To Answer Your Questions...

We could here more about T, any long term plans for you all. Is he still looking for a job nearby?

Actually he ended up getting that job I told you about a while back. He starts on Monday and we are both excited for the change. The job involves some travel, but is mostly based in the Boston area. We decided to wait 6 more months before he moves in though. We both feel good about that decision. When he's working out of Boston, like he is all of next week, he'll spend every night here. But when he's based in another state, we'll still have our space.

How's school going? (Graduate stuff, not your day job.) Tell us about that!

Ugh. Well, as you know, I am taking my second to last graduate class. It started out as a breeze, and the class itself is still easy. But I have a gigantic research paper due 3 weeks from tomorrow, and I haven't started yet. I mean, I don't even really have my topic yet. I also have a lot of smaller papers due, so I've been working on getting those done so that I can fully (yeah, right) focus on my big paper. The big paper needs to be about a problem facing schools, and a way to resolve the problem. I need 10 journal articles that examine a solution to the problem. Half should be supporting one way, and the half should be against it. Then I need to state my opinion. I'm open to any and all suggestions for topics.

How about the boys' Hanukkah wish list? What WAS on that Thanksgiving day menu? How is Brooklyn? Is the WW thing still on track?

The boys really don't have a wish list for presents. Every catalog that comes to the house they grab and say they want every item in them. They are getting an easel, art supplies, books, and dramatic play items. Josh is also getting a doll, and Jacob is getting the kiddush cup he wanted :O)

Thanksgiving Day menu was delicious. We had the obligatory turkey, stuffing, and cranberry sauce. Plus gratin potatoes, twice stuffed sweet potatoes, grilled root vegetables, asparagus, brussel sprouts, and broccoli and cauliflower with melted cheese. For dessert there was an apple crisp, two types of brownies, a pumpkin roll, and an ice cream cake. (all homemade)

WW is still on track for the most part. Thanksgiving was a lost cause, but this week I'm back on course.

Any other questions?

-b

I don't have much to say

That's a first, huh?

Maybe I need a little blogging break.

I'll be back soon.

-b

I am thankful

for memories
for photographs
for hugs & kisses
for the ability to laugh
for books
for a boyfriend that adores me
for the pitter patter of little feet
for the sound of my boys singing
for a home
for enough money to support my family
for friends who care
for music
for a job that I normally like
for family
for my health
for reality tv
for a place to write my thoughts
for freedom
for life

I am thankful

-b

You are The Tower

Ambition, fighting, war, courage. Destruction, danger, fall, ruin.

The Tower represents war, destruction, but also spiritual renewal. Plans are disrupted. Your views and ideas will change as a result.

The Tower is a card about war, a war between the structures of lies and the lightning flash of truth. The Tower stands for "false concepts and institutions that we take for real." You have been shaken up; blinded by a shocking revelation. It sometimes takes that to see a truth that one refuses to see. Or to bring down beliefs that are so well constructed. What's most important to remember is that the tearing down of this structure, however painful, makes room for something new to be built.

What Tarot Card are You?
Take the Test to Find Out.

Things that make you go hmmm...

• Today Jacob announced that when he gets older he wants to wear underwear like mine.
• There is a new reality tv show about brothers named Jacob and Joshua. They are gay rock singers trying to break into the business. Don't believe me? Check this out.
• I went to a Thanksgiving Day feast at Jacob's preschool yesterday. A mom that I had just met told me that every time she brings her daughter into the classroom, she notices Jacob sitting by himself looking sad. She wanted to know if anything was going on at home. "Well," I responded, "His dad died." That shut her up.
• This Thursday will be my third Thanksgiving without Joe. That seems so unbelievable to me. He was just here, wasn't he?
• My bottom left tooth hurts every time I eat something the least bit sweet. Does that mean I have a cavity?
• Brooklyn continues to bark every timeT and I have "alone time." WTF is up with that? T tells me to tune it out, but that's just not possible for me. It's the same as one of my kids crying. Hard to feel aroused while such things are going on.
• There is a small outbreak of lice at my school. By small I mean contained to one class. By contained to one class I mean contained to my class. I had the nurse check my head today, but despite her assurance that my head was nitfree, I can't stop scratching my head.
• I think this Thanksgiving will be a good one. I really do....
  
