Do No Harm

Do no harm.

I took an oath, dammit. 20 years ago. I meant it then, I mean it now. I have sacrificed my time, my youth, my family, friends and paid dearly for that oath. I studied, succeeded and sometimes flopped, but always, had the patient in my foreground. Today is a day where I have seen a country split hopelessly in half. The frontline of medicine now as broken as everything else in our country.  We stand around bickering about an ancient, non lethal medication and trying to ruin each other's careers while the diseased collapse in our rear view. 

Do no harm, dammit.

I have watched medications swing in and out of fashion like flare bottom jeans and scrunchies. When I started residency, we would put patients on Mag Sulfate drips for a week for preterm labor, give Phenobarbitol for brain protection of the preterm during delivery. We would put Zofran subcuticular PUMPS in pregnant women for nausea for Pete's sake!  Mag went out of fashion, but now is back once again, but not more than 2 days... and round and round we go...

The wonderful thing about the practice of medicine is that you have the ability to actually practice medicine. It should be a relationship, not a formula. 

We are now in the dizzying world of COVID, a disease we've never had to deal with until a few months ago. Like any clinician, I started reading early about what they were doing overseas to treat this, and read of a few protocols that used HCQ, or Plaquenil. I found it interesting because, I take it regularly and have for several years. Started researching in my Harrisons (authored by Fauci), and noted that HCQ has some weak anti viral activity. In the early days of US COVID, it looked like a promising combination, at least for outpatients. Unfortunately, we got overwhelmed on the coasts with older, sicker inpatients too quickly, and that outpatient cocktail was ineffective. It's now percolated to the inner part of the USA, and the patients contracting it are younger, healthier and able to be managed outpatient, and thus the HCQ, Azithromycin, Zinc combo keeps poking it's head up. (also in various combinations with Vitamin C and D, Quercetin, Melatonin, Famtodine, and a Symbicort inhaler)

Here's what I don't understand, it wasn't until after the President touted it's use that it became illegal to use in some states. Did you read that? ILLEGAL. A 60 year old, generally safe, well studied medication, used all over the world for decades - suddenly physicians were being punished by governors and their state medical boards for giving treatment that they decided was in the patient's best interest. What world am I living in? 

Do no harm.

We give medications ALL DAY LONG that are not FDA approved for the induction of labor. We give Makenna for preterm labor, even though they say now it's not recommended. WHY? Because it won't hurt anything and it might just help. Why is it that when you go to the hospital and pee and they find 2 bacteria in your urine you leave with an antibiotic? Because it won't hurt anything and it might just help. Why is it that you get diagnosed with COVID and go home and get told to take some zinc and Tylenol, and if you're lucky you get a Symbicort inhaler? I have no freaking idea. Take the Vitamin C, D, and Zinc, + the Azithromycin and HCQ. It won't hurt, and it might just help. By saying something so grossly obvious its almost painful, I will be looked at as unscientific, fringy, and some would be malignant enough to try and strip my medical license. If you don't agree with it, don't prescribe it. If it is prescribed to you and you have concerns, DON'T TAKE IT. It really doesn't have to be any more complicated than this. 

People take that approach with hormones all the time. Some are pro hormones, some are deathly afraid of them causing cancer, some doctors give compounded ones, some use only FDA approved ones, none of us are trying to attack each other. There's room for everyone in medicine. At least there was. Look, the doctor that gave the HCQ speech was passionate, not terribly prolific and the delivery could have been much better, but I think her heart was in the right place. She just wants to see COVID patients recover. We all do. Why obstruct the use of HCQ? Just let people use it, and document the heck out of it and lets find out if it works! It just might! Or, it might not! Arguing about it isn't getting anyone better, and its killing the doctor's souls. We need each other, so we've got to stop eating our own. COVID doesn't have to kill us all, but if we don't stop this nonsense, it really might. 

Do no harm.

Uncommon Core

1 + 1 = 5. Math doesn't even make sense anymore.

The world has now spun off its axis.  We kill others as a means of peaceful protest. Americans are being told that we should fear the Police, the very people we are supposed to call on when we are afraid. I had to explain to my 8 year old son why a woman might want to dress/look like a man and use the boys restroom at Target, and moreover, why this is even news at all. We apologize for saying "God Bless you" or "Merry Christmas". People blow up buildings, kill children, and bring down airplanes while confessing a faith in their god. The leaders of our day have taught my children that "law" is relative, there is no such thing as justice, and that anything is acceptable as long as it seems right at the time. I have to explain relativity to my 8 year old. I also have to explain why Bruce Jenner has a new name, and boobs.

