Ep 27: “I just bottle it all up” – understanding emotions and how to process them

Posted October 10, 2023

Show Notes —

It is such a common strategy or coping approach for many nurses to bottle up their feelings and hold on to things. This strategy makes sense in some circumstances. But in the long run, it can be harmful.

In this podcast episode, Nathan Illman discusses the common phenomenon of bottling up emotions. He provides a step-by-step process for individuals to start acknowledging and expressing their emotions. And he shows how you can support those you work with to share their emotions too.

Tune in to this episode as Nathan offers valuable insights and practical advice for nurses and healthcare professionals to improve well-being and foster open conversations about emotions in the healthcare field.



Nathan discusses early experiences and cultural influences shaping emotional responses.

  • Societal norms influencing the expression of anger, especially among women.
  • Cultural variations in expressing emotions based on experiences.

The effects of bottling up emotions.

Self-reflection on the usefulness of bottling emotions.

Nathan emphasizes the importance of cultural competence and understanding diverse emotional responses.

Nathan offers strategies for individuals to explore and overcome emotional suppression.

Describing emotions as an aid in identifying and expressing their feelings.

Nathan gives a guide for professionals who are supporting individuals in the context of supervision or line management.


If you have found this helpful, you can check out Nathan’s self-compassion course for nurses online.


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Transcript —

Nathan Illman 00:04

Welcome back everyone, it’s Nathan Illman here. So, in this episode of Nurse Wellbeing Mission Podcast, I am here to talk about something that I think shows up quite a lot in my work with nurses and conversations I have, and it’s around the way that people respond to emotions. So something I hear is something similar to this phrase, is that I just bottle it all up. So it’s such a common strategy or coping approach for many nurses to bottle up their feelings and hold on to things and to either not acknowledge the emotions that are going on to oneself and certainly not to acknowledge those emotions or talk about them with other people. In this episode, I want to share with you, hopefully be some helpful tips around. First. to how to understand why people do that, where that kind of strategy and approach comes from, but also ways that you as an individual can start to examine perhaps the usefulness of that strategy, how you can try something different. And I also want to share in this episode for people who work with other nurses by providing clinical supervision, kind of pastoral support, any kind of wellbeing support for your colleagues, how you can approach this with colleagues and start to have hopefully more effective, helpful, constructive conversations with people who tend to bottle up their feelings. So let’s dive straight in, shall we? So I think the first place to begin with this is to try and understand why it is that people do bottle up their feelings. Why do people hold on to emotions? Say, for example, someone has offended you at there may be something someone has said, a manager or a coworker.


Nathan Illman 02:08

Maybe someone’s rolled their eyes at something you’ve said. There’s been some passive aggressiveness and you feel angry about that and you hold on to that. You hold on to feeling hurt, perhaps feeling embarrassed or feeling angry about something and you don’t share it with anyone. Now, there are a number of different reasons why people… Bottle up emotions and hold on to them. Let’s start with your early experiences. So when we’re babies and then infants and toddlers, we are learning and navigating through the world from what is said to us and the actions. That happen from our caregivers often our parents people look after us and then at school through our teachers and other important people in our life and we learn how to respond to emotions going on inside us based on the kind of attitudes that our parents have had so A really great example, I’ll stick with this anger example. And I think this is particularly relevant for women as well. I know that there will be male nurses listening to this. Women in society are typically kind of given the subconscious, maybe very conscious and explicit message sometimes that it’s not okay to be angry. There’s a lot of societal messaging that girls should kind of keep quiet and carry on with things and just be gentle and soft and kind and compassionate all the time. And many women would have had the experience as girls where if they were to express anger or being irritated or frustrated about something, they would have been given the message, basically, that it’s not okay to feel angry. So it might be that a parent has just laughed at you when you’ve been angry, for example. They’ve laughed it off and not taken it seriously that you were angry and hurt about something that had happened. Now, if this kind of thing happens all the time, maybe you grew up in a family in which, in general, that kept happening.