• Happy Thanksgiving to all of you!

-b

Knock on Wood

Jacob may actually
be potty trained!

-b

Random Notes

• When I told T that I was joining weight watchers, he looked me in the eyes, and said, "Why?" And he didn't start laughing, he meant it. He's too sweet.

• Weight watchers/exercising is going well so far. Have stuck to the program, and worked out 2 out of the past three days. Fingers crossed that I stick with it.

• T bought the boys books at Barnes & Noble the other day. He bought them Clifford and Where the Wild Things Are. The past two nights Jacob has requested Clifford, while Josh has asked to read Where the Wild things are, in his crib. While I've read to Jacob, Josh has been reading to himself in his crib. It's the cutest thing to witness. He reads each page with voices of monsters. The words are all about being monsters, not what the real words are, but he's reading! I have to catch it on video. And his little voice making the noises is priceless.

• Yesterday was a very long day of meetings to discuss issues with my class. We made up a plan that will hopefully help things. Today was actually my best day yet with my class. The best way to describe my class is with the title of my blog. I am always on Relaxed Alert with them. I can never let my guard down. But they are neat bunch of kids and I'm hoping we can have a great year together.

• I can't believe that next week is Thanksgiving! And I'm hosting everyone here. And it will be our third Thanksgiving without Joe. (Holy crap, that's crazy!) Next entry I'll post the menu.
  

• Last but not least, tomorrow is the one year anniversary of this blog. Thank you to all of you who read daily, weekly, monthly, or just every once in a while. You have all helped me through some miserable times, and I can't imagine my life without you in it. If you have never identified yourself, I would love for you to say a quick hello. C'mon, it's my blogiversary!

Love you all,
b

If at first you don't succeed....

I rejoined weight watchers today
and I just got off the very neglected
elliptical machine in my room
I must get my body back

Wish me luck

-b

Missing Joe

Two and a half years later I can honestly say that I miss Joe less frequently. I'll go hours, days, weeks even that I'm not actively missing him. He is not my first thought when I wake up, nor is he my last thought when I go to sleep. I am not constantly reminded of him, nor do I feel the need to bring him up in every conversation I have with people.

But the times that I do miss him are more painful than I can even put into words. Every pore in my body aches for him, my mouth can't open because no doubt I will cry instead of speak. Every song, commercial, comment by a passerby, all remind me of him. I want to smell him, feel him, talk to him, laugh with him. I just want him here.

And then I picture him in his hospital bed dying. He died in front of me and I don't think I can ever get over that. His body failing, his heart rate decreasing. I am just so sad for him. And for everyone who knew him, and everyone who didn't know him.

He was one of a kind, my husband Joe. One of a kind.

-b

6 Months Ago

six months ago
tonight
I was awakening
from a deep
depression

I had a date
with someone I had
met
online

I had very
low
expectations
that night
but I went
anyways

who knew that
that someone
would turn into
that someone

who knew
that I
could experience
love
again

here's to six more months...

-b

2 1/2 years later.....

Today is the two and a half year anniversary of Joe's death. I wasn't aware of the date all day, but strangely enough, almost cried twice at school today. I associated my vulnerability to my students, but driving home from group tonight, I was hit like a ton of bricks. He's been gone for two and a half years! And I'm in love with someone new. Life has continued moving forward even though he's not here to take part in it. Crazy.

Anyways, a long time ago I shared that Joe's doctor in ICU wrote an essay about being Joe's doctor. It has now officially been published in The Journal of Science and Medicine. I thought tonight was an appropriate time to share it.

-b

Ghost Story Ian Jenkins, MD

On my first day as a nervous, third-year medical
student, a nurse offered to orient me to the pediatric
ICU. I expected a litany of facts to memorize.
Instead, she pointed at each room in turn and
described the tragedies they had hosted.

"Room one: a little girl just died of meningitis
[brain infection] there. Room two: that boyís liver
transplant failed and he had a massive stroke." The
father sat holding the jaundiced hand of his
unresponsive son, whose
stapled abdomen held back
tense ascites [fluid filling the abdomen]. "His wife
died of cancer two months ago. Now he has no one.
Room three: teen with cystic fibrosis; sheíll be ok.
Room four, I will never forget. A teenager died of
leukemia there and refused all painkillers. He
wanted
to be lucid for his family, and they huddled on his
bed and sang "Amazing
Grace® until he died. Most
beautiful thing I have seen."