Right has become wrong. Left is right. And I don't know what's left.

I keep reading that we need more love in the world.

It's my 23rd wedding anniversary today. I had planned to write out our love story in 2 years for our 25th. Since I'm not planning on being anywhere different in 2 years, and I'm awake thinking about how backwards our world has become, I decided that a little love story was just what I needed to read.

I was 14. The two people in my life who anchored me had moved to Oklahoma. They were the youth ministers at my church. Bob had decided to further his education in Tulsa. Wanda, his wife, and I kept in touch with lots of letters, and a few really expensive phone calls. For my 15th birthday, my Grandma and I hatched a plan to get me to Tulsa for a week over my spring break by riding out to Tulsa with a girl from my church that went to Oral Roberts University, who was home for her spring break. She bought me a one way ticket back to Cleveland.

Chris was a freshman at the time and knew Jenny, the girl from my church. He had hitched a ride to Ohio with her and was riding back with her as well. We packed her car and off we went! I sat next to this guy (and probably talked) the whole way there. We arrived in Tulsa, they dropped me off and that was it. I'm pretty sure he didn't even know my name. Fast forward 4 years...

In the meantime, Chris had dropped out of school for a while to go back to Cleveland and get a job as a draftsman. I had gotten into Bowling Green University and was planning on a music degree. I was going back to Tulsa right after high school graduation to spend some time with Bob and Wanda before the fall semester. I also totaled my car on graduation night. I ended up getting dropped off in Tulsa, registering for classes at ORU, getting a job, and buying a new car. That same year, Chris had decided that he needed to think about going back to college and finishing his engineering degree in earnest.

It was "state night" my sophomore year. I went to the "Ohio" table and met a guy named Chris. Turns out he was also on my brother wing in the dormitory. He happened to be from Chardon, not far from Warren. I had a car, was going home for fall break and he needed a ride. I agreed. Prior to fall break, I had run into him numerous times, and he was always very friendly. Our dorm wing had a party at Bob and Wanda's house that he ended up attending, he noticed a picture of me at about age 13 hanging on their wall. Over and over he told me how familiar I looked. It was an awful picture and I was horrified, yet relieved that he could in no way know me, especially then.

We spent about 1000 miles getting to know each other and enjoyed each others company. We were about 2 miles from my house when he said, "I've been here before. I remember this curve. You know, I knew a girl from Warren once; back when I went to ORU the first time. (He had told me over the trip about leaving, working in Cleveland, the decision to return and finish his degree...) Her name was Jenny..."

"I know a girl from my church that went to ORU. Her name was Jenny Smith. Her parents are friends with my Grandma and I rode out to Tulsa to visit Bob and Wanda once with her..."

He slowly answers, "...in a green car, with a beige suitcase stuffed..."

"In between us. For 1000 miles..."

"Uh huh."

Bob & Wanda on our wedding day

By the time we hit my front door, we were both wide eyed and speechless. We introduced our mothers to each other, only to realize we had all met 4 years ago. We went on a date over that break, and have been together ever since.  I told my room mate that he was the one right after we had gotten back from fall break. I really did know, deep in my soul that he was the one. That he was saved just for me.

I also know that love isn't like that for many people. All I ever wanted growing up was a fairy tale, because all I had ever known was chaos. I so deeply hoped a real love would happen for me, and I'm still pinching myself 23 years later. The story of us is so uncommon, and the equation that completed my life happened this day in 1993.  1+1=5

We do need love in the world. So, today, I celebrate ours. Fairy tales do come true sometimes.

The Wildest Ride

I'm going to attempt to shine a little light in a long dark hole, and hope that maybe someone, anyone, will see the light at the end of this 40 week tunnel.  For those fortunate enough to get pregnant "the normal way"(in other words, not with a box of injections and weeks of ultrasounds) ,you woke up, felt a little nauseated, tapped your boobs and thought, "hmm, when was my last period". Your mouth goes dry, you get sweaty and go to the cabinet, pull out a pregnancy test and: two lines.  Uh oh.

Welcome aboard, sister.  Mommyhood awaits, with all of the dirty diapers, crying, teething and spit up you can stand. But you've got about 36 weeks ahead, and things are fixin' to change. Big time. You have a tenant in the baby house and this will change your emotions, your weight, your skin, your body shape, your ability to see your toes, your relationship with your parents, in laws, and your baby daddy.  With your head spinning, you sit down on the toilet, and try to assimilate what has just happened.  And promptly call your OB.