Nathan Illman 04:14

Maybe other emotions were judged negatively. Maybe you were mocked for expressing emotions in your family. And perhaps your parents had extremely strong views around not expressing emotions. There was lots of unsaid things going on in your family. Of course, you’re going to carry that with you into your adult life. You’re going to carry rules in your mind around what it means to express certain emotions and whether or not it feels okay to. Now, of course, what happens then is as an adult, often unless we have done some kind of self-work or we’ve had coaching or therapy, we stick with the same strategies we’ve learned as a child. So some of these strategies will work in some context probably is helpful to not express everything you’re feeling, right? Certainly in professional contexts and even some friendship contexts, you know, we kind of have to be discerning about what we express and how we express it. But often what I see is when people have learned to kind of bottle up their feelings, and if this has come from their previous early experiences, then they apply it kind of all the time. And it leads to this unhelpful bottling up, where they’re really suppressing everything they’re feeling. They’re not honoring any of those feelings, not allowing themselves, giving themselves permission to feel what they feel, and this creates a lot of stress internally and can really amplify how someone is feeling. And then, of course, what can happen is it can lead to these explosive blow-ups. Often this happens in relationships. So we’re holding on, holding on, holding on. Sort of saying to yourself, it’s not okay to feel what I’m feeling. That might be a kind of subconscious thing. And then everyone has their limits. And then of course you might have a disagreement, some sort of conflict in a relationship or at work. And then boom! You get really angry. And then what might happen is… That anger, you judge it negatively, because it probably did have some kind of negative consequence. Maybe it felt inappropriate at the time, the other person reacted negatively to it, and of course, this can continue the cycle then. Then you might say to yourself, oh, well it was actually really bad that I expressed that emotion. That means I just need to keep holding on and not expressing emotions. So you can see there, there’s a combination of how you learn to deal with emotions when you’re younger, and then how you deal with them as you’re older, and it becomes this kind of pattern.


Nathan Illman 06:45

Now another thing that’s really common within nursing, probably other aspects of healthcare, but I definitely see it in nursing, is that there is a culture of bottling things up. A culture of really expecting people to just get on with things and not talking about how they feel. Again, this can happen through very explicit things that people say. So it might be that a manager or a coworker has said to you, basically, to just get on with it, get, you know, stop whining, stop complaining. Someone might have actually said that to you. And of course, that would probably stick in your mind. But often it’s very subconscious or implicit ways in which bottling it up is expected of people. So, this might be within meetings that no one is really talking about the underlying feelings. You always get this sense that there is emotional stuff going on in the team. There is a lot of silence around how people are really feeling. And of course, if leadership or management are not encouraging open discussions, not modelling that kind of openness, then what happens is there becomes a culture of bottling things up. It’s expected that you don’t talk about things. So this can combine with your potentially already existing kind of attitude that you should keep things to yourself. And then of course, if there were not systems or ways of encouraging people to talk about how they’re feeling, to make it okay, to talk about how you’re feeling, and to kind of just own the fact that we have emotions at work, then that, again, um, persists this notion that we should be bottling things up.


Nathan Illman 08:36

So, yeah, if you’re never given an opportunity to express how you feel about something, then that is going to perpetuate this notion that you should bottle things up. Now, another influence as well is people’s culture. So this is something that I think is absolutely crucial for everyone to understand in healthcare. It’s part of cultural competence, so especially if you are working supporting people from different cultures, which you will be if you’re in a position of leadership. There is so much diversity within healthcare, within nursing, which is fantastic, and we need to respect cultural differences in how people deal with emotions. And it may be that you’re listening to this and you are a nurse from overseas and you’ve been getting this sense that the way you deal with things emotionally is different from people who perhaps were born in the UK or maybe even from a different culture. So we know that, for example, you know, quite a classic thing of people from British culture is that sometimes we do kind of hold on to emotions and we’re not fully expressing how we feel. There can often be this kind of self-deprecating kind of humor that sometimes serves or functions to avoid people’s true feelings about something. I have a, I remember a personal experience of a real cultural difference in expressing emotions. I remember my wife and I went to Bali in Indonesia.


