You are then allowed to spit.

Reminds me of an incident.

Elderly lady.

Elegant, actually.

Didn’t speak English.

Smiled at everyone she passed.

She smiled at me.

Just before turning her head, clearing her throat and spitting three feet across the hallway.

Then she smiled and continued down to her husband’s room.

I didn’t take it personally. I did, however, feel my jaw hit the floor…

(Postcard courtesy of Michael Zwerdling, RN of the Zwerdling Nursing Archives.)

********************

Emily over at crzegrl.net really is CRZE this week! She’s doing Grand Rounds on Tuesday and Change of Shift on Thursday!

Help send her over the edge and get your CoS submissions in! You can send them to me and I’ll forward or send them directly to Emily at “emily at crzegrl dot net”.

*********************

Browsing through my October ENA Connection the other day, I noticed the theme was “Government and Advocacy”. Came across an article on domestic violence. It’s a short article, written by Carrie Norman, RN, CEN, member of the Government Affairs Committee. The quotes below are taken from Carrie’s article.

“The CDC estimates that 37 percent of women who sought emergency department care were victims of domestic violence.”

What? 37 out of every 100 women I have triaged?

Seriously?

“Domestic violence victims are more likely to seek treatment for chronic and psychological conditions.”

Okay. But no way have I been taking care of victims of domestic abuse – I mean, hello, wouldn’t it be obvious? The hovering, overbearing abuser who answers all the questions for the patient? The bruises that aren’t explained by the story?

You know, the stereotypical, classic scenario?

“The stress of physical/emotional abuse has been linked to many chronic conditions such as: chronic pain, fibromyalgia, frequent migraines and abdominal and gastrointestinal complaints.”

Well, yeah, I knew that.

But….

I screen them, right? It’s part of triage.

Well, actually I check one of two boxes. Abuse: “Not suspected” or “Yes”.

And unless someone says “He/she hit me”, I check “Not suspected.”

What kind of a screening is that? How can you screen for a problem when you don’t even have to ask the question, you just have to “not suspect” it?

*****

How many women have I missed?

When you came in for the fifth time in a month with abdominal pain for which no etiology could be found and for which you never sought follow up…

Did I miss you?

I’ll never know.

I didn’t ask.

When you presented with migraines on such a regular basis for so many years I got to know you like family…

Did I miss you?

I’ll never know.

I never asked.

When you sat in triage inconsolably sobbing over a skinned knee at 3:00 am because you “tripped in the garden”…

I missed you, didn’t I?

Because I never asked.

*****

“Many women experience some form of violence in their home. I’m here to listen and I may have some suggestions to help.”

Hopefully, there is something we can do immediately.

Or, the patient may not be ready, may not feel it is a safe time to leave.

But, just having someone ask the question and offer resources for when she is ready can let her know she has options.

And give her a sense of empowerment to make the decisions she needs to make.

The bottom line?

Ask the question.

I am.

Should have been doing it all along.

Domestic Violence – Did I Miss You?

When John was in the hospital, that’s where I bought the donuts for the nurses.

After immigrating to the U.S. from Cambodia in 1987, Sam started working at the shop and by 1990 he owned it (Update via Steve in comments: When he was 13, his parents were murdered by the Khmer Rouge. He spent several years in a displacement camp in Vietnam before finally being sent to the States as part of an entire plane load of orphans).

With the exception of a few holidays, Sam is in the store every morning at 3:30 am and works until 6:00 pm.

Seven days a week.

His wife, Lori, works with him, but she wasn’t there on that Wednesday morning in October.

Thank God.

Somewhere around 4:40 am, the donut shop was robbed. Sam was alone when the assailant entered the shop and he was pistol whipped so badly that he was rushed to Eden Medical Center for emergency surgery to have part of his ear reattached (Update from Steve in comments: “The pistol whipping was so bad that it not only almost severed one ear, but broke the occipital bones around one eye, severely damaged the other eye, and loosened his teeth so that it was more than three weeks before he could eat solid food).

After insurance, the bills for his surgery and health expenses could reach as high as $15,000. Pretty steep for someone who works 15-hour-days to make ends meet. Lori and the kids are trying to keep the shop going until Sam can recover enough to go back to his old schedule.

They need help.

