Indwelling Catheters and their Relation To Urinary Tract Infections Essay

Indwelling Catheters and their Relation To Urinary Tract Infections - Essay Example Catheter- associated urinary tract infections (CAUTIs) are caused by bacterial infections (e.g. Escherichia Coli), which is the common bacteria (Lindsay, E. 2001). In our place of practice, which is a nursing home facility, there have been significant increase in the amount of catheter and non-catheter related urinary tract infections in the patients undergoing treatment in the hospital. Research has shown that5% of patients that come to the hospital per day has urinary tract infection. Common endemic infection outbreaks as well as colonization and infection with antimicrobial drug resistant microorganisms have become a common feature within long term care facilities (Lindsay, E. 2001, pg. 205). Catheter associated urinary tract infections entail increased morbidity, mortality and financial costs. The nursing home facility has a protocol in place to reduce the number of UTIs, but it is rarely being utilized, and, therefore the system needs to be modified. CAUTIs can be reduced by rem oving the catheters upon arrival to the facility. Health care professional must assess the patients for the prevalence of UTIs, since this is a very common infection within nursing home facilities. ... Working in a nursing home and rehabilitation (NH/R) sub-acute environment has many challenges deriving from staffing problems, such as shortfall in nurse to patient ratio of 14 to 20 besides the chances of endemic infections. My main concern is the increased rate of urinary tract infections in patients with urinary catheters whether it is from the hospital or in-house (NH/R). In my facility, newly admitted patients from hospitals have or had indwelling catheters. Within 48 hours of admission, a few of the patients have showed signs and symptoms of urinary tract infection such as fever, abdominal tenderness and frequent need for urination with complaints of burning sensation. In such cases, the normal practice is to commence the administration of antibiotics prophylactically after collecting their urine specimens. The elderly are prone to a decrease in fluid intake due to a decline in the thirst mechanism and enhancing the chances of UTI. Urinary Tract Infections are caused by poor as eptic techniques and, therefore, catheters should not be used for convenience but for exclusive medical purposes only. According to the Center of Disease Control (CDC), the appropriate measures for indwelling urinary catheterization are: acute urinary retention, accurate measurement of urine output in critical patients and patients requiring prolonged immobilization, such as unstable spine or pelvic fractures. (Dumont, C. &Wakeman,J. 2010.Pg. 29). I, therefore, encourage charge nurses to discontinue the use of catheters. Studies have shown that infections in long-term care facilities are highly prevalent in the United States. The most frequent infections within nursing homes

lord of he flies :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Over a month ago a tragic incident occurred that tested the unity of this country. Terrorist attacks tested the will power and the strength of all. On September 11th the Osama Bin Ladens of the world committed an evil act that attempted to destroy all. Americans were disturbed mostly because the people who committed these acts are human like the rest of us, meaning basically everyone is capable of causing such a disturbance. William Golding came to the same conclusion in his book Lord of the Flies. Throughout his novel, Lord of the Flies, Golding illustrates mans inhumanity to man.   Ã‚  Ã‚  Ã‚  Ã‚  Using conflict between characters, Golding shows how easy it can be for innocents to become evil. First of all, Roger throws stones at Henry. Henry plays on the beach quietly, and Roger hides behind the trees and chooses stones to throw at Henry. Henry never does anything to deserve it, but Roger throws them anyway. Golding writes, â€Å"This side and that the stones fell, and Henry turned obediently but always too late to see the stone in the air†(62). Roger shows cruelty to Henry and several other littluns. Jack also shows ruthlessness to other boys on the island. For example, Jack breaks Piggy’s glasses. As Piggy takes a step forward to talk to Jack, he smacks Piggy’s head. Piggy’s glasses fly off and shatter onto the rocks. This action makes one of his lenses break, which causes Piggy, blind in one eye. Jack does this out of pure evil in hopes of releasing his anger. At this part of the novel acts of evil increase in the boysâ€℠¢ actions.   Ã‚  Ã‚  Ã‚  Ã‚  Using conflict, Golding again attempts to demonstrate mans capability to lose sight of what’s important. The boys destroy their own friendships for no reason at all. Maurice kicks sand in Percivals’ eyes in hopes of harming him in some sort of way. Maurice does this out of pure anger, choosing to release his anger on Percival, who did nothing to deserve this. Maurice at the time was acting on his feelings: â€Å"†¦laughing, and add[ing] to the destructionâ€Å"( ). Jack also demonstrates the same kind of evil that Maurice does. Jack reacts on his feelings by punching Piggy out of pure jealousy. Piggy, was given the gift of intelligence, a gift Jack wishes he had. Jack then uses his insecurity to destroy Piggy’s self-image in hopes of boosting his own. Piggy does nothing but try and help out the boys by using his knowledge and sense of humanity, but the boys can’t simply deal with the fact that there is much more to Piggy than his appearance, and they show only cruelty to him.

