hadn’t yet quite learned how to identify appropriate prey. I took a (blurry) picture of this unbelievable and hilarious scene:

Battle of the babies: Fox vs. Deer

This little fox was focused and determined. He was brave. He was like Oscar — exploring life on his own, finding his own interests, discovering his natural instincts.

The fox family reminds us that the circle of life will always continue, even if it doesn’t quite fit our picture. The average litter is 4-6 kits, but sometimes there is only one. Sometimes, the promise of new life gets taken away too soon. We may not have the future we planned, but that doesn’t mean we are defeated. It reminds us to be stronger, braver, and more motivated to make the most of life.

The foxes returned the morning after Julian died. For the first time, there was only one baby. These were not coincidences. Instead, these were just the first of several signs that there is something bigger at work here. Call it God, the Universe, Mother Nature. No matter what you call it, it is significant. It is meaningful. It is the circle of life.

I’d love to know who visits my blog, and I’d especially like to know if you have any thoughts or comments about it. If you’d like to post a comment about this specific post, click the “Comment” link below. Or, leave a general comment on my Guestbook Page.

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Posted by on May 20, 2011 in month 3

 

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