Lewis Grizzard and his Bicuspid Aortic Valve
2017; Elsevier BV; Volume: 121; Issue: 2 Linguagem: Inglês
10.1016/j.amjcard.2017.10.014
ISSN1879-1913
Autores Tópico(s)Literature, Film, and Journalism Analysis
ResumoLewis Grizzard, through his body of work, has been compared with both Mark Twain and Will Rogers.1Goldberg D. Humor grounded in the Southern tradition.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 7-11Google Scholar, 2Minter J. Lewis Grizzard: The ultimate newspaperman.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 54-77Google Scholar From a geographic perspective, analogies have been made comparing Mike Royko of Chicago, Jimmy Breslin of New York, and Art Buchwald of Washington with the South's Grizzard.2Minter J. Lewis Grizzard: The ultimate newspaperman.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 54-77Google Scholar, 3Harris A. Lewis Grizzard, The Ol' Boys Sage.http://www.washingtonpost.comDate: 1985Date accessed: August 21, 2017Google Scholar Before his untimely death at the age of 47 on March 20, 1994, Grizzard had earned other notable comparisons, including “Everyman's George Will,” “Faulkner for just plain folks,” and the “Huey Long of literature.”3Harris A. Lewis Grizzard, The Ol' Boys Sage.http://www.washingtonpost.comDate: 1985Date accessed: August 21, 2017Google Scholar From his adopted hometown of Atlanta, Grizzard viewed the world from a traditional and somewhat conservative viewpoint that was not always politically correct. In fact, Grizzard's viewpoint was almost never politically correct but was funny and, at times, poignant. Moreover, Grizzard wrote about it, talked about it, and became a cultural icon of the South. Most importantly Grizzard became known as a “great Southern writer,” and he was enjoyed by millions4Lieber D. Smiles, and then sorrow.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 33-35Google Scholar (Figure 1). Grizzard had a health issue—a congenital bicuspid aortic valve. It was discovered early, followed routinely, and operated on at the clinically appropriate time in a world-renowned medical center. That operation began a journey for Grizzard in which he experienced usual and customary care, medical noncompliance, disastrous complications, and miracles before March 20, 1994. Not unexpectedly, this journey impacted Grizzard in many important ways. He became a quick study on structural heart disease and operations on the aortic valve, especially from a patient's perspective. These experiences provided Grizzard with unique source material for 2 books, multiple newspaper columns, and 1-man live performances. This intersection of an extremely talented Southern writer and humorist with the health-care system demonstrated an extraordinary work ethic and health literacy that played a major role in a very successful livelihood. Lewis McDonald Grizzard, Jr., was born on October 20, 1946, at Fort Benning, Georgia. His mother, Christine Word, was a schoolteacher, and his father, Lt. Lewis M. Grizzard, Sr., had returned from active duty in the European theater during World War II as a decorated veteran.5Grizzard L. My Daddy Was a Pistol and I'm a Son of a Gun. Villard Books, New York1986Google Scholar, 6Grizzard L. Don't Forget to Call Your Mama … I Wish I Could Call Mine. Longstreet Press, Atlanta1991Google Scholar Lt. Lewis M. Grizzard, Sr., served his country again during the Korean War, where he spent time as a POW and rose to the rank of captain. Upon returning home, Capt. Lewis M. Grizzard, Sr., experienced what is now known as post-traumatic stress syndrome and battled alcoholism.5Grizzard L. My Daddy Was a Pistol and I'm a Son of a Gun. Villard Books, New York1986Google Scholar These issues led to Lewis Grizzard, Jr., parents' divorce when he was 6 years of age. He returned with his mother to her parents' home in Moreland, Georgia, where he would spend the remainder of his childhood and graduate from nearby Newnan High School, Georgia. His mother remarried, and Grizzard only had kind words for his stepfather.6Grizzard L. Don't Forget to Call Your Mama … I Wish I Could Call Mine. Longstreet Press, Atlanta1991Google Scholar Grizzard's mother died at the age of 76 in 1989 after a long battle with and multiple complications from scleroderma.6Grizzard L. Don't Forget to Call Your Mama … I Wish I Could Call Mine. Longstreet Press, Atlanta1991Google Scholar Grizzard's relationship with his father was sporadic, chaotic, and primarily disappointing. The relationship he had longed for was never fulfilled, yet he cared deeply for his father. Capt. Lewis M. Grizzard, Sr., died at the age of 57 in 1970 after a stroke and pneumonia.5Grizzard L. My Daddy Was a Pistol and I'm a Son of a Gun. Villard Books, New York1986Google Scholar, 6Grizzard L. Don't Forget to Call Your Mama … I Wish I Could Call Mine. Longstreet Press, Atlanta1991Google Scholar After high school graduation, Grizzard enrolled at the University of Georgia (UGA). As a UGA freshman in Athens, he entered the newspaper business, writing for the Newnan Times-Herald. He then became Sports Editor of the Athens Daily News before leaving the university a few months short of graduation to become Sports Editor of the Atlanta Journal at the age of 21 in 1967. (After years in the newspaper business, Grizzard received his UGA degree in 1984 by successfully utilizing the university's challenge procedure to satisfy the 2 remaining journalism course requirements; a physical education course requirement was waived due to his cardiac history.7Smith L. GA Bulldogs: the state's majority party.