Modern Theatrical Practices Essay

The play ‘Macbethà ¯Ã‚ ¿Ã‚ ½ was written by William Shakespeare in 1606 and is thought to have been written for King James I. The play was found by Shakespeare in ‘The History of Scotland’ and in there it was suggested that Banquo had helped Macbeth in the killing of Duncan but Shakespeare cleverly left this out as King James I was an ancestor of Banquo and the thought of regicide in his family would have killed Shakespeare’s career and most probably, he would have been killed himself. For maximum effect, I believe the best stage for this play would be a proscenium arch. This is so the actors will always be facing the audience and when the apparitions happen, the audience will not be able to see being the gauze and alter which would spoil the effect given. Also the audience’s seat will not go that high up for the same reason. Originally, the audience should react normally to the acting going on, then when Macbeth enters with thunder booming about, and I feel like this should scare the audience to show that something bad is going to happen. Throughout the Apparitions I think the audience should feel a small bit of fear but I expect them to really understand what is happening on stage so the fear cannot be too strong. I believe fear is an important feeling as it symbolizes that something evil is happening on stage. At the same time I want the audience to be excited and on the edge of their seat, wondering what is going to happen next. In this scene Macbeth again visits the witches who he thinks are helping him. The Witches are of course evil characters and don’t have his good at heart. This is a fault of Macbethà ¯Ã‚ ¿Ã‚ ½s, as he doesn’t realize the Witches are evil an thinks he is unbeatable until it is too late and Macduff, with the help of Malcolm, has rallied support to overthrow him. The first time Macbeth meets the Witches they predict that Macbeth will become Thane of Cawdor, King of Scotland and that the children of Banquo will also become kings. These predictions lead to the murders of Duncan and Banquo. This meeting tells Macbeth to ‘Beware Macduffà ¯Ã‚ ¿Ã‚ ½ (IV, i, 70) and leads to the murders of Lady Macduff, her children and the majority of the Macduff castle servants. The witches also lull Macbeth into a false sense of security by telling him that â€Å"†¦for none of woman born shall harm Macbeth† (lines 79-80). Macduff was born by Caesarean section and so ‘isn’tà ¯Ã‚ ¿Ã‚ ½ born of woman. Macbethà ¯Ã‚ ¿Ã‚ ½s security is also lowered when he is told that he is safe until ‘Great Burnham Wood to High Dunsinane Hill† (line 92). Macbeth believes this to e impossible so sees himself as indestructible but this prophecy comes true when the English soldiers carry branches up to the hill to disguise how many of them there actually are. These two lapses in security will lead to the eventual downfall of Macbeth. The scene is described as a ‘miserable place near Forresà ¯Ã‚ ¿Ã‚ ½ (The royal castle of Scotland); Thunder is also described as happening. I think that it is vital to get across the fact that this place is barren and contaminated by immorality due to the company of the witches. I would set this scene in the hours of darkness, there will be fire-torches stuck in the ground providing some dim light to show that it is an isolated area and not a common rest ground for people. Light bulbs will be used, not actual fire as fire may cause a safety hazard. Also Lighting will be coming from behind a gauze, which is hanging towards the back of the stage. This will enhance the effect that the place is evil. The torches on the floor will give the audience the impression of a medieval setting. They will be randomly arranged around the stage to show a mild, or delicate case of the chaos that is linked with the Witches. The gauze will be hung towards the back and no light will be shone behind it until the apparitions, this is so the apparitions can come from behind the gauze so the audience cannot see them coming out of a cauldron for example. Seeing something rising from a cauldron cannot be made to look good in a theatre and may come off as looking tacky. The actual stage itself will be decorated to look like a cave, mould and dirt should be on the stage floor and small boulders scattered over the ground. I think that an actual cauldron would be a bit odd looking seen as nothing will be rising out of it and also a cauldron is slightly pantomime. So instead of a cauldron I think that a large, stone alter, with a large bowl shaped crevice carved into it will be well received. There will be a light bulb in the base of the bowl crevice, which will shine up into the witch’s faces as they move around it. This would create strange shadows; which would make the Witches look physically evil. My