Our friend, Steve Dimick, has helped set up a fund to help Sam and Lori to stay afloat as they deal with their upcoming medical bills. The full story can be found here, at the Castro Valley CARES! website.

Please consider hitting the “Donate” button – and anything, and I mean anything would be appreciated.

Castro Valley is a great community. My husband grew up there, works there and we live so close that it is my community, too. Please consider joining this community, if virtually, by helping Sam keep his business.

They say that charity begins at home. Well, this has hit extremely close to home.

And I want to help make it right.

The Need for Help Hits Close to Home

I almost expect the zombies from “Thriller” to come dancing out of my den!

(shudder)

Read at your own risk!

Want to host? Contact me. I should come out of hiding in a few hours!

********************

A terrible injustice is being perpetrated against a very dear friend.

Zippy is being held hostage.

Dr. Rob told me about this at Blog World Expo.

We know where he is.

He’s been forced into areas of high radiation and indoctrinated with huge radiology books that would numb the mind of Einstein. He was forced to sleep with a crab! A crab that stole his lunch!

Now, I don’t want to name names (Vijay!), but Zippy must be free!

(Speaking of Dr. Rob, if anyone knows how to get a Golden Llama award, please email me. He treats those things like precious metals and I can only kiss so much of the ground he walks on, ya know. A girl has to have limits.)

********************

The story of the nursing student who was expelled for blogging got me thinking.

(If you haven’t heard the story, check out What Can Nursing Students Blog About? at Code Blog, with an update at Kevin, MD)

Just what can you write about on your blog?

Well, you can write on just about any topic.

It’s not a case of what you say, it’s how you say it.

*****

So how can you make sure that your blog post won’t get you fired (or expelled)?

Three things come to mind:

• Blog about the issue.

Got a co-worker that is driving you nuts because they steal your Diet Pepsi from the fridge?  Got a manager that makes life hell? Tired of taking abuse from the “regular” drug-seeking patient who has called you fifty different names for a female dog?

Great! You have blogging material! But…instead of insulting the people involved (as tempting as that may be), make that blog post about respecting your co-worker’s space and property. Or the top five traits you think a manager should possess. Or how to stay cool in the face of verbal abuse.  Whether you use real or hypothetical examples to illustrate your point, make your point about the issue,  not the person.

• Wait.
  

Did something good/bad/funny/sad/dumb/crazy/awful/miraculous happen on your shift?

As a blogger, you’re first thought is “whoa, I am so blogging about this!” And you can!

Later.

Let some time pass before blogging. This is prudent whether you blog anonymously or under your own name. Time gives perspective,  a chance to see underlying issues and an opportunity to keep emotions (and any inappropriate statements) in check.

• Choose your words.

It is possible to blog about a difficult, sensitive or emotional topic and do it without being derogatory or insulting.  You can be humorous, sarcastic and over-the-top or angry, frustrated and at the end-of-your-rope and still convey an underlying sense of empathy and respect.

What is laughed at over a margarita after work is not necessarily appropriate for a blog.  What we post in a blog is a reflection of ourselves (and the nursing profession). Don’t just hit the keyboard in a blast of blogorrhea. Think about how your words will “sound” to someone else’s eyes.

If you do these things, I think you can pretty much blog about anything and everything without worrying about your blog bouncing back and biting you in the butt.

Because it’s not so much what you say…

…it’s how you say it.

It’s Not WHAT You Say…

“The modern way to bring up their baby.”

Baby? That kid is four-years-old if he’s a day.

And the trauma!

Dad wants to give the kid his laxative.

Mom says “No! It’s too harsh!”

Good grief.

Of course, in 40 years, the kid will have to deal with his parents being constipated.

The circle of life…

Then again, Castoria did taste better than Milk of Magnesia.

Or so I have heard…

********************

Re-entry into the real world after four days in Vegas has taken a bit of time. Got back on Sunday.

The medblogger meet up was fantastic – again, thanks to Dr. Val at Better Health for putting the panels together, to Johnson & Johnson for sponsoring the track and to MedPage Today for adding their sponsorship!

Lots of fun, but lots of serious discussion about where we are going as a genre and the challenges that lay ahead.

Here’s to next year! Start planning now!

(Speaking of Dr. Val, check out her interview here with ABC – Medbloggers making news!)

*****

Alvaro is hosting Grand Rounds today at Sharp Brains: The Brain and Cognition Edition.