Nathan Illman 10:01

We stayed there for a couple of months after we got married. And I remember having a great conversation with a local Balinese man, and he was telling me that a kind of cultural norm, if you like, in Balinese culture is really to not express how you’re feeling with other people in public. It would be considered really rude, and people tend to want to kind of maintain harmony. They sort of feel that if they’re going to express anger or resentment, something like that, you know, some negative emotion that they believe that it would create disharmony within a group. And they want to kind of, I guess it’s almost trying to manage other people’s feelings, right? It’s trying to make sure they don’t upset anyone else. So they sometimes neglect this guy said they pretty much neglect how they really feel about something in service of, you know, hoping that everyone is going to be happy. And we might not do that in the UK. And there are going to be other cultures where that kind of approach to emotions is valued as well. So again, kind of more eastern cultures, you know, China and Japan. This is again a very common thing. Certainly, not for every person from those cultures, but in those kind of cultures, people may tend to not express how they individually feel about something. Again, they’re trying to make everyone in a social environment feel comfortable, and they don’t want to create discord or disharmony by expressing things like anger.


Nathan Illman 11:24

So it’s really important for ourselves to understand our own kind of cultural upbringing and where our approach to emotions may have come from, but also if you’re working with someone else and respecting that. If you’re working with someone from a different culture, it may be that the reason that they’re bottling things up is because of their kind of cultural programming, if you like, their cultural experiences. Now, this isn’t to say that one approach or the other is better. There’s no better or right or wrong. The way I like to approach emotions and managing emotions, expressing emotions with anyone. Any nurse I work with individually or in groups is helping people explore for themselves how useful or workable their strategy is for them. So exploring really the pros and cons of bottling things up, if you like, because as I said before, sometimes in some contexts, bottling things up and not expressing emotions can be helpful, but at other times it might not be helpful at all. So let’s talk about that now. Let’s talk about the usefulness of bottling things up and perhaps the dangers of bottling up emotions. So it’s really important to understand that there is a fair amount of research literature that shows that chronic suppressing emotions and really not allowing yourself to feel what you’re feeling has negative health outcomes. And I guess in a kind of a simple way to understand this is that when you’re feeling stressed about something, that’s when we tend to feel negative emotions.


Nathan Illman 13:06

So stress comes along with other feelings like anxiety or anger, resentment or shame. When we don’t allow ourselves to express, process, regulate, really feel those feelings, the stress in our body can persist and many people understand this notion that chronic stress can lead to mental health and physical health problems and part of the cause of that can be suppressing how we feel. So when we say bottling it up It’s that’s basically it’s a really good metaphor, right? That’s why we have that metaphor it’s like you’re bottling the stress up and if you can’t release that stress it creates chronic stress so holding onto emotions can lead to chronic stress and inflammation in the body and in the brain and that can lead to a whole raft of problems later on for you. So, as I said before, this isn’t really about telling people that they should always be opening up about but we might want to explore, or you might want to explore yourself, how, what the negative impact of you bottling things up might be. So you might want to just check in with yourself and ask yourself if you feel any of these things. So do you feel a sense of chronic inner tension or achiness in your body from stress? Do your shoulders and neck feel tight? Do you have… maybe gastrointestinal problems, maybe you’re feeling fatigued or you’re not sleeping well. So these can be real signs that we’ve been bottling up emotions and bottling up stress and it’s been affecting our body.


Nathan Illman 14:52

Perhaps you get a lot of colds and you’re sick quite a lot. This is another classic sign that someone might have been holding on to stress and other emotions and that of course can affect our immune functioning. We might want to look at our relationships. If you take an honest look at your relationships with perhaps your partner or family, friends, or even your coworkers. Do you find that there is a lot of tension in those relationships? Do you find that you’re quite reactive and maybe snappy? This can be a good sign maybe that we’re bottling things up a lot and then we’re getting into these kind of explosive moments. Another one is really looking at how you feel about yourself. So, often what happens is when people are really bottling up their emotions and not giving themselves permission to feel what they really feel, is they just feel a bit lost as to kind of who they are. You’re kind of maybe struggling a little bit with your identity. Something really important to bear in mind is that our emotions are part of us, right? They don’t define us. So we’re, you know, if we’re feeling anger or anxiety, that isn’t the entirety of us. If we don’t allow ourselves to feel what we’re feeling, we’re kind of cutting off parts of ourself. So sometimes people can go through life if they’re bottling up their emotions, often just not really feeling confident in themselves.