Witches don’t actually look evil, only ragged and dirty. This would make more sense to portray them as this as Macbeth does not see the witches as evil so if the looked normal, this could show why Macbeth is tricked by them. The audience would be able to see the evilness of the Witches as well as feel it in their actions. The rock effect would be more natural looking and a fire isn’t necessarily needed as the evil ingredients generate their own heat. The natural look would also mean that it doesn’t have to disappear in a puff of smoke like an iron cauldron would. The three Witches are moving around the rock whilst describing the evil ingredients they are throwing in. They will speak gently, but not essentially evilly. The voices used should be enough to tell the audience that these people are not pure and good. I think that although the witches are fundamentally evil and therefore don’t really need a reason to hate Macbeth it would be original to give them a reason. Macbeth will be wearing his feudal colours when he finds the witches. Two of the witches will be wearing ragged clothing but it will be obvious to the audience that some of this clothing bears the colours of Macbeth, suggesting that these too were once loyal servants to him but due to Macbeth committing an evil act against them, or by an evil such as the one that is corrupting Macbeth now, they have turned. Two of my Witches will be men, enhancing the idea that they were maybe soldiers of Macbeth who were punished by their master and so have decided to oppose him. The third will be wearing clothes that were once very expensive, a dress of a noble lady of the period, torn and ripped by time. She may have been an old love of Macbeth who was dropped by the man and is now bitter. The clothing of the witches will strengthen the atmosphere of evil that is opposing Macbeth; but that it is his own fault that evil has picked him out to be converted. The Witches won’t have evil cackling voices but instead keep normal human voices; showing that there is still some humanity left in them at the same time as showing that humanity can be so easily converted to evil. Once the spell is completed Hecate, the Queen of Witchcraft enters. Expanding the idea that the witches were once subjects of Macbeth I think that Hecate could also be an ex-subject. I however like that idea that Hecate is a ghost like figure of an old woman, maybe an ex queen or his mother, dressed out in normal clothes. She will not be raggedly dressed but instead his clothes will be fresh and clean. I believe she could be his mother and ghost like o show that it could all be his sub-conscience, screening that he really isn’t evil and feels bad about what he did. The three ‘witchesà ¯Ã‚ ¿Ã‚ ½ who accompany her will also be cleanly dressed, wearing the Armour and colours of their lord (they will be men-at-arms, footmen etc†¦). Hecate’s lines are often spoken in a cackling way but this won’t be very appropriate for my Hecate. As she speaks her lines the lord (Hecate) will slowly walk back and forth in front of the Witches. When this small speech is finished a song and dance is described as occurring. Instead of this my three main Witches will get down on one knee and bow to the lord. They will remain like this for several seconds until the lord (Hecate) and his entourage has exited the stage. When Macbeth enters there will be a loud clap of thunder issued in a surround sound bomb followed by the light behind the gauze flashing for a few seconds to simulate lightning. Macbeth will have a faint spotlight of white light will shine on him. The light will not be too strong to show that the good that is left in Macbeth is waning and it will take little persuasion from an evil force to drive him all the way to eternal damnation. The thunder and lighting will alert the audience that something important is happening. When Macbeth speaks he will have a deep, booming voice. Clearly belonging to the higher orders although now and again in his dialogue his voice will wobble and break into that of an underling, like the Stereotypical voice of the witches. His voice will do this when he speaks of murder or of other foul acts he has committed. This means that it will happen mainly after Lennox has informed him of Macduff’s flight to England. This will show the audience that Macbeth would be a strong (Psychologically) man if he could stand up to the handling and dishonesty of the Witches. When the witches speak to Macbeth they will not do so in a dissident manner as they will consider themselves to be his equal, as they know they have power over him. Shakespeare also reveals something by making them speak in blank verse, the manner usually reserved for upper class characters. Possibly the witches really are upper class characters? This