Vacation So Far....

Yesterday we had a great visit from my friend Nikki, and her two daughters. We had a mock birthday party for the boys since they (along with everyone) will be away when the real party occurs. They even brought cupcakes for dessert. When it was time to light the candles and sing happy birthday, Josh asked "What about party hats?" So they made party hats.

Today we went to a strawberry festival with a group of friends. It felt like apple picking weather. It was just perfect. Here are some pictures:

Tonight is Girls Night Out in honor of JRowe's return to the Boston area. I volunteered to be the driver so that I won't have a repeat of the other night! Hope everyone is having a great weekend!

-b

Summer Vacation Has Officially Begun!

and I'm already hungover
this is not a good start..

-b

edited for clarification: It was a perfect way to end the school year. Our school knows how to throw a party like no other. But perhaps I should not have had 8 shots? Or maybe cut back on the 4 margaritas? Because it is hard to be productive today, and I had many goals that are not getting met. But it was a fun party.

With Summer Here, How Shall I spend My Time?

With school ending tomorrow at 12:05 pm, you may be wondering what my summer plans are. Be prepared to be jealous. Yes, you just might actually feel a twang of jealousy when you read what I have in store for myself.

The boys are going to be attending day camp. I know, I know, they are a little young for day camp. But It's part of their preschool. It's cheaper for me to send them to the year round program, instead of the school year program. So since I'm paying for them to go during the summer, they will be going during the summer.

They will be gone from 8-4 Monday-Friday. I know. You're feeling a little jealous, aren't you? Now before you accuse me of being a bad mom, the boys are going to love camp. They have swimming lessons every day, nature, music, art, etc. They will be with friends, and will be getting exercise. It's good for them.

As for me, I am beyond excited to have 8 weeks of days to myself. The preschool is at a local JCC, so after I drop the boys off, I am going to work out at the gym. I've even scheduled 4 personal training sessions to get me started. (The 4 sessions are free)

Once I get home from the gym, I will shower, straighten up the house, and write. I will hopefully get in an hour or two of writing a day.

After I pick the boys up, we'll play with our neighborhood friends, takes baths, have dinner, and take our nightly walk with the dog.

This is my plan. I know. You're jealous. It's OK. :O)

-b

I made it...

This was the most challenging school year of my 10 year career. These kids tested me every chance they got. They questioned my every direction, and interrupted my every word. Some students chose to speak only in bird, or cat. Some refused to budge from fetal position on the rug. Some took up belching as a pastime.

This class made me cry almost nightly in frustration for the first 5 months of school. They frustrated me to the point of feeling like quitting. They made me turn into a teacher who yells, and threatens.

Why is it then, that I am tearing up thinking of saying goodbye to this crew? Strangely enough, I have grown to love them. Even stranger, I will actually miss them. All of them. Even "bird girl."

Go figure.

-b

The Card

The card went over well
it was one of those
"Like a father" cards

You know,
thanks for being
"like a father to me"

and I asked j&J
what they liked most about T
and wrote down their answers
(pretty funny ones)

I had the card sitting on T's pillow when he came in the
room from taking a shower

He read it
and I said
"Happy Like A Father's Day!"

He responded,
"we need to remedy the like part"

Happy Father's Day!

Father's Day

Last year on Father's Day
T and I had a bad date
It wasn't a deal breaking disaster
obviously
but it was bad
and awkward and frustrating
all mixed in as one

This year on Father's Day
the moving truck
will be bringing all of
T's belongings
and we will have a
celebratory dinner

I even went against a
poll I took
on another website
and I bought t
a card
it won't scare him away

-b

Dear Jacob,

Tomorrow you will be four years old! Your short life has been so full of chaos and sadness, and for that I am so sorry. Despite all that you've been through in your short life, you have turned into a wonderful person.

Jacob, you have an amazing sense of humor. You crack yourself up all day long, and you crack Joshua and me up too. You have a smile that can light up a room, and a pout that makes me give in way too often.

You ask me questions that I have no idea how to answer. Two weeks ago you asked me, in a serious voice, "Where exactly IS Humpty Dumpty's wall?" You ask me questions about nature and weather all the time, and are curious about everything you come into contact with.

You are such a great brother. Today you received two birthday cards in the mail, and you gave one to Josh to open, because "That is fair." You love to do everything with your little brother, and are his best friend. I love watching you teach him things you have learned, and watching you cheering him on.