There will never be another time in your life that will feel so completely out of control, and be such a defining moment in your life as the day you deliver your little baby.  I know that it is scary as hell, it hurts so very much and you don't even know what to expect exactly.  So you do what everyone does, get on the internet and read up.  I certainly applaud you taking a interest in your labor education, but it seems lately, that either there is a bunch of absolute garbage out there, or a bunch of very angry mothers or both contributing to your educational pursuits.  So, in desperation of some sort of control, moms think that if they can control the delivery, it will somehow alleviate the anxiety of it all. So, patients walk in with Birth Plans. I'm all for planning ahead, and I often tell patients to give me any specific requests that we can discuss like two adults.  But I'm talking about Birth Plans, the 8 page birth plans.

I hear folks tell me that they've read all about "birth trauma", "birth rape", and unnecessary c-sections and so, they are going to bring me a list of do's and don'ts that I get to follow during their labor. Allow me to inform you all of something that seems to be missing in all of your internet education: baby trauma.  The most stressful thing you can do to your baby while pregnant, is birth your baby.  That's why, supposedly, you asked for my help.  Your baby has a special type of hemoglobin that holds oxygen so tight, that at an oxygen saturation of 60% your baby can actually be okay, for a while.  You and I, however, get pretty grey at that level.  The reason for this special type of hemoglobin (called hemoglobin-F) is because when your uterus contracts, up to 1 liter of blood is squeezed out of your uterus, and away from your baby.  Couple that with a cord around the neck, or feet, or sometimes both, and the baby's heart rate can do some interesting things to compensate.

You, who spent more than 100 dollars on a baby monitor so you can watch it from your iphone, are informing me that I am not to monitor your baby during contractions? Because you want to walk around. Because you want to feel some level of comfort. This isn't about you.

You don't want an IV with Pitocin in it. Well, I guess you'll need to carve your pituitary gland out of your head, then.  Your pituitary gland already makes it.  Would you rather be in a dysfunctional labor pattern for 18 or 20 hours or a regular one that gets your baby out as soon as possible?  No one advocates nuking your pitocin receptors half to death, just get your pattern regular, because labor is stressful on the baby (for the reasons mentioned above). You don't want an IV because it hurts? How on earth am I supposed to give you pain medication? What do you expect me to do if you hemorrhage after your delivery?  I can't put it in then, you've already clamped down in an effort to maintain your blood pressure and I can't find a vein.

You don't want an episiotomy. That's fine, I'd rather not do one. But, if it looks like you are going to need one, or your baby is in distress, I shouldn't have to beg you for it. You don't want an epidural. I couldn't care less. Just don't kick me. I don't care what you say in the delivery room, sister. What happens in labor stays in labor.

And finally, you sure as hell don't want a c-section. You know something? I don't want to do one on you. Or on anyone else. But, I also don't want your to baby die either. Or be so oxygen deprived that they have a lifetime of hardship because of your birth plan. They either fit, or they don't. And if they don't somethings gotta give: your pelvis or their skull (or shoulders).  I can promise you that any delivery I can leave without sewing anything makes my day!

Your baby's delivery isn't about you. It is the first time in your life that you will be totally selfless, giving your lifeblood, your energy, your strength and your all into another human being. Your ability to deliver vaginally with minimal intervention, or c-section with admission to the ICU does NOT equal in any way your ability to mother this child. So, please, please, let me help you and your baby off of this wild ride uninjured.

Allow me to introduce to you my birth plan for you: I need only 3 things. I need IV access for emergencies, I need the ability to monitor your little one during this transition, and most of all, I need your trust. When things go awry, and they sometimes do, I need to have the ability to keep your baby safe, and you safe as well.

Lately, I have seen way too many disasters that could have been averted by better communication between mother and doctor.  Let's stop this madness and commit to safe deliveries and healthy babies regardless of how they are birthed.

What's Under the Cape

I know you've seen it by now.  The pic snapped by an EMS driver of an ER physician hanging onto a wall while trying to compose himself after loosing a 19 year old patient... It's struck a nerve across the country, but why?  I know that when I saw it, I instantly teared up.  I felt his pain.  I, too have at times slumped to the floor too overwhelmed to even stand.  Any nurse that has worked with me can tell you this is true.  The most recent being, well, this week.  I cut a fallopian tube out of a woman with a moving, live baby in it.  This woman had been trying to get pregnant for years, and this was her miracle baby, and if I didn't remove it, it would have killed her.  While opening her tube fully, after the case, (as it had already started to rupture) we saw a tiny, little helpless baby. The tech wanted to see it.  Not because it was a freak show, but because she wanted to say goodbye.  We stroked it's head and said that we were sorry. I choked back tears (which are flowing freely now) and went to talk to the husband.  I approached him as upbeat as ever, completely stuffing the moment I shared with his unborn baby down in the crevices of my soul.  I told him how perfectly the surgery went, how little blood loss there was, post operative instructions and when to follow up.  "Any questions?', I asked cheerfully.
"Did you see it?  Was there really a baby?"
"Yes, sir.  I did." And I proceeded to talk to him about how we can never make another Momma, and how dangerous ectopic pregnancy can be and...
"Was it alive?"