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 119-128Google Scholar) It was during these years that Grizzard learned the newspaper business: the long hours, late nights, early mornings, and weekends that needed to be worked to be successful. He thrived in that environment and never complained. He rose through the ranks, becoming Assistant City Editor of the Atlanta Journal and subsequently a freelance writer for Sports Illustrated before being named Executive Sports Editor of the Chicago Sun-Times in 1975.8Grizzard L. If I Ever Get Back to Georgia, I'm Gonna Nail My Feet to the Ground. Villard Books, New York1990Google Scholar The year and a half spent in Chicago was a checkered one for Grizzard. He hated the cold weather but made new and lifelong friends. He ably performed his job but was involved in litigation with racial overtones. His second marriage ended, and he was homesick and lonely. The entire experience provided source material for a book, and he would forever refer to the time spent in Chicago as the time he was held “prisoner-of-war in Chicago.”8Grizzard L. If I Ever Get Back to Georgia, I'm Gonna Nail My Feet to the Ground. Villard Books, New York1990Google Scholar, 9Applebome P. Is it true what he says about Dixie?.http://www.nytimes.comDate: 1990Date accessed: August 25, 2016Google Scholar Grizzard returned to Atlanta in the spring of 1977 as a sports columnist for the Atlanta Constitution at a reduced salary primarily to be able to leave Chicago. This evolved into being a news section columnist for the Atlanta Journal-Constitution in 1978.8Grizzard L. If I Ever Get Back to Georgia, I'm Gonna Nail My Feet to the Ground. Villard Books, New York1990Google Scholar In this position, Grizzard expanded his writing and his audience, and it marked a turning point in his career. His column was a huge success throughout Atlanta and across the South. It became syndicated by King Features, ultimately to 450 newspapers.2Minter J. Lewis Grizzard: The ultimate newspaperman.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 54-77Google Scholar, 10Seabrook C. Bennett T. Lewis Grizzard 1946–1994.http://www.AJC.comDate: 1994Date accessed: January 18, 2017Google Scholar His first book, a collection of his columns, was published in 1979 and sold 75,000 copies during the first week. His second book was a New York Times bestseller. Bestsellers then appeared nearly annually.9Applebome P. Is it true what he says about Dixie?.http://www.nytimes.comDate: 1990Date accessed: August 25, 2016Google Scholar, 10Seabrook C. Bennett T. Lewis Grizzard 1946–1994.http://www.AJC.comDate: 1994Date accessed: January 18, 2017Google Scholar He was profiled by the Washington Post in 1985 and by the New York Times in 1990.3Harris A. Lewis Grizzard, The Ol' Boys Sage.http://www.washingtonpost.comDate: 1985Date accessed: August 21, 2017Google Scholar, 9Applebome P. Is it true what he says about Dixie?.http://www.nytimes.comDate: 1990Date accessed: August 25, 2016Google Scholar He was planning his twenty-first book at the time of his death.10Seabrook C. Bennett T. Lewis Grizzard 1946–1994.http://www.AJC.comDate: 1994Date accessed: January 18, 2017Google Scholar By 1985, his literary success had led to live appearances, comedy albums, and $20,000 appearance fees.2Minter J. Lewis Grizzard: The ultimate newspaperman.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 54-77Google Scholar, 9Applebome P. Is it true what he says about Dixie?.http://www.nytimes.comDate: 1990Date accessed: August 25, 2016Google Scholar, 10Seabrook C. Bennett T. Lewis Grizzard 1946–1994.http://www.AJC.comDate: 1994Date accessed: January 18, 2017Google Scholar He produced 20 books and 5 comedy albums. In 1987, he received the John E. Drewry Award from the Grady College of Journalism and Mass Communication at UGA.11University of Georgia http://www.grady.uga.edu/alumni/alumni-awardsDate accessed: May 2, 2017Google Scholar Grizzard had some “issues.” There were problems with drinking too much and managing finances.12Privett T. At the reins of a runaway rocket….in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 129-179Google Scholar, 13Enoch S. Highs and lows: life on the road.