Caregiver Syndrome

Me: Why am I so tired?
Christine: Where would you like me to begin?

"Elderly caregivers are at a 63 percent higher risk of mortality than noncaregivers in the same age group"¹

"Researchers likened exhausted caregivers' stress hormone levels to those suffering from post traumatic stress disorder...caring for someone can lead to high blood pressure, diabetes and a compromised immune system."²

This will not be an entirely objective thing.

Ask any caregiver. They will tell you (and Wikipedia will confirm) that they feel a wide range of emotions from exhaustion, anger, rage, and guilt. The process of providing extended care to anyone with a chronic disease is wearing. I've been providing care for Christine for seven years, beginning with her mastectomy and running through countless rounds of chemotherapy, every scan known to medical science, not to mention gamma knife surgery and whole brain radiation. I watched as she struggled with a loss of proprioception, lost mental faculties and now, in the late stages of hospice care, her mental agility and communication.

It takes a toll, this caregiving. Carers are looking after loved ones with all sorts of ailments, from cancer throughAlzheimer's Disease, degenerative disease, Multiple Sclerosis. The list goes on, and so do the symptoms. Increasingly, people are choosing to have their last days at home, or families are forced through financial need, to care for family members at home. It's a tough job, someone has to do it, and there are many known effects, both psychological and physical.

Why am I so tired, again?

It started with tiredness. I was working at that time, coming home and preparing meals, running errands, cleaning house, doing laundry. Even in the early days, when Christine was able to return to work and there was little care, it started to affect me. Once we were in the full round of treatment following her diagnosis with metastatic cancer, the tiredness crept up. I began grieving, started to imagine myself at her memorial; we started to plan it. I became riddled with guilt because clearly, I had not done enough, could not do enough. My concentration span was so short I oft fell into the trap of leaving a trail of half-done things about the house. The mostly-emptied dishwasher, the half-swept floor, the laundry basket in the hallway. Memory? You name it, I misplaced it. Keys, wallet, spectacles, shopping list and that thing that someone just told me. All gone in an instant.

I would become angry, take it out on the medical system, insurance companies and occasionally on myself and my family. I didn't go to see the doctor because I felt I was malingering.

In addition, I caught every bug going, had a constant stream of colds (pun intended) and stomach ailments. I had erratic sleep, struggled to go to bed early, had many bad, vivid dreams. My back hurt, shoulders ached, joints were stiff. Above all, I was exhausted. Damnit, I was angry with myself for being so weak.

It's real, this thing, and only now starting to be recognised, rather like PTSD a few years ago. It can affect anyone caring for family, and the causes are often the same. Caregivers seem to become martyrs to their role, sometimes even forgeting that behind the pain and suffering, is a loved one who still needs the carer to play the long-standing role of spouse, lover, offspring, brother, sister. Friend.

It's hard to be all those things, provide day-to-day support, often round the clock. I would forget to take care of myself. didn't make time for a catnap even when I was exhausted. I lost count of the cold breakfasts I rediscovered at midday, the half-cups of tea scattered around the house. Did I mention not going to see the doc? I would try to get out of the house once or twice a day to take a brisk walk or cycle ride. Once in a while I remembered and made time, to meditate or stretch. Then I would just forget to eat, get to tea-time and realise that the half-slice of breakfast toast that I'd eaten at ten-thirty comprised my entire intake for the day. Feed everyone else, then rush around being the martyr again.

Fixing the Problem by asking for Help

"Give up sainthood, renounce wisdom, and it will be a hundred times better for everyone." - Tao Te Ching

All I can say is "Thank God for friends!". Were it not for them, most meals would consist of rice, beans and maybe bacon. Cheese sandwiches. Friends brought food - someone organised a rota to bring meals two or three times a week. Friends sat with Christine and sent me out to have coffee. These days, friends come overnight and stay in the room with Christine so I get some unbroken sleep.

This weekend, several noders showed up with gifts. Gifts of food, beer, time, treats, cash. Gifts of love, companionship, conversation, sharing. Were it not for them I swear I would have folded up into skinny, dark-eyed madness weeks ago.

Thank you for friends, because otherwise caregiver syndrome might have been the death of me. I cannot imagine what it would be like on my own.