It looks wonderful.

It has been months since I’ve been able to sit and read Grand Rounds with a latte in hand – I think that will be my treat to myself tomorrow!

*****

I’m sitting in the McCarran airport in Las Vegas on Sunday, thinking my adventures in blogging were over for the weekend. I noticed a tweet from @nicurnmama (Laura, from Adventures in Juggling). Seems she was sitting in Sammy Hagar’s Beach Bar and Grill. In Las Vegas. At the airport.

Say what?

Laura hadn’t been to Blog World.

And I had just walked by that bar and grill!

Well, Laura had been right next door at the Venetian attending another blogging conference (SITScation) the entire weekend!

So I was able to meet Laura (at Gate C 16 in the Southwest Terminal)!  I won the Blogger Jackpot! We corralled a total stranger to take our picture (thanks, total stranger!).

And hopefully we can get Laura at the next medblogger conference!

Hint, hint!

*****

This is just bizarre!

Las Vegas’ elevation is about 2000 feet above sea level.

Is this really necessary?

I mean, maybe a few conference goers might have visited a regular bar, but to the point of needing an oxygen bar?

I didn’t try it.

Let’s put it this way: there were more people in Sammy’s Beach Bar and Grill than even glanced at this O2 bar. I mean, think about it. A nasal cannula or a Cabo Wabo margarita?

You make the call.

Only in ‘Vegas.

Just sayin’.

Post Blog World Post

God, I love books!

But the highlight of the day? I met my Blogfather! Meet Hugh Hewitt, talk show host extraordinaire! I think if you did a “paternity” test on every blog online today,  75% of them would be related, in some way, to Hugh’s influence.

Blog World CEO Rick Calvert was interviewed by Hugh, and he mentioned the medblogger track!

*****

This banner blew me away! It was at the Alex’s Lemonade Stand Foundation booth. The banner tells you where their donations go.

They actually recognize, and fund, nurse researchers!

Do you know how rare it is to find that anyone realizes that nurse researchers exist, let alone see it on a promotional banner?

I’m so impressed!

Until 8 pm on Saturday, October 17th, for every hashtag of #beatcancer that is used on any tweet, blog or website, donation is made to cancer research. The goal is to set a Guinness record. So please use #beatcancer whenever you tweet, blog or facebook!

*****

A bit of unfinished business from last night: a photo of Doctor Anonymous “taking one for the team”. Seems there was one last King crab leg and someone had to eat it. It was a sacrifice, but he managed to do it.

The Singing Medbloggers video is now up over at Doctor Anonymous: Medbloggers at BlogWorld.

They swear that this is three-part-harmony not heard since the Bee Gees graced the stage, and I have the tweet to prove it.

Listen to the self-described harmonic convergence and judge for yourself.

*****

I guess I was the only blogger on the face of the earth who did not know who Chad Vader was!

He is Darth Vader’s younger brother and works as a day shift manager in a grocery store. He’s actually quite the gentleman if you like the heavy breathing type.

Well, I picked up my share of swag and tomorrow I’ll pick up some more!

I’m all about the swag, baby, all about the swag…

BlogWorld/New Media Expo – The Exhibited, The Uninhibited!

And it went beautifully!

The panels were informative, the audience engaged and we even got Paul Levy in via telephone hook up through a device that looked like a giant Star Trek communicator!

A most interesting day!

*****

The first surprise was seeing Ramona’s “Blogger Quilt”!

She made it for the conference to be given to one of the medblogger attendees via drawing.

It is beautiful! And even better, on each of the white diagonal lines is the signature of one of the medbloggers.

So, the drawing was held before the fourth panel and the quilt was won by…

Gary Schwitzer, of Health News Review.org!

He wore it as a cape for the first part of his panel! Super Blogger!

Ramona’s fingers must have been flying because she made me a mini-quilt of Rosie the Riveter!

She says it looks like me! I wish I was that buff!

(Right now I feel like Rosie the Wilted; that was some margarita at dinner!)

The quilt is gorgeous and will have a special place on the wall at home!

Well, there was much introducing and hugging and excitement as everyone gathered (most of us meeting for the first time), and then the day’s sessions began.

*****

My two fellow nurse bloggers pictured here are Gina, of Code Blog fame and Terri from Nurse Ratched’s Place.