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 186-202Google Scholar, 14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar He could never rid himself of a cigarette habit, and he experienced 4 marriages and 3 divorces. Importantly, there was inconsistent compliance with medical advice (Martin R, personal communication; Winter T, communication). However, the bane of his existence was a bicuspid aortic valve. Grizzard had known for years that he had a precordial murmur. The precordial murmur was initially discovered in 1961, at the age of 14, during a routine sports physical for baseball. Grizzard was cleared to play as the murmur was considered benign. In 1964, at the age of 18, he was assigned to Air Force ROTC at UGA. Not desiring to be in ROTC, he went to the campus physician to have the murmur re-evaluated. A clinical diagnosis of aortic insufficiency (AI) was made, and he was excused from ROTC. In 1968, at the age of 22, he was living in Atlanta and working at the Atlanta Journal. He wanted to clarify his draft status at the height of the Vietnam War and presented for another evaluation. The earlier clinical diagnosis was confirmed with the advice that the valve problem would need to be addressed in the future. His draft classification was 1-Y as physically unfit.15Grizzard L. They Tore Out My Heart and Stomped That Sucker Flat. Peachtree Publishers, Atlanta1982: 15-17Google Scholar, 16Grizzard L. My draft board understands.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 51-52Google Scholar Internist Thorne S. Winter III followed Grizzard from a primary care standpoint and kept a check on the AI. In 1982, it was he who first detected a significant increase in his heart size on serial chest x-rays. The referral was made to cardiologist J. Willis Hurst at Emory University. An echocardiogram confirmed the clinical findings, and cardiac catheterization revealed no evidence of coronary artery disease. Surgery was recommended and Emory cardiac surgeon Ellis L. Jones was consulted. On March 22, 1982, at the age of 35, Grizzard underwent aortic valve replacement (AVR) with a 27-mm porcine heterograft. The procedure and postoperative course were uncomplicated, and the patient did well.15Grizzard L. They Tore Out My Heart and Stomped That Sucker Flat. Peachtree Publishers, Atlanta1982: 15-17Google Scholar The entire experience provided abundant source material for Grizzard's book, They Tore Out My Heart and Stomped That Sucker Flat (Figure 2). The book was written 4 months after surgery and published in the same year, in 1982. It is his hilarious personal account of the journey through the initial evaluation, referral, cardiac catheterization, consultations, surgery, and recovery. The book was remarkably detailed and medically accurate and was hugely successful. Hurst recommended the book for his patients who underwent heart surgery.15Grizzard L. They Tore Out My Heart and Stomped That Sucker Flat. Peachtree Publishers, Atlanta1982: 15-17Google Scholar The experiences also provided material that Grizzard used in newspaper columns and, later, live appearances and comedy albums. Grizzard had experienced a painful dental encounter as a child and from that experience developed a “dentist phobia.”14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar The resulting sporadic care as an adult led to dental decay in a wisdom tooth. In 1985, this dental decay was discovered by Winter, who advised Grizzard to seek prompt attention to it before joining a tour group to Russia. Grizzard deferred the advice, proceeded with the trip, and would take full responsibility for his noncompliance with medical advice as “the worst mistake of my life.”14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar While in Russia, Grizzard became severely ill but persevered until the return leg of his trip took him to London where he was hospitalized. The diagnosis of prosthetic valve endocarditis was made. Grizzard, believing a 6-week course of antibiotics in London was to follow, left the hospital against medical advice and took the next Delta flight to Atlanta. He was hospitalized by Winter, where the gravity of the situation was delineated, and he was transferred to Emory under the care of Drs. Hurst and Jones. Urgent surgical intervention was recommended due to presumed aortic annular abscess. He underwent urgent redo AVR with a porcine heterograft and aortic annular patching. The procedure and the recovery were uncomplicated. He completed a month-long course of antibiotics and had all of his wisdom teeth extracted before hospital discharge.14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar The second AVR did not generate a book but did provide ample source material for his newspaper columns, live appearances, and comedy albums. Grizzard did generally well over the next few years. He remained active, continued playing tennis until he was sidelined with chronic arm pain, and then transitioned to golf with the same intensity and dedication. He appeared twice on The Tonight Show with Johnny Carson, and his books continued to do well.14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar In 1986, his third ex-wife published a book about life with Grizzard that he enjoyed.17Schmook K. How to Tame a Wild Bore. Peachtree Publishers, Atlanta1986Google Scholar