is why I have decided to portray the witches as possible subjects of Macbeth. Shortly before the first apparition appears the 3 witches all speak together. I think this (Come high or low: Thyself and office deftly show.) should be spoken softly, inviting Macbeth to ‘follow’ them in the abyss. Then I shall have the stone alter to make an exploding sound and a bolt of lightning should fill the stage up with light. Then I would establish the gauze to its bursting effect. The whole area in front of the gauze would be blacked out apart from the dim spotlight still on Macbeth, as it is he who is being shown the apparition. The light behind the gauze will be a dreary grey/white glow and will appear rather dusty. Then as if from nowhere the first apparition will appear. Really the suit of armor will slowly rise from the ground, the actor get up from the floor, but due to the rock alter obstructing the audiences view, it will look as if it is rising from the altar. The apparition is an armored head. This doesn’t mean that it’s a head with arms. That would be stupid. It is in fact a head with a helmet on. I think that it is hard to actually portray a floating head on stage without special camera effects like in a film. Therefore I will make the ‘armed headà ¯Ã‚ ¿Ã‚ ½ into an actual armored warrior. The helmet will be one that encloses the bearer’s head fully, so hiding the face inside. All the lights in front of the gauze will go out apart from the one in the alter and the light on Macbeth. The helmet may cause the voice of the ‘headà ¯Ã‚ ¿Ã‚ ½ to be muffled so I believe a pre recorded speech by the actor would be better to use in this case, and also it would have a surround sound effect to frighten the crowd maybe. This is to show that what the Witches are doing is evil. I would make my armored warrior wear exactly the same clothes as Macbeth, but he will not notice this. The identical clothing will act as a testament that is Macbeth himself who is causing him to fall from grace. The warrior will chant the word Macbeth louder and louder as he walks around. He will do this once until reaching the point from which he appeared. He will appear to leave but will turn around at the last moment and say, in a deep, booming voice, ‘beware Macduffà ¯Ã‚ ¿Ã‚ ½. He will then go on with ‘Beware the Thane of Fifeà ¯Ã‚ ¿Ã‚ ½ (Macduff’s title) before ordering Macbeth ‘Dismiss me, enough!’ He will be one of the only characters in the play who will speak to Macbeth in such a way and not cause Macbeth to become angry. I think that the strong contrast of the long loud chants and the short booming ‘beware Macduffà ¯Ã‚ ¿Ã‚ ½ will enhance the fact that Macduff is a major enemy of Macbeth and will end up killing him. The contrasting way that the apparition speaks to Macbeth will show the audience that it is Macbeth who is insulting or degrading himself, as the apparition will appear to be Macbeth himself. All the original lights in front of the gauze will come on again and the behind gauze light will slowly fade as the apparition disappears. The second apparition to appear to Macbeth is a bloody child, supposedly coming from a caesarean operation. This will be a difficult apparition to show as I think a baby is a hard member to work with and using an actual baby may be an infringement of human rights. Due to this I think that a child of maybe four or five years will be used. Once again, all the relevant lights will dim and this time a beam of light, hinted with red shall shine on the child who again rises behind the gauze. The high voice of this apparition (a pre-pubescent child) will contrast sharply with the mighty voice of Macbeth and again should be pre recorded, as a really young child cannot be expected to perform in front of that large a crowd. The child should be with his mother on stage and be cuddling the woman. This is so Macbeth has reason to think that no one is of woman born and he is indestructible. The audience should notice that the power of the Witches has caused Macbeth to focus all of his attention on a small child. After Macbeth has heard that ‘none of woman bornà ¯Ã‚ ¿Ã‚ ½ can harm him Macbeth becomes happy as he thinks that he can defeat Macduff and is indestructible. He will turn away from the apparition towards the audience and smile and nod to himself. When the light comes on after this apparition as left the beam on Macbeth will be noticeably dimmer than before, showing that Macbeth has taken another step to eternity in the presence of Beelzebub. Macbeth has decided that Macduff must go, but he hasn’t decided on a time yet. The change in strength of the beam should be subtle but noticeable so that the audience will clearly notice, so only an alert member of the audience will realise the rapid fall of Macbeth. Finally the