The "fix" is simply, to seek help. This was the hardest thing for me - even after starting hospice care, I would try to do everything on my own, and that simply Will Not Do. Many people offer help, so a caregiver should accept it. Lots of laundry? Ask for help. Dishes in the sink? Ask someone to do them. Errands to run? Give someone a shopping list and a handful of cash. Above all though, get professional help. See a doctor, a counsellor, talk to a nurse, a social worker, spiritual counsellor, priest, whatever you got.

When people ask "What can I do?", and they will, tell them about the pile of laundry that needs folding, or the hallway that needs sleeping. The best friends come round and, unasked, do stuff, like the woman who turned up with mop and bucket and offered to clean our bathrooms. I said "yes", and that is the fix.

Positive Caring

On reflection, my last post was a tad unbalanced. It is a hard row to hoe, I admit, but I recognise that there are positive aspects, and I feel the need to address those now. I've done venting and feeling sorry for myself for now, I'm ready to move on.


One of the things I've learned from my reading of others' experiences is that there's nothing like a life-critical situation for changing one's perspective. In the case of Christine's cancer, there's always been that "Oh my God, things are bad" feeling for both of us; when we first began this journey, nearly seven years ago, there was a lot of fear, uncertainty and doubt about the future, but also a sense that "this is worthwhile doing".


I can't really feel too sorry for myself; after all, I volunteered to do this. When Christine was first diagnosed and the seriousness of the disease was apparent, I immediately came over to join her. I'm no shrinking violet, I made my decision; made my bed, so to speak.


So without further ado, here's a glimpse into the positive:

The Angry Carer

Scared? In shadow? You bet.

A few months ago, Christine gave me the book Grace and Grit to read. The author, she said, is quite the philosopher. "Good", I thought, this will do me the power of good; a man describing the joint journey of a couple going through cancer. The ups and downs, the coping, the dealing, the however-many-stages-of-grief. This, I thought, will be good.


I read a little; I thought a little. I read a little more; thought a little more. Read more, thought more. Then I read some more, and stopped. It turns out that my journey is very different from his, Christine's from Treya's. It irritated me, he irritated me, and I finally decided that this was a book I would gladly burn pop in the yard sale box.


There is, of course, a reason. I am not Ken Wilber. I'm a little angrier than he; coarser, more...vulgar. I dislike bullshit and I declare that "it's not fair!" because deep down inside I still have the little boy who wants and expects the world to be a just and honest place, where there are no monsters hiding under the bed.

It's been a while...

Actually, it's been far too long. Several people have asked me what's going on in my life, and I have been saying things along the lines of "Semper in excreta sumus solum profundum variat". Which is not strictly true. Christine still has cancer, I'm still seeking honest employment, still struggling some with stress and depression, but this is not to say that there are no silver linings.

We're surrounded by loving, caring people, Christine and I danced in the Nutcracker in November, as did Tess (of course!)


I have been meditating, attending a men's circle, and have gone so far as to attend a "men's retreat" - the New Warrior Training Adventure in September.


Each of these elements have conspired (can one conspire constructively?) to help me out in some measure. Meditation has given me a sound, balanced and well-grounded core, has helped me develop inner peace and count to ten before throwing my teddy out of the pram. Dancing in the Nutcracker was an enormous amount of fun and gave me a lot of confidence, having been told at age 13 that I would never be able to dance.


The men's circle was another boon, albeit an almost accidental one. A pal of mine had invited me to go, and in my usual rather skeptikal fashion, I kept turning down his invitation. Oh, all right, I'll fess up; I made countless excuses. Finally, one evening, I was dragged along, and found myself in one of the few places I could be truly honest about myself, my feelings and behaviours. It was like confession, only without the kneeling, and it worked. 


Suffice to say that after even more excuses, I signed up to attend the weekend "training", an eye-opening adventure into myself. It's produced lasting effects, all positive. I find myself more rounded, balanced and positive. Christine and I are even better friends as a result.


That said, I'm still struggling. The "carer" element of my life has all but taken over, and I have a fight to look after myself. I've been a cancer carer for most of the last seven years, and it's tough sometimes. Its hard to look at Christine and know that even with the best outcome, I won't have her for much longer. Not that I let it get me down; I think of the line from Theodore Gesiel (Doctor Seuss, to you): "Don't cry because it's over. Smile because it happened."

Three Nutcracker dancers

Oh yes. I smile.