This was my first time meeting Gina – much fun, and Terri is always a hoot!

Jamie Davis, host of the Nursing Show Podcast was on hand doing on the spot interviews with the bloggers, and Terri had us all busting up with her interview and her panel contributions!

*****

Doctor Anonymous (Mike) will be doing his BlogTalkRadio show directly from the BTR booth in the exhibit hall, tomorrow at approximately 2:00 pm.

I don’t want to give too much away, but let’s just say you might hear a rousing rendition of “Let It Be” and “Amie” as sung by a few of our blogging colleagues. At dinner. In harmony. Sort of.

*****

Grunt Doc and Dr. Wes may look innocent, but ask them about “The Lunch Incident”.

The true story may never be told.

While I’m sitting in front of these guys giving my full attention to my distinguished colleagues on the panels, they are tweeting funny things to the Twitter stream that is running on the screen in front of the room!

I will say this: they are not the ones on Dr. Anonymous’ infamous “Let It Be” tape.

I shall say no more.

*****

If there was an award given for who traveled the longest to get to BlogWorld, Bongi would win, hands down!

Neal and his (gorgeous) significant other (whose name is escaping me at the moment, I apologize) traveled all the way from South Africa. Together they comprise 2/7 of the entire blogging population of South Africa – seriously. Neal knows of five others.

It was absolutely stunning that he came to the conference, and we are thrilled to see him!

*****

And lastly, here is a photo of Gene, Nick, Kevin and myself (you can see Mike in the background filming Alan). Nick and Kevin, along with Kerri, did a great job on our panel!

Tomorrow, in addition to Dr. A’s BlogTalkRadio show, I get to see my blog father, Hugh Hewitt, in the keynote and he will be broadcasting his show from BlogWorld tomorrow from 3 pm to 6 pm, PDT. If you want to listen, you can hear it streamed live over KRLA’s website.

I hope to get a picture with Hugh, if I don’t get too freaked out to ask! Wish me luck!

*****

There are still two full days of blogging goodness ahead of us! More to come tomorrow, including photos of tonight’s dinner and sing-along! Now it’s time for bed! Been up since 0600 and it’s almost 0100!

One For the Medblogger History Books

It’s the BlogWorld Expo edition of Change of Shift!

Well, at least it’s being compiled in the same city.

We have a new blogger again this edition, and an unintended ER theme seems to have arisen from the nursing blogosphere this week!

So, without further ado -

Let’s get started!

********************

A big Change of Shift welcome to NURSE ME, an 11 year ER/ICU veteran who describes themselves as…” blunt and to the point, pragmatic and methodical. That is until I look into your eyes as I’m performing chest compressions and remember that you’re human.”. A blogger since September, today’s submission is called Just the facts?..

NPs Save Lives gives an online interview to a nursing student. Great questions, great answers! (Did you know NPs in Florida can’t write for a controlled substance?)  Interview From Me For A Nursing Student is posted at The Nurse Practitioner’s Place.

After 19 years in ER, stories like this still make me (a) laugh or (b) slam my palm into my forehead or (c) both! Today’s “Life in the ER” story comes from Ross as Nurse In Australia. Never forget the Piña Colada for the Patient, Please?.

*****

Anne Simone from the LPN to RN Blog finds the Top 10 Most Ridiculous Uniforms in Nursing History. Some look pretty cumbersome, but I have to disagree with the cap – nothing beats a great nursing cap! Then again, I could never stand Sue Barton because she wore those muffin top monstrosities…

I’m detecting a theme in CoS this week! An ICU nurse decides to help Man-nurse with his clinical assignment in Emergency Room Edumacation posted at The Man-Nurse Diaries. Having done both ICU and ER, this is a hoot!

It happens to us all, usually in the first semester. That’s how it was for CeeCee who describes her experience in  I Changed an Adult Diaper with some very poignant thoughts. In: From Suit to Scrubs.

*****

I’ve heard a lot of talk about violence against nurses in the ER, but it happens everywhere. Even in labor and delivery. Reality Rounds looks at the vulnerability of nurses (and recounts her own experiences) in Assault.

Think you’d be grossed out by stuff you’d see in the ER? Well, shrtstormtrooper as her limits and she describes them vividly in Things I Can’t Handle posted at New Nurse Insanity: Fundus Chop!. For me? Sputum. Anything but sputum.