In 1990, Grizzard developed weight loss, fatigue, weakness, and jaundice. Evaluation by internist Winter excluded hepatitis, AIDS, and hepatic malignancy before diagnosing mechanical hemolytic anemia from the bioprosthetic aortic valve and aortic patch. Referral was made to Emory cardiologist Randolph Martin, and transesophageal echocardiogram (TEE) confirmed a significant paravalvular leak and the probable origin of his symptomology. Surgery was recommended and considered inevitable but not necessarily urgent or emergent. Grizzard deferred for 3 years and was able to continue his routine activities with regular follow-up under the care of Martin. Grizzard was proud that his lifestyle was not sedentary.14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar In February 1993, Grizzard met with Drs. Martin and Jones to discuss surgical intervention. The situation was reviewed and discussed in detail, and Grizzard agreed to proceed. Preop cardiac catheterization was recommended, and Grizzard refused. Martin finally recommended a nuclear cardiac scan as an alternative, and this procedure revealed no evidence of coronary artery disease.14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar On March 22, 1993, Grizzard underwent second-time redo surgery and received a composite mechanical valved Dacron graft conduit to replace the aortic root from the aortic valve to the aortic arch with coronary artery reimplantation (Bentall procedure). Findings at the time of surgery noted that the previously placed bioprosthetic valve was nearly completely dehisced. The operative experience for Grizzard lasted from 6:30 a.m. to 12:00 a.m.—17½ hours. During that procedure, he sustained acute intraoperative cardiac failure that precluded weaning from cardiopulmonary bypass. He underwent coronary artery bypass grafting times 3 out of concern for an embolic event to the coronary arteries, placement of right and left ventricular assist devices, and epicardial pacing. Concomitantly, he was receiving significant transfusion and pharmacologic hemodynamic support. With mechanical, electrical, and pharmacologic support, he was successfully separated from cardiopulmonary bypass and was able to be transferred to the intensive care unit, where he was listed for cardiac transplantation. Over the next 24 hours, he was re-explored twice for bleeding. The bleeding was subsequently controlled, and the chest was closed (Martin R, personal communication; Guyton R, personal communication).14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar Miraculously, Grizzard survived and began to recover. He was weaned off mechanical and pharmacologic support and extubated on postop day 11. He was discharged after a hospital stay of about a month and began an extended and gradual recovery period. His first stop after hospital discharge was The Varsity, Atlanta's renowned fast-food restaurant, for chili dogs and fries. He spent time at his lake house on Lake Oconee, Georgia. With an abundance of new material from his most recent intersection with the health-care system, Grizzard worked throughout this period of recovery. He produced his newspaper columns and was writing his next book by 2 months postoperatively (1 month after discharge). The book, I Took a Lickin' and Kept on Tickin' (And Now I Believe in Miracles), was published in October, 1993 and is a hilarious and poignant account of the entire ordeal of his third heart surgery experience and also incorporates the second heart surgery experience (Figure 3). Once again, the book was detailed, medically accurate, and quite successful.14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar He continued to use a typewriter rather than transitioning to a computer despite a dry gangrenous right index fingertip that he refused to have amputated. The fingertip would subsequently autoamputate while Grizzard was playing golf.18Grizzard L. Ginsu loses the point.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 180-181Google Scholar During the final year of his life, Grizzard endured significant pain and suffering.19Grizzard L. Shut-in but not shut down.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 226-227Google Scholar He experienced bleeding hemorrhoids on anticoagulation, an infected pacemaker site, a splenic infarct, hepatic hemorrhage that required embolization, renal embolism and infarction, and ever-present long-term antibiotic and antifungal therapy (Martin R, personal communication).14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar, 19Grizzard L. Shut-in but not shut down.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 226-227Google Scholar, 20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar He bore it all with strength, dignity, and as always, great humor (Martin R, personal communication).15Grizzard L. They Tore Out My Heart and Stomped That Sucker Flat. Peachtree Publishers, Atlanta1982: 15-17Google Scholar, 18Grizzard L. Ginsu loses the point.