Mammogram Day

It's almost 4½ years since Christine was originally diagnosed with breast cancer, and occasionally people will ask me how she is doing. These days my response is pretty much always the same: "She's doing pretty well, the cancer seems to be in remission", I'll reply, whilst thinking "why don't you ask how everyone else is doing?"

I think this because cancer affects everyone around the patient, and this week has been a classic example of familial cancer. A week ago, or thereabouts, Christine had a sore spot in her remaining breast. This is the continual dread of cancer survivors; every lump or swelling, pain or discomfort suddenly turns lives upside-down all over again. The bright hope of survival dims until the next test confirms or denies more cancer, more treatment, less life.

So we have a mammogram today. I say "we" because she has an entourage. I'm going and at least one of our friends will come along to keep us company and encourage us, holding our hands through the darkness of not-knowingness, and afterward to celebrate a negative (no-cancer) result or help us cry if it's positive.

I need to get this out of my system today because anyone who hasn't been through the whole cancer thing can't understand that the lump circus can occur at any time. My reckoning is that we go through this four times a year. A lump is found, then Christine's off to have a scan of some sort. Mammograms, PET, MRI, CSI, drinking contrast fluids, fasting for twelve hours, trekking hither and yon and all the while wondering if This Is It Again, while all we really want is five years free of cancer. Then we can call it "cured". Four times a year.

So being moderately brainless at the moment (see stress) I looked on an online thesaurus for "four times a year" because I knew that it wasn't quadrennial. The result of my search was "No results found...did you mean 'doomsayer'?" No, I didn't, thank you very much. Let's just hope that the doom is a long way off.

Update: Both the mammogram and subsequent ultrasound scans showed no evidence of worrisome stuff. But the stress and anxiety take their toll, nonetheless.

Better you than me?

When Christine was newly diagnosed with cancer four years ago, we talked, as many couples must in such circumstances, about the injustice of it all. One of the things she found so hard to deal with was that, after years of looking after her body so well, it nonetheless rebelled against her. The body she'd honed through being active (she was a firefighter and forest ranger) and fed (lots of good fresh food) let her down. I remember saying that it would be more just had I had the cancer, having abused my body with drinking to much, smoking and not exercising. But we play the hand we're given, and play it as best we can. "If wishes were horses", the saying goes, "then beggars would ride".

So it goes. Christine suffered the indignities and discomfort of chemo and radiation therapy, and I stood by and watched, supporting her and Tess by doing shopping, cooking, laundry and all those little things. But it's hard to be a carer. It exacts an emotional and mental toll that is seemingly unending. Worthwhile? Of course. But a toll nonetheless.


The worst part of it was watching her pain get worse over the long months. Spring meant recovery from surgery, watching violated tissue knit, heal and scar. She mourned the loss of her breast and I could only watch, in my widow's weeds, crying my own silent and hidden tears over her poor lopsided body. We married in May, the weekend her hair really fell out, so our wedding pictures are of my scraggily-bald bride and I together.

Summer was for chemotherapy, and trying to keep her mind and spirit active and healthy while the poisons stripped not just the rebellious cancer, but her hair, skin and energy. When she couldn't face a full meal, I'd cook up rice, potatoes; bland foods for easy digestion. When she could barely stir from the couch, I'd hold her and comfort her with touch and words. She'd cry as she watched Tess and I playing and forging our relationship in the heat of the California summer; crying because she no longer felt alive, shackled in the house, separated from the real world by a veil of pain and fatigue.

Autumn meant radiation, the third dreadful blow. This was the cruelest time for me, watching her go every day for treatment. Each day a new horror on her tired flesh, each day the burns flushing brighter until they wept. And we wept too. She with the pain of happening, I with the pain of watching. She'd cry in her sleep each time she turned, a childlike whimper that belied her daytime stoicism; she'd cry, and my heart cried with her.


Our honeymoon had been the baptism of fire. Of course, we still talked; talked of how things should have been, how we wished it had been otherwise. I of course talked of the injustice I felt, and oft said that, in the words of the song, "it should have been me". But the cards were dealt, and Christine would often say that we had the right cards, that I would have been a far worse patient. I don't suffer well.

Now, years along, that is still true. At this moment I'm in bed with a cold, and I hate it. I hate being weak and in pain, and I'm assured that I'm a poor patient. I moan and make demands, and Christine, despite her own problems, fusses over me in a reversal of roles that she adapts to far better than do I. She of course, reminds me of this whenever I moan about my poor, pathetic lot. I may have been a hero to come and support her years ago, but now, struck by my own viral Kryptonite, I have to admit that she's right.