third apparition appears, for this I would have a projector behind the gauze, which has an animation of the apparition on. I shall have the apparition portrayed as a forest moving over the hills towards Macbethà ¯Ã‚ ¿Ã‚ ½s castle. Amidst the moving forest an army should be able to be just seen, barley noticeable unless you are an alert member of the audience, this is to show that the apparition is actually looking into the future and this is exactly what will happen, and those with previous knowledge of the play should realize this. The apparition will then be spoken, also in a pre recorded voice, but this one should be spoken in Macbethà ¯Ã‚ ¿Ã‚ ½s voice, This will indicate to the audience that it is Macbeth himself who is causing all the corruption and unrest. Macbeth is very happy at what the apparitions have said and fails to notice the many hidden symbols that they bear such as the identical clothing worn by the first apparition and the voice of Macbeth in the third. Only one thing troubles Macbeth now, the idea that it may be the offspring of Banquo who rule the kingdom instead of his own. Macbeth therefore orders the Witches to tell him about this. After he has made the question â€Å"†¦shall Banquo’s issue ever reign in this kingdom?† There will be a pause of about 3 seconds; long enough to alert the audience that something important is about to happen. Thee Witches will turn away from Macbeth and look to the floor before saying â€Å"Seek to know no more†; they know that the images that they must now show Macbeth will not please him, but he has demanded it and although the Witches have infinitely more power than Macbeth they will show him this apparition as they have shown him the apparitions that have pleased him. All of the lights will go out so that the stage is completely dark. Again the projector will be used for this apparition and a bright light will shine on the screen to make the vision stand out. Within the first few seconds of this apparition showing, a King, slightly resembling Banquo will appear on the screen. Then after about ten seconds a sound effect, similar to a camera click effect, will sound and the King will disappear and another King, resembling Banquo a little less will appear, then again the sound effect will sound and another King, resembling less of Banquo but similar to the previous King, to show the audience that they are indeed from the same family, will appear. And so on and so forth until all eight Kings have appeared on the projector. Then a loud boom of thunder in surround sound will echo around the theatre in addition to a lightning flash filling up the stage. The screen will then have all eight kings showing and then a computer character of Banquo will appear in the center of the screen, covering the Kings behind him to enhance the effect of him being there, will start laughing and mocking Macbeth, this will go on for about half a minute then the apparition will disappear. The Witches will now begin to smile and look pleased with their work. They will begin to mock Macbeth with the song they will sing and the first Witch praises Macbeth as a ‘great kingà ¯Ã‚ ¿Ã‚ ½ in a voice of mock worship. Once more the audience will realise that Macbeth has no power over the Witches and how they are the real evil in the play. The Witches dance and vanish (the lights will go out again). When the lights come back on they will be noticeably brighter due to the departure of the Witches, showing that the Witches were really evil. Macbeth will be shouting out his lines while on his knees about how the Witches have abandoned him when Lennox enters accompanied by a messenger who will be muddy and look tired. In his hand he will be carrying a large leather bag. This man will be the messenger that Lennox will inform Macbeth about. Macbeth will still have his dim spotlight on him but Lennox will have a bright light, his uniform/armor will be clean and shining, showing that Lennox has not fallen from grace as Macbeth has. Lennox will inform Macbeth of Macduff who has fled to England to bring back an army. This will lead to Macbethà ¯Ã‚ ¿Ã‚ ½s final soliloquy of this scene. During this Macbeth will speak of his plans to murder Macduff. He will pace around the front stage whilst Lennox walks towards the back of the stage to talk with the messenger so it doesn’t look like that Lennox can actually hear what Macbeth is saying. Macbeth should look flustered and angry, he should look as if he has lost all sanity and means of rational thought, showing the audience that in this one scene Macbeth has gone from a murderer to a madman and is still plummeting to worse things. The spotlight over Macbeth will start to fade until it eventually is put out permanently. This is to show there is no way back for Macbeth now.