This year was your first year being separated from Josh, and it was hard for you at first. You used to cry every day when I dropped you off for school. Not a sobbing cry, but the silent cry with tears rolling down your face, and a quivering lip. I hated leaving you, and would cry myself as I drove to work, but I knew that it was the best thing for you. You have become an independent thinker this year. You have grown to love school, made many friends, and tried so many things.

You are a baseball player, a dancer, a singer, a joke teller, a reader, a writer, an artist, a storyteller, a snuggler, a student, a teacher, a magician, a friend.

You, Jacob, are a remarkable little boy, and I am so proud to be your mother.

Happy Birthday. May this year be your best year yet.

Love,
Mom

Painting With T

priming
painting
singing
laughing
talking
sharing
dancing
joking
resting
eating
planning


Mason Jennings
playing over the speakers
"Be here now"

There really is
no other place
I'd rather be

-b

Busy!

Sorry for the lack of posts. I've been busier than ever, and haven't been on the computer for days! (*Gasp!*) What have I been doing? Well, for one, I've been trying to spend quality time at night with T, sans computer. Being a computer addict, this is a hard task. But last night I sat down and watched an entire movie without checking my email, or this bog, or a website that I spend way too much time on.

It helped that the movie was in Spanish, and so I had to read the subtitles to know what was going on. (It always amazes me how much prettier other languages sound. English sounds so crass, and Spanish was just so beautiful to listen to.) It also helped that the movie was beyond amazing. It was called, "Pan's Labyrinths," and if you haven't seen it, you must! It made my top ten list. JRowe, and MK, you two in particular would love it, I think.

We've also been painting the basement. T moves in next weekend, and all of his stuff is going down there. We're making it into a guest suite, which will be nice when either of our families come to visit. It's been a while since I painted, and I'm not very good at it, but we've been having a ton of fun working on it together. Last night T told me that while he was painting he was thinking about how lucky he was to have me in his life. I asked him why, and he gave me about 7 reasons, one of which was that we work so well together. And it's true. We are are a really good team.

I've also been working on my memoir. I got some amazing feedback from my writer's group. I can't wait to go back on Wednesday. I have something school related every night this week, plus Jacob turns four on Thursday.

I'll try to post when I get a chance. But it may be a few days. Miss you all!

-b

Talk About Timing

Have I told you that a few weeks ago T accepted a new job nearby?
This job won't involve any travelling
which we have both had some mixed feelings about

But it's for an amazing company
that is always written up
as one of the top ten companies
to work for around here

and it's a great position
and he will be here
a lot more

Well, he gave his notice two weeks ago
and guess what he found out today?

In two weeks he was going to be laid off
along with everyone else!

How's that for amazing timing?

-b

Quick Update

Tonight was amazing
better than I could
have hoped for

Thanks for all your support!

-b

Anxious

I am anxious
as in
feel like I'm going to puke
anxious

Is it the workshop
that starts tomorrow
that I really want to back out of
but won't because Melanie will kick my butt?

It could be
I've seen the writing the other writers
are working on
mine is inferior
by far

I'm not saying that so you can tell
me how great my writing is
I'm saying that because it's true
my writing looks like
whining by a five year old
don't deny it

Am I anxious because
it's the end of the school year
and there are about
one million things that
I need to get done
in the next ten days?

It could be
I never handle the end of the year
very well

Am I anxious because
T is moving in
and he's talking about all
of the changes we're going to
make to the house
and it's freaking me out
but I don't want to tell him
that it's freaking me out?

It could be that
as well.

Maybe it's something else entirely

-b

A Very Busy, Yet very Wonderful Weekend

My graduation dinner was perfect. The food was unbelievable, the never ending wine was delicious, and the company was superb. I really felt blessed sitting at the table with a group of people who really helped me get through grad school. Each person at that table was responsible in some way for me completing my degree. They either gave me money to pay for classes, offered babysitting so I could go to classes, offered emotional support and encouragement, or all of the above. I am eternally grateful to all who who there, as well as to a few (like my sister) who could not make it.
Here is a picture:

Mel, her husband, my brother, my sister-in-law, my parents, Joe's cousin, T, and me

Today we packed up T's apartment! He's really moving in! I couldn't be any happier about it. Once all the boxes were packed, we danced to a u2 song playing on T's ipod speakers. It was a perfect moment.

T in his packed up apartment. So so cute.