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 180-181Google Scholar, 20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar Yet, in spite of these challenging health issues, Grizzard was able to travel, do book signing appearances, perform speaking engagements, play golf, and go fishing in Canada with Dick Butkus for ESPN (Martin R, personal communication).14Grizzard L. I Took a Lickin' and Kept on Tickin' (and Now I Believe in Miracles). Villard Books, New York1993Google Scholar, 19Grizzard L. Shut-in but not shut down.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 226-227Google Scholar, 21Grizzard L. I caught one this long.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 184-186Google Scholar Remarkably, Grizzard had undergone cardiopulmonary bypass (“pump runs”) 3 times without apparent neurocognitive impairment of professional productivity. In February 1994, while at his vacation home in Orlando, he sustained a right renal embolism and infarction. He was transferred by air to Emory where TEE by cardiologist Martin revealed a fungal mass in the valved conduit. This was felt to be the probable source of the renal embolism.20 Options were limited: surgery or no surgery. Cardiac surgeon Robert Guyton reviewed the surgical option and gave a 50% survival prediction for the third time redo procedure with Grizzard (Guyton R, personal communication).20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar He processed the information and, when asked if he had any questions, Grizzard remarked, “When's the next bus to Albuquerque?” (Martin R, personal communication).22Ferris G. About the title.in: Ferris G. The Last Bus to Albuquerque. Longstreet Press, Atlanta1994: 1Google Scholar Grizzard opted for surgery, made his wishes known, and underwent the corrective procedure on March 18, 1994.20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar, 23Grizzard D. Knight J. A reason to fight even harder.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 259-268Google Scholar The procedure consisted of explantation of all prosthetic material and homograft replacement and lasted for approximately 8 hours (Martin R, personal communication; Guyton R, personal communication).20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar The expertise of the Emory surgical team, led by Guyton, enabled the procedure to be completed as well as could be expected. In the early postop hours, the medical team was cautiously optimistic, but Grizzard failed to wake up into the first postop day. Computed tomography of the head confirmed a significant neurologic event, and he never regained consciousness. Life support was withdrawn on March 20, 1994 (Martin R, personal communication; Guyton R, personal communication).20Martin R. Beating the odds—again and again.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 269-274Google Scholar, 23Grizzard D. Knight J. A reason to fight even harder.in: Perry C. Don't Fence Me In. Longstreet Press, Atlanta1995: 259-268Google Scholar Obituaries appeared in the New York Times and in Newsweek and Time magazines. People magazine published a tribute.24Carpenter B.B. “Grizzard, Lewis McDonald, Jr.” The Scribner Encyclopedia of American Lives.http://www.encyclopedia.comDate: 2017Date accessed: November 11, 2017Google Scholar The editorial cartoon by the Atlanta Constitution's Mike Luckovich was especially poignant. The editorial cartoon showed Grizzard being met at the Pearly Gates of Heaven by his beloved dog, Catfish.25Atlanta Journal-Constitution Remembering Lewis Grizzard.www.ajc.com/news/local/remembering-lewis-grizzard/tox8fdQD2AtFcbkCnAXQ2O/#7Date accessed: March 27, 2017Google Scholar Grizzard married Dedra Kyle a few days before his final operation. After his death, wife Dedra handled his estate and currently manages all issues associated with it (Grizzard D, personal communication). Fittingly, there is a “Lewis Grizzard Special” on the menu at Sprayberry's Barbecue in Newnan, Georgia, consisting of a barbeque sandwich, Brunswick stew, and onion rings. (It is excellent.) The Grady College of Journalism at UGA has the Lewis Grizzard Journalism Scholarship for students majoring in newspaper journalism. A museum of his memorabilia is in his boyhood hometown of Moreland, Georgia. He produced 20 books and 10 comedy albums. Five posthumous collections of his works have been published. Actor Bill Oberst, Jr., performs a 1-man show as Grizzard. Grizzard remains a significant figure in Georgia and in American pop culture. Grizzard had a keen intellect, a sharp wit, and an extraordinary writing talent and work ethic. He also had remarkable health literacy but inconsistent compliance with medical advice. Yet, he was able to chronicle his journey through illness and to effectively incorporate it into his livelihood. His remarkable and accurate knowledge about his health issues contributed significantly to a prolific and successful literary career, nearly all done with great humor to millions of fans. The author has no conflicts of interest to disclose.
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