I had thought, "Beautiful? How can you even come to
work?"

Five years later, I remembered that conversation as if
it had just happened. I was the senior resident in
the medical ICU, it was 3 AM, and I was gathering my
thoughts amid the whooshes, beeps, and flickering
monitors of the sleeping unit. I was preparing to go
tell Betsy that Joe, her 31 year-old husband, needed
prone ventilation. Joe lay dying, of all things, from
chickenpox. He was receiving twelve infusions,
including four
pressors [blood pressure medicines],
sedatives, antibiotics, acyclovir, full strength
bicarbonate [combats acid], his 26th amp [or ampule]
of calcium, and liter number-who-knows-what of saline.
He sprouted two IVs, two central lines, a foley
catheter, endotracheal and orogastric
tubes, an
arterial line, and an array of monitor leads. His
blood pressure
plummeted*from a systolic of
80*whenever we interrupted his bicarb drip to spike
[to start or hookup] a new bag, so we knew moving him
might kill him. Every nurse raced to finish tasks on
other patients, preparing to help.

Joe'­s admission began, like several earlier ones, with
a chief complaint of "Crohn's flare." This time,
however, he had a new rash, and while John's ward team
suspected medications were to blame, they soon started
acyclovir. In days, hepatitis, acute renal failure,
and pneumonia prompted his ICU transfer. He required
intubation hours later.
His course since had been
like watching a pedestrian struck by a truck in slow
motion: a sudden, jolting, irreversible cruelty*drawn
out over hours. Anasarca [the diffuse swelling] had
folded his blistering ears in half and forced us to
revise his endotracheal tube taping
three times so it
would not incise his cheeks. He had
unremitting
hypotension [low blood pressure]. His transaminases
climbed above 6,000 and his creatinine to 6 [measures
of liver inflammation and kidney failure]; his
arterial pH dropped to 7.03 and his platelets fell to
16,000 [both commonly fall with infections]. His
partial pressure of oxygen sank below 60 mm Hg despite
paralysis, maximum PEEP and 100% oxygen [we were
unable to keep his oxygen at goal despite best
efforts]. Crossing that terrible threshold felt like
drifting below hull-crush depth in a submarine. I
waited for the walls and windows of the ICU to groan
with the strain as
disaster neared.

My intern followed me to the waiting room where Betsy
slept. She hadn't left the hospital in days. I knelt
beside her cot and woke her, and she supported her
pregnant abdomen her hand as she rolled to face me.
We smiled. Then she remembered where she
was.

"Is something wrong?" she
asked.

"No, he's about the same. But the other things we
tried didn'­t help. We need to do what I mentioned
before*turn him over so he can use his lungs better."
She nodded. "We're very careful but he has so many IV
lines right now. If he loses one, he could get much
worse. So I wanted to make sure you spent some time
with him now, just in case."

Her eyes teared. "He could die?"

"Just a small chance. But possible."

"And if it works, he might get better?"

I paused. "He's very sick."

"There are other things you can do?"

"We have to really hope this works."

"This isn't supposed to happen. I don'­t know if I can
raise two children without Joe. I can't be a widow
at 29." I sensed I could have talked her*sleep
deprived and stunned*back into sleep, into a
conviction her nightmare would pass by morning.
Instead I squeezed her hand
and listened.

"We need to do this, ok? You'll have ten minutes to
talk. Remember how his blood pressure rose when they
cleaned him? He's still in there. I believe he can
hear you. So you tell him to keep fighting."

Betsy wiped her eyes and searched for her shoes. As
we walked briskly back to the unit, I composed myself
and told my intern, "I'll be 29 in 3 weeks."

"Me too. What day?"

"May 28th."

"Same as mine," he said.

It took 25 minutes to prone Joe with every nurse
assisting, but the maneuver went well. His
oxygenation improved, but his relentless decline
resumed within hours. Sometime the following
afternoon, I went home to sleep, and Joe's blood
pressure eventually dwindled to nothing, leaving only
sinus tachycardia on the monitor [the heart electrical
system working but no blood pressure] and the rhythmic
puffs of the ventilator.