Quotes From Controversial Book The Giver

The Giver is a middle-grade dystopian novel by Lois Lowry. Its about Jonas, who becomes the Receiver of Memories and then begins to understand the deepest secrets of his society. The book teaches a valuable lesson on the importance of individuality, emotions, and having a connection with others. It is often part of a middle school curriculum. On Aging Chapter 1 â€Å"After Twelve, age isnt important. Most of us even lose track of how old we are as time passes, though information is in the Hall of Open Records. Chapter 2 Whats important is the preparation for adult life, and the training youll receive in your Assignment. On Memories Chapter 23 It was not a grasping of thin and burdensome recollection; this was different. This was something that he could keep. It was a memory of his own.   Chapter 18 Memories are forever. Chapter 10 Simply stated, although its not really simple at all, my job is to transmit to you all the memories I have within me. Memories of the past. Chapter 17 With his new, heightened feelings, he was overwhelmed by sadness at the way the others had laughed and shouted, playing at war. But he knew that they could not understand why, without the memories. He felt such love for Asher and for Fiona. But they could not feel it back, without the memories. And he could not give them those. On Courage Chapter 8 You will be faced, now, with  pain  of a magnitude that none of us here can comprehend because it is beyond our experience. The Receiver himself was not able to describe it, only to remind us that you would be faced with it, that you would need immense courage. But when he looked out across the crowd, the sea of faces, the thing happened again. The thing that had happened with the apple. They changed. He blinked, and it was gone. His shoulder straightened slightly.  Briefly,  he felt a tiny sliver of sureness for the first time. On Fitting In Chapter 1 For a contributing citizen to be released from the community was a final decision, a terrible punishment, an overwhelming statement of failure. Chapter 3 No one mentioned such things; it was not a rule, but was considered rude to call attention to things that were unsettling or different about individuals. Chapter 6 How could someone not fit in? The community was so meticulously ordered, the choices so carefully made. Chapter 9 He was so completely, so thoroughly accustomed to courtesy within the community that the thought of asking another citizen an intimate question, of calling someones attention to an area of awkwardness, was unnerving. On Happiness and Satisfaction Chapter 11 Now he became aware of an entirely new sensation: pinpricks? No, because they were soft and without pain. Tiny, cold, feather-like feelings peppered his body and face. He put out his tongue again and caught one of the dots of cold upon it. It disappeared from his awareness instantly, but he caught another, and another. The sensation made him smile. He was free to enjoy the breathless glee that overwhelmed him: the speed, the clear cold air, the total silence, the feeling of balance and excitement and peace. Chapter 4 He liked the feeling of safety here in this warm and quiet room; he liked the expression of trust on the womans face as she lay in the water unprotected, exposed, and free. Chapter 13 They were satisfied with their lives, which had none of the  vibrance  his own was taking on. And he was angry at himself, that he could not change that for them. Sometimes I wish theyd ask for my wisdom more often — there are so many things I could tell them; things I wish they would change. But they dont want change. Life here is so orderly, so predictable — so painless. Its what theyve chosen. Chapter 12 Our people made that choice, the choice to go to Sameness. Before my time, before the previous time, back and back and back. We relinquished color when we relinquished sunshine and did away with difference. We gained control of many things. But we had to let go of others. On Grief and Pain Chapter 13 Now he saw another elephant emerge from the place where it had stood