Nathan Illman 16:19

That’s really a good indication that someone might be bottling things up a lot. Just not really having much confidence in you, in your abilities, and just having this kind of wandering sense of who you are, and just feeling quite unsettled all the time. That might be another indication that there are kind of, you know, negative effects if you’re bottling things up. Okay, so in this final part of this podcast episode. What I want to do is talk to you about some strategies that you can use for yourself. If you want to start approaching things differently, you’re really interested to explore how to stop bottling things up and try something alternative. And I’m also going to talk through some guidance for people who may be professional nurse advocates, professional midwifery advocates, or anyone else working in a wellbeing or pastoral role who is working with people in a context in which they might be expressing emotions, or it might be helpful for someone to express how they’re feeling. So let’s just start with individual nurses, if you’re a nurse listening to this and you’re someone who tends to bottle it up, you may be thinking, well, okay, well, what do you recommend I do then? So, the first thing I would really say is to just get in touch with and acknowledge what your fears might be around expressing things.


Nathan Illman 17:42

That’s a really helpful place to start. So asking yourself, okay, if I started to express or really allow myself to feel my emotions more, what am I worried might happen? And really try and be as concrete about that as possible. Because as with other worries we have about things, they’re often so abstract and when we dig into it, it’s actually quite hard to find a really concrete, really negative outcome. It might be that because in the past you were mocked for expressing your feelings, that is what has stayed with you on a very kind of subconscious level. So it’s the kind of fear that if you were to express sadness, true sadness to yourself about something, you’re worried that someone else might mock you. So I’d really kind of examine that and you might want to do it for different emotions. You might want to ask yourself, okay, what am I worried? What might the consequence be of me feeling sadness? What do I fear if I were to actually allow myself to feel stress or anger and just kind of explore that? And you might want to do some journaling on that, write it down. I will never forget one of the first-ever workshops I ran with nurses, and we did some exercises on opening up to your own emotions, kind of emotional acceptance is what we might call this, and there was a nurse who, I think she’d been a nurse for something like 30 odd years, and very commonly, as I’ve been saying in this episode, she was someone who said it was just expected that you didn’t express things that it was a cultural norm within where she worked to just bottle things up and her family had always bottled things up and she had this kind of fear that if she allowed herself to Really feel something that it would be like turning on the tap and it wouldn’t stop, right?


Nathan Illman 19:27

People sometimes fear that once they allow themselves to feel sadness, for example, that the sadness will never stop, and of course there is an avoidance of wanting to feel sad because it’s an unpleasant emotion. And she courageously took part in a brief exercise that I did where I guided the group to allow themselves to sit with and to just be with an emotion. And to her absolute amazement and surprise, this nurse found that she was able to be with this sadness that she had been feeling and it didn’t get to a point where she was totally overwhelmed and she actually found, contrary to what she was predicting, that by allowing herself to feel the emotion the kind of intensity of that emotion actually reduced. So, this is what we tend to find with people is that the thing that they’ve been avoiding and trying to kind of minimize or suppress Say again this example of sadness Actually when we approach that emotion There’s a kind of paradox in that when we fully allow ourselves to experience Something that might be an unpleasant feeling more often than not when we do that the intensity of the emotion actually doesn’t get out of control and increase and keep increasing, increasing.


Nathan Illman 20:52

It will reach a kind of peak of unpleasantness if you like, but it will then reduce as we begin to process it properly. So what I’d recommend to anyone who wants to experiment with this is do just that is to experiment. So it’s always helpful to start small and go big. So if there is some extremely painful past trauma you’ve experienced, then definitely don’t start with that, the emotions surrounding that. You might want to just start with something that’s happened recently that has created some kind of negative emotion for you that you feel like you might have been holding on to. It could be a work situation in which you feel angry at someone, or it just could be stress from being overworked. And you can go through this brief process. Right now, as I’m talking, if you want, is to ask yourself questions. That’s how we do this. We start asking ourselves different questions to allow ourselves to start feeling what we’re feeling. So you might ask yourself, what is it I’m really feeling in this moment? And. If you’ve been someone who has bottled up emotions for a long time, you might struggle with naming your emotions, so sometimes it can be helpful to ask yourself, Am I feeling X? Am I feeling Y? So you might say, am I feeling angry? Am I feeling stressed? Am I feeling sad? Am I feeling irritated? Am I feeling frustrated? Am I feeling hurt? So just go through emotions in your mind and then one of them will probably resonate with you it will kind of hook on and you might notice, yes, I’m feeling that.