-b

Graduation Dinner

I'm off to celebrate my graduation
at my favorite restaurant
with some of my
favorite people
T brought me the most perfect
white roses
and told me that I look
beautiful
It should be a lovely night

-b

Jacob Got married!

While playing with his best friend (Mel's daughter), he was proposed to. The happy couple couldn't wait for a proper service, so the got married in Mel's apartment. They even remembered to kiss. And yes, Jacob does have fairy wings on. He was "Prince Jacob the Butterfly." (Don't ask)

-b

I Got In!

The workshop starts next Wednesday.
Now I'm nervous!
Wish me luck!

-b

Pictures From Yesterday

-b

Memorial Day

Tonight during dinner
I told T
that this was my favorite
Memorial Day weekend ever
"Ever?" he asked
"Ever," I responded

and then I felt sick
to my stomach

How could I have forgotten
Memorial Day Weekend
10 years ago?

That was the weekend that
Joe proposed to me
he got down on one knee
on the swan boats
in Boston

He pulled out a ring
that was perfect in my mind
he asked me to be his wife
and I was happy
I was beyond happy

We celebrated by walking over to
Fenway Park
and telling the man at the gate
that we just got engaged
he let us in to the game for free

The next day I graduated from college
and I got to show off my ring
to all my classmates

How could I say that this weekend was better than that?
What is wrong with me that I could forget
such an important weekend?

What is wrong with me that I would rather redo
this weekend
and not that weekend?

I'm so screwed up....

Great Day

You know those rare perfect days?
The ones where everything falls into place
and no one fights
and the sky is the perfect shade of blue?
We had one of those today.
Here are some pictures:

We are really lucky to live around the corner from the coolest sprinkler park. To get there you walk through a really pretty park full of paths. Here are the boys with T walking over the bridge:

Jacob having some fun with water:

J & J playing with water:

T and I had a date tonight, and he gave me my graduation present. Here it is! My very first ipod ever:

Here's hoping the night continues to go as well as the day!

-b

Reason # ____ That I Love T

I hurt my neck last night. I'm not sure if I slept on it wrong, or what. But I can barely move it today. It hurts big time. T found me outside with the boys tonight looking like I was in a lot of pain. He rubbed my neck, and I couldn't even thank him.

"Go upstairs," he ordered.
"huh?"
"Go upstairs, take a bath, and lie down."
"But the boys.."
"I'll play with the boys. I'll get them changed. I'll get them to bed. You go lie down."
"But..."
"Do it woman!"

I'm crying as I type this. I'm so lucky. I'm so in love. Or maybe it's the vicodin I took. Either way, T is pretty cool.

-b

Some Pictures From Saturday and Today

Mel came over with her girls to help me clean out the attic. I hired a sitter to watch all the kids. Josh also got a new bed delivered that day. Here they all are, still in pajamas, watching the bed enter the house.

Josh's new bed with the overflow garbage bag on it

The hallway

Tomorrow is garbage day, so tonight Mel, T and I brought the garbage to the curb. I really need to tip the garbage men!

The kids never get to play in the front yard, and for whatever reason they thought it was great fun. Here they are playing tag.

-b

Allow Me To Explain
(If that's even possible)

disclaimer: I am about to put down someone who is dead. I know I'm not supposed to do that, but even the dead aren't perfect. If you feel like you will be offended, please don't read.

The person that I was when I was married to Joe is no longer the person that I am today. So many of you have commented on this blog about how strong I am. It hasn't always been that way. I loved Joe. You all know that I loved Joe. But I don't love who I was with Joe. Remember the title of this blog? I was ALWAYS on relaxed alert. I could never fully relax, and I never stood up for what I believed in when it came to my marriage.

This wasn't Joe's fault. It just was what it was. My childhood was less than ideal, and I met Joe when I was 15 and vulnerable. He took care of me, and I fell in love with him for that reason. But Joe always ruled our marriage. He was never abusive, he never mistreated me really. But I never told him what was really on my mind. I never said, "no" to anything. I mean, I had a whole freaking room of my small house dedicated to cigars! Who allows that?

Was Joe a perfect husband? No. Not in the least. Was I a perfect wife? No. Not in the least. We both did our best with the baggage that we both brought to our marriage. When I was unhappy with Joe's behavior, instead of confronting what was bothering me, I looked the other way. When he was upset with my behavior, he took off, and drank.

I can count on one hand the number of fights we had during our 14 years together. I don't think that's a good thing. I was always scared to fight. Not because Joe would hurt me, but because I was afraid he would leave. This was not the behavior of someone who was strong.