Sometimes it's like housework...

"It's not all beer and skittles", they say, and it's true. Sometimes, life is harder than we'd like it to be, the cards we are dealt are not the cards we'd like. I was talking to a poker-playing friend once, and I wondered aloud how the heck anyone could want to play a game where the odds are apparently stacked against you. His response was fairly simple. He said that in poker you get to fold, take a little loss, and come back in the next hand. That and you can work out the odds, or you can bluff and still win with a poorer hand.

The hand I currently hold doesn't seem to be entirely a strong one. I have an Ace of hearts in Christine, a Queen of hearts in Tess (who is 10½), but for the most part, I feel that I have dross in the rest of my hand. Not that I'm going to fold, not that I'm going to lose entirely, but playing the hand right is important for me and the rest of the family.

Christine is treatment-weary, the chemo is hard on her both physically and mentally. I'm treatment-weary too, just in a different way. One of the things that I am finding as a carer is that I feel I should always be doing stuff. If it's not making drinks, or meals, or juice, it's laundry or housekeeping or shopping. If I'm not doing one of these things, I tend to feel guilty. I fret if I'm sitting and relaxing. I agonise if I sit down to write.

I was talking with my sister-in-law a few days ago, and she came up with an expression that I'm going to share here. To put it into its proper context, we were talking about why some doctors really seem to enjoy their jobs, and some don't. Part of her reply was this - I think lots don't enjoy it because it isn't what they thought. They thought they would make people better. But it turns out to be messy and complex and the person gets sick again, damn it. It's like housework.

Well, what do you know. That's just like looking after someone with cancer. You do a thing, and do it well, only to have to do it all over again soon afterward. Chemo is like dusting. While it's going on, it seems never to end. There's always more tiredness, always more painful and inconvenient symptoms, always the fatigue. What respite there may be after a few days is too short-lived. The dust will be back on the bookcase all too soon, and out comes the feather duster once more.

This is how it is - if Christine stays in, I stay in unless there's an errand to run. Once she goes out, then I feel free to go out myself.

That's the tiring bit, that doing it all over. So why do we do it? I don't know about doctors, but I do know this. Looking after Christine (and Tess too) is a lot more rewarding than you might think. We know right now that Christine has no evidence of disease (NED, nice acronym from her oncologist), and the last round of three sessions is an insurance policy. Whilst it's expensive (in terms of the short-term suffering), it's worthwhile in the long term. Even if all this means just a few years (and we're hoping to beat all the odds), it will be worth it.

I am starting to realise that the way to tackle this is not to try and do it all at once. Vacuum the living room carpet, have a cup of tea. Tidy those books away, sit and read a few chapters. Make the bed with clean sheets, treat yourself to a wee snooze, not forgetting to set an alarm. For the love and the pride and the honour and the joy, I carry on. I just need to remember to take some time to look after me, too.

Fingernails and whatnot; it's all about the chemo

So we're down to the last round of three chemo treatments, which will start in a little over a week. Meantime, Christine gets a week off (no chemo this Friday!) and I will be taking three weeks of leave to nurse her through those last few dreadful days.

Chemotherapy is hard, let no-one deceive you by saying otherwise. In addition to the reduction in skin growth (tender skin and a painful and less-effective digestive system), there's neuropathy (a reduction in peripheral nerve sensation), hair loss and now, to cap it all, painful fingernails. Yes, her fingernails are not growing properly. Her nail beds are painful, so picking things up, cooking, typing - all these things are now painful. Oh, and did I mention mouth sores? Shame on me.

It's hard to be a carer. Watching the one you love suffering because everything hurts, there's a lot of emotional pain that goes along with that. Coupled with the fact that the medical bills are flowing in at a time when the State of California has enforced two furlough days a month to save money, and everything's under stress.

What could be worse? Well, how about my being suspended from work for three days? Yes, that's what's happened. This was after I had been called into work on my day off for the disciplinary meeting. Truly it was Saint Bastard's Day. So now I have a few days to kick about at home, wondering what happens when the disciplinary action is re-opened, and what happens when (if?) I am able to return to work. Time to worry about paying bills, putting food on the table, time to worry about Christine's future (both health- and job-wise). Time to make a new start? Possibly. Watch this space.