Our eyes locked. His filled with tears. And, this giant of a man, I hugged. And he cried. Hard.  I didn't.

This is why that picture has gathered so much attention.  We are often seen as cold, emotionless, robotic, overpaid bookworms that get to wear scrubs and call ourselves "Doctor".  If we're really lucky, the patients even call us that too.  (Although I don't mind that half of this city calls me "Fletch")  What you don't see is what we look like on the drives home, what we tell our best friends, spouses, and colleagues.  Why sometimes we walk into our children's rooms, children that we sometimes haven't seen for literally days, and hold them while they sleep.  You don't get to see us cry.  That's not part of the deal.  We swoop in, save the day, smile cheerfully and discharge you back home like mini superheroes.

I've hauled pregnant women twice my size down the hall singlehandedly, in a bed, with the breaks stuck on, then all but throw her on a c-section table to help save her baby's life.  You don't believe me?  There's a hospital with wheel marks down the hall to this day from her room to the surgery suite.  How did I do it?  I don't know.  I've delivered a premature baby, breech, in a triage room.

Wanna know a secret?  I was scared to death, both times, and hundreds more.   No one would ever know.   When you are the doctor, then you run the room.  If you panic, everyone else does too, if you are nervous, everyone else is.  These feelings spill all over the room and eventually to the patients and their families as well.  If you aren't strong, then no one else can be either.  And so, day after day, we muster superhuman strength emotionally, mentally and sometimes even physically for our patients.

Every once in a great while, we have a moment when our guard comes down, the tears flow, the cape comes off, and you all now see, that we're human too.  Just like you.  I'm just grateful that no nurse ever got a pic of me, and grateful for that doctor's sake that there are no identifying factors in his picture.  He probably splashed his face at the drinking fountain on the way back in, grabbed a chart, worked the rest of his shift, and hopefully saved a couple more lives by the time the sun came back up.  The day we can't grieve over the ones we can't save is the day we need to hang up the cape for good.

The Unsung Hero

I would write this as a personal letter, but as I thought about it, there are so many of you that might need a "shot in the arm" I decided to dedicate this blog to the performer.  All of you.  Big household names, names on the inside back cover of a CD, those of you slumped over composition books, those panicking tonight about "juries", contest , scholarship auditions, a Friday night gig, that solo that you landed last week for Church that you now dread, and everyone else along the spectrum.

I want to say thank you.

Many who read this blog would be dumbfounded that I would spend more than a sentence or two thanking those of you who over the last week, month and many years have heard thunderous applause, seen endless standing ovations, and endure people taking endless pictures of you. I also want those of you who are still waiting in the wings, those of you that stayed up all night last night rearranging a piece for the 10,000th time because one person couldn't hang on, the person who is back stage frantically changing a broken string with hands shaking, I want you to know how grateful I am for your sacrifice.

I've even watched some of you grow since junior high contests, I've seen the exhilaration of a perfect senior recital.  I've watched you crumble with letters of rejection.  I've heard the criticism directed at you from your colleagues, your teachers, your parents, your spouse and especially - you.  I've seen you running into the corner drug store in a long tail tuxedo.  I've shopped with you as you're trying on another black blouse.

I understand what it takes to do what you love, and when what you love to do takes all you have.  I've seen you miss an entire month of your life preparing, practicing and performing, running frantically from one gig to another.  I know you forgot to eat breakfast, snagged a lukewarm plate from the wedding you just finished and are trying to remember if you even brought the music for your next gig.  I know you are going to fall into bed at 1 or 2 am exhausted and have to be at a church at 9am to do it again.

I know that everyone expects to see you fresh-faced, smiling and excited to play or sing.  I love how you can inject new life into a work created centuries ago.  I love that you love what you do,  it makes us love you more.  I know how you dread a mistake and I marvel at your recovery.