After Joe died I became someone new. I gained a strength that I never knew I had. I stand up for myself. I speak my mind. I don't stay in relationships that aren't healthy for me. I fight with T when I feel a fight is warranted. I don't take crap from people.

And so, when I went into the attic after three years, and found remnants of Joe's past that I wish I hadn't found, I got angry. Angry at Joe for lying to me. Angry at Joe for keeping secrets from me. Angry at Joe for being so selfish. But mostly angry that my new strong self, will never have the chance to confront Joe with what I found. Because the new me would love to confront the old him.

-b

Secrets

I hate secrets
I hate keeping them
I hate telling them
I hate finding out
that the person I loved
that the person I knew
(or thought I knew)
kept so many
fucking
secrets
I think he even
kept secrets from
himself
Sometimes I hate him
How's that for a secret?

-b

Cleaning House

We did a lot of cleaning today
and by a lot
I mean over thirty bags of trash

Most of it came from the attic
and all of it
belonged to Joe

It was hard

I found things that
I wish I hadn't

I didn't find things that
I wish I had

Joe was an interesting
and
complicated guy

That's what made
people love him
I guess

-b

I Need Your Help

My neighborhood bookstore that I frequent is offering a four week writer's workshop course. Each session is three hours, and they are led by a well known author. The workshops are geared for those wanting to work on a memoir, and it costs $100. The bookstore is currently accepting applications, and will only accept 8 writers in all. To apply you need to submit 5 pieces of writing.

I originally started this blog with the hopes that it could possibly be turned into a memoir. So.... do you think I should apply? Will it be worth the money? And if so, help me choose 5 blog entries that show quality writing. (If any of it is quality writing.)

If I do someday publish a memoir, it will most certainly be dedicated to all of you. (and Joe, and my family, and T, and the boys. But you'll be mentioned. I promise :O) )

-b

Analyze This

Horrible Nightmare

Joe wasn't dead, but had gone missing 3 years ago
Every thought, every movement I made
I was wondering where Joe had gone

Finally he called

"I can't tell you where I am, or who I'm with, but I'm happy."

"Happy without me? You left me here with all your crap to clean up, and no note, and you're calling me now to say you're happy!"

"I'm sorry B. I'm really sorry."

At this point I forced myself to wake up, and felt relieved that he was dead, not missing, but dead. Or is that the same thing?

-b

Dinner At Our House

I always swore that I would be
the type of mother
who cooked one meal
for everyone

We would sit down
as a family
and everyone would eat
what was on their plate

No exceptions

Hasn't quite worked out that way
Somehow no one can agree on
what to have for dinner
and if T isn't here
I don't argue

Here's what the boys had for dinner
tonight

(Tuna sandwich on whole wheat, scrambled eggs, oranges from a jar)
*sigh*

-b

Song

Soon after I became a widow, someone posted a song on my widow support board. The song had been written by a 17 year old girl who lost her father. She won an award for young song writers, and I fell in love with her song. Even though she wrote it about her father, I could so relate to it from losing Joe. When you read the lyrics, I think you will understand why. I couldn't find the song for the past two years. I lost it and couldn't find it through google. Today it showed up on my computer. I don't know how or why, but it was there. Someone on the widow board then helped me find the lyrics. I hope you'll take a listen, and read the lyrics while doing so.

Lyrics And Music Composed By Gin Wigmore

Take your last step towards heaven and its glow
Take your last breath of sunlight, don't let it go
Take your last look to remember, so that you know

I wont let you fade from no mind
I wont let you fade from no minds
I wont let you fade from no minds

Hallelujah for these eyes to see your painted life
Hallelujah for the touch of skin to skin with mine
Hallelujah for this mind that keeps our souls combined
Hallelujah for this life that let me be your child

Have your mind, have your strength to stay alive Keep your eyes open with mine

You followed the road for the angels and you left me behind
A face without words can last a lifetime but it's never the same
So, don't say goodbyes that last forever just for a while
Because I'll be by to see you some day soon

Hallelujah for these eyes to see your painted life
Hallelujah for the touch now of skin to skin with mine
Hallelujah for this mind that keeps our souls combined
Hallelujah for this life that let me be your child

Hallelujah, to be a part of your life
To see inside of all your smiles
You're a traffic light of fire
You're a man who I believe will never die

-b

It May Have Taken Seven Years But...