Nathan Illman 22:33

So acknowledge that feeling and then ask yourself can I give myself permission to feel this feeling in this moment? And then you might want to explore where you are feeling that in your body. So ask yourself, where do I feel this feeling internally? And kind of use your attention to look inside your body. Again, you can ask yourself, where do I feel it most? Do I feel this feeling in my chest, or my neck, or my belly? They tend to be ones that show up the most for people. And then you might want to say to yourself something like, Can I be with this emotion for a few moments? Can I just simply sit with it for a few moments? And continue to acknowledge how you’re feeling. So you might want to just steady your breathing into your nose and out through your mouth. And really you’re just pausing here. You’re pausing, you’re inquiring internally into your mind and your body. What am I feeling? Where do I feel it? And can I just sit with this for a few moments? And notice any resistance to doing that and seeing if you can just open yourself up. To tell yourself, I don’t have to like this emotion, but can I simply acknowledge it? And recognize that it’s there for a few moments. And as you do that, just notice how intense it feels. And kind of track it, monitor it over a period of 20 to 30 seconds or maybe more.


Nathan Illman 24:09

See what happens and notice any shift in the intensity of it. So often what we find is that there is a kind of wave of experience of emotions. We fear that that wave would just keep increasing, increasing, increasing. But if we stay with the emotion, we find that it reduces and becomes less threatening. So I’d really recommend trying that out and trying it out multiple times at different times for different emotions. So starting small and then working your way up to more intense emotions. Okay, so let’s move on to briefly talking about how you can support other people. So if you are in a supervisory, leadership role anywhere in which you’re talking to other people, could be student nurses, about how they’re feeling and you might be interested to know how you can support people to express themselves. Well, I’d say one really great thing you can do is to just explore people’s attitudes and their strategies Towards managing their emotions and you can do that just with some really genuine curiosity and asking some key questions So when someone’s talking about something difficult You might want to just ask him, I’m really curious to know, how do you normally respond to how you’re feeling?


Nathan Illman 25:28

And you might want to give examples, you might want to say, you know, I’ve worked with some people who tend to bottle up their feelings, whereas other people really kind of allow themselves to express it and feel it inside. So by doing that, you’re very likely to get the person to give you some clues or very openly tell you about how they respond to different emotions. And for me, when I then get an indication from someone or some clues that that person tends to not want to express themselves, that gives me an idea of perhaps how I could support that person in processing their emotions. So as I kind of alluded to before, is that when people have this tendency to bottle things up, often what happens is people start to not even know what they’re feeling. So if we keep ignoring, suppressing emotions, it all becomes this kind of blurred mess of just bleh and yuck. And we just feel kind of meh inside. We don’t know what we’re feeling. Because we haven’t given ourselves the opportunity to name our emotions. And naming, putting language to how you’re feeling is really important for helping to process those feelings.


Nathan Illman 26:45

Now, if you’re working with someone who has this tendency and they might not even know what they’re feeling, something that you can do which can be really, really helpful is to put a name to how they might be feeling. So this is what empathy is, right? You’re listening to someone’s story and you are actually reading between the lines of what they’re saying, and you are imagining what might they be feeling in this moment. And then you’re asking them. You can check in with the person. So, the person might be talking to you about a difficult experience they had. Let’s say for example it’s a student nurse that you’re working with pre-reg. nurse and they’re talking about an experience they had where they were on shift and you might acknowledge or recognize that they just felt completely incompetent. They were doubting themselves and they had this experience where they just didn’t really seem like they knew the knowledge and it was kind of embarrassing. Now the person might be talking about this experience in kind of general terms and you might in your mind be thinking well actually if that was me maybe I would feel embarrassed or I would be feeling incompetent or feel hurt by something or be feeling anxious.


Nathan Illman 28:04

So you might want to say to the person were you feeling embarrassed because you wanted to come across well to your peers? And then pause. And then in that moment, that person is going to check in internally, and then you’re inviting them to explore the emotion inside. And the person is then going to give you basically a yes or a no. They’re going to say, well, yeah, actually that is how I felt, or no. And then you can proceed from there and what I like to do is continue to go a little bit deeper and keep offering other emotions that the person might have been feeling. Especially if you know this is someone who tends to not express their feelings. So you might want to say something like You know, sometimes I feel disappointed and angry at myself when I don’t feel like I’ve performed as well as I would have liked to. Were you feeling disappointed or angry with yourself? And the person is then going to do the same thing, they’re going to check in with themselves.