On the upside, the trees are starting to show green, shoots and flowers are appearing all over the oche, and life is rearing its delightful head. Hope? Always.

The last few rounds

So we had some good news recently. In short, Christine's cancer seems to be on the run, at least for the moment. When she was first diagnosed, we were devastated to learn that we the docs weren't looking to cure it, rather to manage it as a "chronic disease". Since then, the various chemo drugs have taken their toll. She's tired, her body aches, she's nauseous and has little appetite.

The change from the original Taxol drug to the newer Paclitaxel NAD has given us a couple of breaks. Firstly, the Paclitxel does seem to produce less neuropathy, so the feeling in her feet and toes is returning. Secondly, it turns out that the new drug gives a better response rate, which is good for the long-term outlook.

All this means that Christine can carry on her ballet lessons. In fact (and I'm proud of her for this!) she recently did some pointe work for the first time. Given that this was a long-term dream for her, see why I'm so proud of the acheivement, not just that she did it, but did it partway through a long and arduous chemotherapy regime. It may not sound like much, but from the look on her face it was worth every moment and every penny, by gum.


After thanking Doctors Dollbaum and Laptalo, I'd like to reserve a moment of silence for the insurance company. Silence, because I lack the words to describe how I feel about you, Anthem Healthcare. Thank you for picking up the Paclitxel, no thanks for declining the anti-nausea drug. Having a wife whose belly is in turmoil is no picnic, and taking a swipe at her quality of life over a few dollars strikes me as pretty bloody poor. They say that the new regime causes less nausea. Well, they are right, but the statistics show that 3% of patients suffer extreme nausea and vomiting. Guess what? Christine is in that 3%, you unspeakable gits.

Speaking of quality of life, I find myself struggling at this point. Goodness knows how Christine is coping, fraught with worries about the future, and with a body poised on the brink of falling apart from the inside. All I have to do is make a few meals, juice her now and again, and try to keep her spirits up. God knows I try, and God knows I fail all too often.

I'm angry. Angry that the damned cancer came back, angry over the health insurance and pharmaceutical companies squeezing every penny for their shareholders. Angry that we have to fight for better treatment, angry that we fail. Angry at myself for failing to cope, angry that I'm probably not looking after myself as I should, which means that ultimately, I'm not best able to look after my family.

I find myself snapping at them, snarling at the world outside, being grouchy and grumpy. And inevitably, we fight. Every weekend, Christine tells me. I have to take her word for this, as I'm not tracking. Only today really exists. Yesterday is a ghost of time, tomorrow is so uncertain.

Finally, I'm sorry. Sorry I rant. Sorry I shout. Sorry I vent and want to throw things. Sorry I'm not caring as I feel I should.

What it is to be a carer

I seem to be writing, slantwise, about Christine's cancer. I realise that I have been avoiding what is actually on my mind, which is about being a carer, about what it means to care for someone who has cancer.

Christine's cancer story, briefly, is this. We met virtually through the website everything2.com - I lived in England, she lived in California. We met in real life four years ago today. She was diagnosed with infiltrating ductal carcinoma in February 2004, following a trip to England. I flew out to be with her, to help her through the start of her treatment, which we hoped would be simple. As things turned out, she would be needing a mastectomy, chemo and radiation. I wound up staying here, as she was clearly going to need more than a little moral support. We were married on 1st May, 2005.

Since then we've been nursing her back to health. This is not as easy as it sounds. Cancer is no joke, neither for the patient nor the family - we've often said that cancer is a disease that affects the whole family. The patient is affected in fairly obvious ways, the family in ways that are not always so obvious. And each case is, of course, different. In this case, the difference was, and is, twofold. Christine has a daughter Tess, now aged ten. Her husband (me!) flew six thousand miles to care for, leaving behind his family, friends and support, to be with her.


Now the cancer has reared its ugly head again. That it did so made me angry at first. I came to realise that I was grieving. This grief is real - after all, there's a chance I might lose her at lot sooner than I'd like, and that's rather annoying, as it took me all this time to find a keeper. I also lost both my parents last year, Dad to cancer, Mum to a broken heart. My sister I lost because she feels I let them all down. I don't intend to let Christine down, or Tess.