Over at NurseConnect, Laura wants to know Should Medical Media Reflect Reality? Lots of nurses on TV these days. What do you think of how they are portrayed? Kathy is ambivalent about the flu immunization and looks at the Vaccination Controversy. Are you getting immunized?

Paramedic Janis at The Jage Page has some thoughts and what constitutes a professional – and not just in EMS. Do you it the criteria in A Word About Professionalism?

********************

And that’s it from Las Vegas!

Next week, our host will be Reality Rounds, and you can send your submissions through Blog Carnival or to ” rrcomadmin at gmail dot com”.

Thanks for reading!

*****

Change of Shift From BlogWorld!

The Medblogger Track at BlogWorld/New Media Expo 09 is actually happening!

I’m sitting at the Palazzo and working on homework.

Seriously.

Then after that I have a track leader meeting at the Convention Center.

And then I have to come back and put my panel notes together.

And…

Oh yeah – Change of Shift is due tomorrow.

Oh well, I could be downstairs spending money.

Nah, I’ll save that for the Nascar Cafe – nothing like watching a race on flat screen TVs surrounded by memorabilia and a ton of booze classy drinks. But that is Saturday evening, and before then it’s 72 hours of pure, unadulterated blog stuff!!!!

So Viva la Homework!

Viva la Nascar!

Viva Blog Vegas!!!!!!!!!!

Viva Blog Vegas!

But she’s smiling, so this can’t be Hell’s Kitchen.

It’s more like pot-luck-in-the-break-room.

Cherry Ames got in trouble for “sampling bread and butter” in the ward kitchen, which was apparently against the rules back in the day.

Now you can come into my department and have a four-course meal laid out on the table, which is great for morale but bad for those of us babes with too much “back”.

And when it really does look like “Hell’s Kitchen” in the ER, nothing boosts your serotonin like a big, chocolate brownie, or nacho cheese Doritos!

Sometimes it feels like my shift is one big exercise of will power, and I usually poop out by by 0300.

********************

It’s less than a week to BlogWorld/New Media Expo 09! But have no fear, Change of Shift will still be up by Thursday morning! Send in your submissions to me – CoS will be right here on Emergiblog.

********************

Somewhere between work, school and full blown addiction to that god awful “Word Island” game on Facebook, I managed to make it to one day of the Health 2.0 conference in San Francisco.

*FTC ALERT: INCOMING DISCLOSURE!*

Rob at Johnson & Johnson let me use their free sponsor’s pass (Thanks, Rob!) and so I found myself walking through San Francisco on a gorgeous early morning!

The conference was being held at the Concourse Exhibition Center. It was an interesting venue – it used to be a train station!

The conference was geared toward businesses and providers, even though many of the programs are designed for patient/consumer use. There was a patient panel that first day, and a panel with patients who had demo’d a couple of apps, but I did not notice patients represented in the other panels.

I came away with two thoughts:

1. Technology is great, but nothing takes the place of a personal relationship with your health care provider. There is not a technology in the world that can replace in-person interactions and assessment.  While this was the opinion of speaker Ron Dixon, MD, it is a belief I share. Technology is an adjunct, not a substitute. (I actually stated that in a paper for a class – and lost points for not being “forward thinking”.)

2. There are a lot of apps and programs marketed “to” patients and “for” patients. Very few of these (if any) have been produced “with” patients.

Of course, the fun of conferences is hooking up with folks you know and folks you “know” from their blogs!

I finally got a chance to meet Amy Tenderich of Diabetes Mine and Trisha Torrey of Every Patient’s Advocate!

I had a blast talking to both blog buddies!

And here is a pic of me and Dr. Val of Better Health!
Sort of a rehearsal for BWE next week!

So in summation, the Health 2.0 conference was interesting and a good look at some applications that are coming down the pike.

As a blogger, I didn’t really feel there was a lot I could relate to, but that’s not really a criticism because the conference is not geared to that audience.

Baby Got Back….to Blogging!

Lots of topics this week: H1N1 is on a lot of minds these days, there are a couple of posts for new grads and it looks like one particular blogger is going to have to re-evaluate her opinion on a certain Showtime show (cough!).

So, let’s get started!

*****

New blogger, first post! Meet RNtoBe as she encounters the “policy vs. practice” in Back to the Grind and is shocked to discover that they teach residents that babies are “sterile”. It’s a hoot!