hidden in the trees. Very slowly it walked to the mutilated body and looked down. With its sinuous trunk, it struck the huge corpse; then it reached up, broke some leafy branches with a snap, and draped them over the mass of torn thick flesh. Finally, it tilted its massive head, raised its trunk, and roared into the empty landscape. It was a sound of rage and grief and it seemed never to end. Chapter 14 The sled hit a bump in the hill and Jonas was jarred loose and thrown violently into the air. He fell with his leg twisted under  him and could hear the crack of bone. His face scraped along jagged edges of  ice...Then, the first wave of pain. He gasped. It was as if a hatchet lay lodged in his leg, slicing through each nerve with a hot blade. In his agony, he perceived the word fire and felt flames licking at the torn bone and flesh. Chapter 15 Dirt streaked the boys face and his matted blond hair. He lay sprawled, his gray uniform glistening with wet, fresh blood. The colors of the carnage were grotesquely bright: the crimson wetness on the rough and dusty fabric, the ripped shred of grass, startlingly green, in the boys yellow hair. Chapter 19 Jonas felt a ripping sensation inside himself, the feeling of terrible pain clawing its way forward to emerge in a cry. On Wonder Chapter 9 What if others — adults — had, upon becoming Twelves, received in their instructions the same terrifying sentence? What if they had all been instructed: You may lie? Chapter 12 Always in the dream, it seemed as if there were a destination: a something — he could not grasp what — that lay beyond the place where the thickness of snow brought the sled to a stop. He was left, upon awakening, with the feeling that he wanted, even somehow needed, to reach the something that waited in the distance. The feeling that it was good. That it was welcoming. That it was significant. But he did not know how to get there. Chapter 13 He wondered what lay in the far distance where he had never gone. The land didnt end beyond  those nearby communities. Were there hills Elsewhere? Were there vast wind-torn areas like the place he had seen in memory, the place where the elephants died? Chapter 14 Was there someone there, waiting, who would receive the tiny released twin? Would it grow up Elsewhere, not knowing, ever, that in this community lived a being who looked exactly the same? For a moment, he felt a tiny, fluttering hope that he knew was quite foolish. He hoped that it would be Larissa, waiting. Larissa, the  old woman  he had bathed. Jonas began to remember the wonderful sail that The Giver had given him not long before: a bright, breezy day on a clear turquoise lake, and above him the white sail of the boat billowing as he moved along in the brisk wind. Chapter 23 For the first time, he heard something that he knew to be music. He heard people singing. Behind him, across vast distances of space and time, from the place he had left, he thought he heard music, too. But perhaps, it was only an echo. On Choice, Change, and Consequences Chapter 20 Its the way they live. Its the life that was created for them. Its the same life that you would  have  if you had not been chosen as my successor. Chapter 7 He hunched his shoulders and tried to make himself smaller in the seat. He wanted to disappear, to fade away, not to exist. He didnt dare to turn and find his parents in the crowd. He couldnt bear to see their faces darkened with shame. Jonas bowed his head and searched through his mind. What had he done wrong? Chapter 9 There was just a moment when things werent quite the same, werent quite as they had always been through the long friendship. Chapter 16 Things could change, Gabe. Things could be different. I dont know how, but there must be some way for things to be different. There could be colors. And grandparents. And everybody would have memories. You know about memories. Chapter 22 If he had stayed in the community, he would not be. It was as simple as that. Once he had yearned for choice. Then, when he has had a choice, he had made the wrong one: the choice to leave. And now he was starving.