Then, within two weeks,the
resident team managed a series of unexpected
tragedies: we lost young mothers to acetaminophen
overdose and lung cancer, and cared for two young
adults with septic shock and a perimenopausal woman
for whom the cost of pneumonia was her first and
probably only pregnancy.

Five years before, when I first stepped into an ICU, I
imagined the residents held a dozen lives in their
hands and faced critical illness at all hours*alone.
By the time Joe died of disseminated varicella, I
realized the truth was far from that vision. Joe'­s
nurse had worked in the ICU as long as I'­d been alive
and expert respiratory therapists guided his
mechanical ventilation. I had co-residents and
consultants*even a rabbi when I guided a family
meeting on declaring "CPR not indicated." Our
institutionís overnight attending assisted me
throughout the night, and the primary attending drove
in at 2 AM to supervise nitric oxide
therapy. At no point did I ever
care for Joe alone.

Instead, the challenge lay in facing the winning
smiles of our patient Joe and his young son, waving
from a month-old photo taped by the head of his bed,
and a young wife refusing to leave her increasingly
unrecognizable husband as his body failed, despite her
conspicuous, 8 month pregnancy. And in the surprising
futility of all of our interventions. Perhaps most
of all, in the persistence of the sights and sounds
and smells of that night, and many others. I've seen
the ___expression a pathologist makes on learning his
daughter has anaplastic thyroid cancer [99% fatal
cancer, something a
pathologist knows best]. I've
heard the sound a daughter makes when her mother has a
ventricular free wall rupture [heart ruptures] while
welcoming us into her room. I've smelled a teenager
who burned to the bone while conscious yet pinned in
his car. I'­ve felt the crackle of subcutaneous
emphysema [air in the skin]after chest tubes for
malignant pleural effusions [fluid in lungs from
cancer], so severe the patient could not open his eyes
or close his hands. And the papery skin and tremulous
handshake of a man after my news of his wife'­s
prognosis promised the 64th year of their marriage
would be the last.

Far from alone, I spend much of my time in the company
of these ghosts, as must many health care workers.
How we make our peace with them is up to us. With
tears? Humor? Alcohol? Sometimes it is by numb
indifference; from most of the businesslike
discussions I'­ve heard physicians hold, you
might wonder if they even existed. Or, we can make our
peace with words. I am grateful for a chance to speak
with Betsy some days after Joe died to assure her that
while we did ask Joe to fight, in the end no effort
could have saved him. I am grateful she later wrote
us to celebrate the healthy birth of their second son,

Joshua.  She assured me Joe would live on for her in
their sons, and live on for them through her memories.
Her strength helped me welcome Joeís ghost, and many
others, into my life.

After five years of clinical medicine, I finally
understood the lesson I received from the pediatric
ICU nurse.  Our ghost stories celebrate healing, or if
there was no healing, then release.  At the very
least, great tragedy reminds us of the great meaning
of our calling.

(For Joe and Betsy B., and everyone at the Beth
Israel Deaconess Medical Center, Boston, who helped
care for them them).

Here's What You've All Been Waiting For...

T gave me permission to post his picture on my blog. Here he is with boys on Halloween:

And here he is with Josh:
Isn't he cute?

-b

Funeral City

I work in a school that seems to have a death related to it on a monthly basis. We have parents die so frequently that we have almost become numb to the news.

Last weekend, two seniors from the high school were killed in a car accident. One of them was the son of our school nurse.

Today was the funeral. It was the first funeral I had been to since Joe died.

And it was awful.

Kids are not supposed to die.

That's all.

-b

Great Halloween

Chris, Mel, Denise, JRowe, and I have created quite the Halloween tradition over the past three years. Pizza, costumes, pictures, and trick-or-treating. Last night was the same as always, except for two noticable differences. JRowe, MK, and baby D weren't there (missed you guys), and T was there. Maybe it was the start of a new tradition for us all.

(Carving the pumpkin)

(the three oldest already jaded)

(The gang's all here. Except for D and Sammy, who refused to pose for pictures)

-b