Beka at In Our Own Words: Medscape Nurses wants to know if you are Ready for the H1N1 (Swine) Flu? Will you be getting the vaccination? Is your hospital prepared? And if want to know what the CDC is tracking, here is their H1N1 Situation Update.

Do you think the H1N1 vaccine should be a condition of employment? Some nurses are protesting this possibility. Cara Matthews reports that Protesters Rally Against Swine Flu Vaccine posted at Politics on the Hudson.

*****

Mother Jones at Nurse Ratched’s Place is all about vintage uniforms, but right now she has partnered with Scrubs Gallery in a “Uniform of the Future” contest! First prize is a $100 gift card from Scrubs Gallery! Details at You’ve Come a Long Way, Baby!

When I read that author (and blogger!) Suzanne Gordon, a major nursing advocate, believes that “Nurse Jackie” is a realistic portrayal of the profession I realized – after I picked up my jaw – that I should, you know, actually watch it and not condemn it from bits of previews. Suzanne makes her case at Nurse Jackie Ends Tonight. (and if you haven’t read “From Silence to Voice” or “Nursing Against the Odds”, go to amazon.com and get them. Should be required reading in every nursing school.)

Barbara at Florence dot com discusses an important contribution to patient safety from an unlikely source in Trolling for Patient Safety in Social Media.

*****

Sean at My Strong Medicine has a great message he’d like to pass along, you know, From One Nurse to Another. Ever felt like saying this to anyone?Anything you’d like to add?

Wendy Jones from NursesPTO looks at nurses’ reading habits in Are You an Apathetic Nurse?. Jennifer can only take sooo much and she tells us My Pet Peeves About Patients. Rachael is not a nurse, but she hires them and in Finding A Nursing Job she gives some hints to new grads on how to stand out from the crowd.

Susan White at RN Central sends in a list of 100 Incredible, Cutting-Edge Lectures for Medical Professionals. It is, truly, an incredible list and I spent some time viewing a couple of the lectures. You have to see the one with the animated cell; it’s breathtaking.

*****

The campaign for a National Nurse is going strong, and now Diana Mason over at AJN’s blog Off the Charts wonders Why Doesn’t the U.S. Have an Office of the National Nurse? Why, indeed!

RehabRN certainly knows how to Vacate for a Vacation! When two days off just isn’t enough…..

It’s easy to criticize, but how many of us take the time to acknowledge a job well done? Mark at Medic 999 did exactly that following a call for an elderly patient (he even gave the staff a copy of the post!) in It’s a Shame It’s So Rare.

*****

Have you heard about The Waiting Room? A film maker follows the life and times of patients and staff at Highland Hospital, in Oakland, California. Watching over the throng is Nurse CJ. She makes an appearance in many of the videos. If I’m ever in an ER, I want this nurse watching over me.

Patrick at the Travel Nursing Blog talks about how to get your focus back when nursing gets to be too much in You Take the Good, You Take the Bad and There You Have… Be sure to read check out the links at the end of the post! (And Patrick, I now have the theme from “Facts of Life” in my head. There will be payback…)

I’m taking a class on health aging so this post really hit home. Alvaro at SharpBrains notes “…not enough attention seems focused on ensuring healthcare systems’ preparedness to deal with cognitive health issues…” He asks: Alzheimer’s Disease: is our Healthcare System Ready?

NurseConnect blogger Laura wonders at the comforting effect of a soft object in Embracing the Heart Pillow. I distinctly remember the nurses putting much effort into these for their pre-op heart patients. Blogger Kathy also addresses new grads, who may be discouraged as they look for their first job, she says New Grads Take Heart!

********************

And that my friends, ends this edition of Change of Shift! And….it’s right back here again in two weeks so keep those submissions coming in! Wow – this time in two weeks I’ll be sitting in Las Vegas at the BlogWorld/New Media Expo 09!  It’s not too late to join us, you know! Email me if you want details on how to register!

So… the next CoS will be coming at you straight from the heart of Vegas.  Hey, maybe you can write about a “gamble” you took in your career that really paid off! It’s good I’ll be working on CoS, it will keep me from hitting the slots!

Many thanks to those who submitted and, as always, thanks for reading!

Change of Shift: Vol. 4, Number 7