Guess who got her Master's Degree in Elementary Education?

Yep, that would be me.

And my GPA was 3.987

Hey, if I can't brag here, where can I brag?

-b

Our Weekend in Pictures

It started out yesterday morning. We all waited very impatiently for Mimi (my mother) to arrive and whisk the boys into Boston with her. She finally showed up (she was only 25 minutes late, but it felt like forever!) and we all rejoiced. The boys left, and T and I hopped in the car.

We stopped in York so that T could show me his favorite diving spot. We sat on the benches and he told me all about what he finds under water. We then went to the Maine Diner
for breakfast. I forgot to take a picture of it, but if you should find yourself there, you must order the blueberry pancakes. They are the best blueberry pancakes I have ever had.

After we checked into out Inn we walked around Kennebunkport.
It was a very cute town, with lots of touristy shops. While shopping, we spied a horse and carriage that was taking tourists on tours. I looked at T, and said, "Wouldn't that be fun?"

Here's a picture of T and me on our very own horse and carriage ride.


Dinner at sunsetThe bush Compound

When we got home, T made us cappuccinos. He topped mine with a heart.

This was a very good weekend, indeed. Happy Mother's Day!

-b

Away With T

Tomorrow T and I will
head off to Kennebunkport
for our anniversary weekend
I am not bringing my computer
Somehow I think I will be ok without it
I will post with pictures upon my return
Have a wonderful weekend

-b

My Little Magician

On the way to preschool this morning, Jacob and I had the following conversation:

J: Mommy, when I grow up, I'm going to be a magician and a doctor.

b: That sounds great!

J: That way, I can say the magic words and bring daddy back, and then I can fix him and make him all better!

b: (at a loss for words) Oh sweetie, that would be so great if you could do that, but it's not possible.

J: Yes it is. You'll see.

b: If there were magic words to bring daddy back, we would have said them already.

J: Hmmm. (long pause) Maybe I'll be a singer instead then.

b: Sounds good.

-b

1st Anniversary

One year ago tonight
I was coming out of a deep
month-long depression

I had a date set up
but I didn't want to go

Patrick came over to babysit
I told him I just wanted to stay
home with him

He kicked me out
of my own house

I drove to a neutral meeting spot
and waited anxiously
for you to arrive

We sat for hours
talking
It was so easy
and you made me
laugh

It had been so long since
I had laughed

A year has gone by

and not one day in that
year
has passed
without me thanking
my lucky stars

that you came into
my life

Happy Anniversary, T

love,
b

Missing You

"I miss you T," I said to T tonight.

"How can you miss me? I'm right here."

"But I don't feel like you're here. And I miss you."

"You're so strange, B."

"I know. That's why you love me."

"You keep telling yourself that."

-b

Meet my niece

Isn't she cute?

The boys (my nephew included) were pretty cute too

-b

May 6th (again)

Today marks 3 years since Joe died. It's crazy, really. We were in NY for the weekend visiting my sister and her family. (pictures tomorrow) We talked about Joe, but it was not a sad weekend, by any means.

It has been requested that "Ghost Story" be reprinted, and today seems like the fitting day for that. Joe's doctor was haunted by Joe's death, and ended up writing the following story, which was published in a medical journal in the fall. I love this story because it shows just how much Joe's doctors did care. They really wanted him to make it.

So here is my final post about Joe's story. Thanks for reading it.

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 boy'­s 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).

Dear Daddy,
Today we went to visit you at the cemetery. For some reason, we think the cemetery is a very fun place to go. We posed for a picture before we left. Mom was cracking up at our silliness. T came with us too, but found our visit to be a little strange. We're not sure what he found to be the strangest. Was it the fact that we kept asking the cemetery for toys? Or was it when we started doing headstands by your tombstone? Maybe it was when we started whispering you secrets and reporting back your answers. We particularly liked when you told us that we should go to McDonald's for dinner.
Regardless, we had a great visit. We told you that we loved you and missed you, and found some nice stones to leave behind. Someone had already been by with a Cuban cigar and a fresh match. Mommy thought that was really nice. T found it a little strange. That's OK, we were just happy he came with us, and held mommy's hand while she teared up. He's so good to her.
We know you're watching over us, and taking care of us the only way you know how. We love you.
J & J

(pre cemetery smiles)

(Josh doing a headstand at your grave)

(a cigar left behind by a friend)

(Searching for the perfect stone)

-b