Nathan Illman 29:06

You have given them the language, you have given them the emotion words and context to understand, to identify in themselves if that’s what they’re feeling. Notice what you’re doing here is you’re not just asking someone, how do you feel about something. So people who tend to bottle up their feelings don’t like that question. I’m sure if you’re someone who does this, um, that might resonate with you. It’s like, it’s quite a difficult question to answer. Even if someone is quite emotionally literate, they understand their emotions. Often we kind of need someone else to use empathy and suggestion to help us unravel what’s going on internally. So sometimes to open a question can be difficult and actually, it’s just really helpful to ask someone, were you feeling this or offer them a couple of feelings that they might have been feeling. And what you’re doing there is you are giving permission for the person to acknowledge a feeling. You’re putting a name on it, you’re saying, really implicitly in what you’re saying is that it’s okay to feel that feeling because you’re just talking about it openly. Were you feeling that emotion? And obviously, the way in which you say it matters as well. If you’re saying it in a judgmental way. Like, oh, were you feeling embarrassed? Is obviously going to come across very differently to, I’m really curious, were you feeling embarrassed in that situation? So notice the tone of voice is one and more of curiosity and it’s kind of setting, setting the scene for compassion.


Nathan Illman 30:38

You’re inviting the person to be vulnerable, but your tone of voice and your facial expression, and your body language is conveying that if the person acknowledges they were embarrassed, you’re there to support them. So. This is just a really good starter set of tools, I would say, for helping people who tend to bottle things up to start to identify, acknowledge, and process how they’re feeling. So really just let’s go through that process again is you’re checking in with them. Perhaps that is a strategy they use. You are then identifying and acknowledging emotions for them, potentially giving them a couple of suggestions, and then they are going to tell you whether or not that’s what they were feeling. And then I’d say the final part of that process, which can be really helpful, is once you have identified a feeling and you’ve, say for this example, you know, were you feeling disappointed and angry with yourself? The person might go, yeah, I actually do is give them the space, use silence to allow that person to then explore that.


Nathan Illman 31:44

And after they have explored that feeling a bit more and they might talk to you about it. Then you could just ask a final little follow-up question. What was it like to identify that emotion? What was it like to talk about that feeling for you? And, of course, we don’t really know what the answer might be to that, and that can be a bit scary, but often we’ll find that people do find it helpful to have had You sat there and really openly listening to them and giving them a non-judgmental space and they have found out something new about themselves and what we would hope is that the person has realized that actually acknowledging how they really feel about something has not been completely overwhelming or scary. And if you do that once in that kind of situation in which you’re, you know, you’re providing supervision to someone. Then that person might then go and have the confidence in their own personal life to start acknowledging that feeling a bit more. So it can really have profound effects if we continue to do this.


Nathan Illman 32:47

Okay, well, I think I’m going to finish the episode here. I’ve covered a fair amount of stuff. I hope this has been really helpful. And if you have found this helpful, what I’d really recommend… is checking out my self-compassion course for nurses online. So often what we find when people are bottling up emotions is that they’re kind of judging themselves or their emotions negatively. And this can be a real kind of sign or clue that someone is not being very self-compassionate. So true self-compassion is where we’re really allowing ourselves to feel what we’re feeling, to be mindful of it, and to allow that emotion to be present. In my online course for nurses on self-compassion, I teach you how to do that. So it’s a four-week course and we go through a range of different skills. We go through how to talk to yourself with kindness and with motivation. We look at how you can take care of your needs and boundaries. And we also look at this emotional part. How to safely open up and kind of give yourself permission to feel feelings.


Nathan Illman 33:56

So, if you’re interested in that, I recommend going over to my website www.nursewellbeingmission.com and there is a link to that on the homepage where you can find out more about that online course and other online courses that we have. For now. I’m going to leave you. I suppose a final thing to say is if you’re not already connected with me, then find me on social media. I’m on Twitter, it’s @nursewellbeing. You can find me on LinkedIn, just under my name, Nathan Illman. If you want to join my free Facebook group where I post posts resources, wellbeing resources for nurses and midwives, head on over there, just search for Nurse and Midwife Wellbeing Mission on Facebook and you will find the group. Okay everyone, well until the next time, I’m wishing you all well and you will hear from me soon.