I want to talk about my feelings, and I hope I don't bore you, or drive you away. I know I'm not alone, but I feel alone. It's not that I have no-one close, I do. I have Christine and Tess. There are thousands of people, millions, going through similar processes during their caring journey, but that's not the alone I feel. Our family is surrounded by people who love us, and bend over backwards to help us, but again, that doesn't address my alone-ness. It's the being alone inside my head with all the hopes and fears, no matter how reasonable or unreasonable, rational or unfathomable.

There are too many things worrying me right now. Things I can barely express, thoughts and feelings that are a knotted jumble. I need to get them out, and I hope that there is someone there who can help me make sense of them. Of course, along the way, maybe I will be able to help someone else. I hope so.

Shooting Cancer

So following my recent bash at shooting, I went back to Vacaville today, and I SHOT AT CANCER. This was the best group, .357 Magnum Smith & Wesson at about fifteen yards.

It was a lot of fun, and for a beginner, not a bad effort, according to the chap at the counter.

Just tell me it won't make me rush off to join the NRA and vote Republican.

The .357 Calibre Stress Management System

So for those of you who don't know, the reason I came to the US was to court Christine. I first came over in November 2004, fell totally in love, and we were engaged "real quick" as they say. In February 2005, she was diagnosed with cancer following a trip to the UK. You can read the full story here, but the short of it is that she's been cancer-free for just three years.

Or so we thought. She recently had a PET scan, which showed enlarged and over-active lymph nodes. This in turn triggered a return of the kind of uncertain stress that's associated with being in the anxious darkness of not knowing. At this moment, we're not sure whether it's new cancer (which would be bad) or some other infection (which would be not so bad). In short, we're all a little variable in our moods. I'm unafraid to admit that I've been running the emotional spectrum from anger through anxiety to tears of pain. None of us are immune to this, and it's a tough one to cope with.

So what to do while we wait for the medical machine to give this fear a name? We continue to work, though my boss, bless her heart, has kindly given me Saturdays off for a while. Tess continues her schooling (Grade 5, she's doing so well, too!) We're trying to live normally, but the worry is apparent. Sleepless nights, poor appetite and all the trappings of the tension.

I have many hobbies. I read, I write. Christine knits, makes jewelry and both she and Tess do ballet. I lacked something physical, something that would burn off some adrenalin. If I were up at our summer cabin in Ontario, I could dig out the old foundations of the deck and porch and make them sturdier, I could build the workbench I promised myself, fix up the dock. Chop down trees. That's how I get rid of stress.

But the problem is that I am basically lazy. I do a little Tai Chi now and then, but not regularly, and I am loth to run because I feel ridiculous. And as for anything else physical, I don't dance and the pools are closed, pretty much. So a couple of weeks ago, I went down to Vacaville to do what many red-blooded American males seem to do. I joined a shooting range and went and shot a rifle.


Now at this point, I will remind you that I am an Englishman. In England, we don't shoot things. You can own a shotgun and shoot clay pigeons or (if you're rich enough) go hunting. But rifles and handguns? No way. Not for many a year has it been legal to own or use a firearm. So for me this was a big deal. I have never fired a gun before, never wanted to. But here in the US, I have the opportunity to do just that, and I decided to give it a shot. So to speak.

The news that I had done this attracted a few raised eyebrows among my mostly-liberal Davis friends, none of whom I can imagine owning or using a weapon. Many have never used one, nor would they consider it necessary. But I went and rented a .22 rifle (a Ruger 10/22, in case that means something to you) and bought 100 cartridges, got a brief demo as to how to load and use the thing, and off I went into the indoor range. It was okay, after I got over the initial nervous shakes caused by "this thing could kill someone" thoughts. But I did it, and even learned how to hit the target close to the bull. Pulled to the left a little, but hey, I'm new at this.

Trouble was, it was interesting, but not really that much fun. The rifle made a crack rather than the BANG that my neighbour got when he was firing his much bigger handgun. So this week, I plucked up even more courage and went back, and this time, rented a handgun. A Smith and Wesson 686P, .357 Magnum. Now that is a gun that goes BANG.

It kicked a little, too. I knew I was firing something, because I could feel it in my shoulder. The .22 didn't have that, there was no immediacy, no impact, no...oomph. This felt like it was doing something, and as another plus, I could see the holes in the target, clear and round and large and black. It was satisfying and, dare I say it, fun. Next time, I shall write CANCER in big letters on the target before I shoot.