I am a physician. I started down the road you travel every day. What I discovered on a dismal rainy day while soaked, and walking back to my dorm after my 5th hour that week, alone, in a grey practice room was that your road was too hard for me.  Breaking up with my dream was one of the most gut wrenching decisions I ever made.  I called a college back in Ohio, declined a scholarship and chose a path that would lead to healing bodies, instead of souls.

I too, work long hours and have to put on a smile every day, in every room. I spend some weekends and evenings away from my family as well, I've spent endless hours practicing my skills.  I don a white coat, instead of performance black.  I have moments of exhilaration, moments of disgust, panic, and devastation.

Only recently have I dipped my toe in the great ocean in which you all get to swim daily.  And, oddly, not even with the instrument that I had trained in, but the one I dreamt of.  I have had to, as an adult, face some of the obstacles that made me quit music the first time and do this with a new instrument. Interestingly enough, it's made me want to sing again, and I've recently jumped both feet into a venue that I would have never dreamt I would do.

This morning, for the first time in more than 15 years, the black pants came back, and I found myself sight singing, acappella.  I was leaning on instruction from vocal teachers from 30 years ago, the names my director wouldn't know.  The foundation solid as a rock.  On a part of me that I've abandoned for nearly 20 years, that I'm finishing, finally.

To all of you who feed our souls with the beauty of music, applause just isn't enough.  The world can be a very dark place.  This road that you have chosen can be exhausting, yet exhilarating.  I see both anxiety and confidence in your eyes.  I can feel anguish, and then peaceful resolution within minutes while you play.  The color of our lives is given to us by music. I stand in awe of you. You teaching our children ensures that the language of our soul will never be lost.

I took the kids and their friends to a Oklahoma City Philharmonic "Discovery" concert this afternoon. Those musicians were there Friday afternoon, played Friday night, most of them taught lessons all day Saturday and gave another fantastic performance Saturday night, then turned around to play their hearts out today to a bunch of little kids.  Many of them probably came from playing at Church straight to today's venue.

After the show, while talking to my friend, the kids were invited on stage.  She led me to the back and eventually on stage to go collect my crew.  She started talking to me about the Civic Hall, I think.  I was trying to act as though I was present, but I was long gone.  I was at Packard Music Hall, my heart was pounding...

...and I was still in my performance black.  In fact, I just took it off a few minutes ago.

Room 21

Dear patient in room 21,

I know you've dreaded this visit for years.  I see the 6 foot man walking ahead of you, assessing the room, looking for his seat.  He is not nervous.  In fact, he is quite talkative, inquiring about my training, where I came from. How long I've been doing this, and that we have some issues to address. What you don't know is that I have him pegged, and have since he marched into the room. The less I say, the more I can observe.  The nurse comes in, asks you a series of questions answered by him.   She then presents you with a gown and a paper towel and you wait.

What you don't know, dear patient, is that I am outside the door.  I'm listening to you interact when no one is watching because I fear that the family I am about to meet is not the family that you experience.

I enter with an outstretched hand and a warm smile to him.  "He's got her snowed", you think, and I see your shoulders slightly slump in defeat.  I sit down, put my feet up and ask what brings you in, to which he answered "decreased libido, too tired and having a hard time keeping up (with what?), she's cranky and she just doesn't listen very well."

I instantly notice him jump out of his seat to watch me perform a routine breast exam.  I say nothing about the bite marks on your chest. I see the bruises on your forearms, in the exact area you would use to protect your face.  Not bruises around the wrists consistent with creative sexual exploration. He's quick to tell me about your fall last week, except these are fresh bruises.

I ask you to follow my pen. Not because I am concerned about your cranial nerve function, but I need to look in your eyes.  Vacant.  Looking at the floor.  And your husband is quick to tell me that he's just started a church.  You smile right on cue, with a nervous laugh. "Yeah, she has NO idea what kind of man he his...", you think.

What I notice first is your pounding heart, anxious breathing pattern ..."Oh she hates these things!", he exclaims.  I lighten the mood talking about your children and that surely a routine gynecological exam can't be worse than an 8 pound baby, right? "Oh, they weren't  mine," I hear your husband say.

Then, I have him breathing at the back of my neck... Your legs clamp tightly, a barely audible sob fell out completely out of your control.  Your breathing is fast, uncontrolled, and tears roll down your checks.  It's fairly obvious at this point that someone, somewhere, has violated you, emptying you of your dignity and self worth leaving a void now filled with a controlling and  potentially abusive  husband.

"I can't see in there!  Do you see anything?  Does she have anything?"  I smile politely and state that her gynecological exam appears normal.  Except for the fact that he had to mark his territory immediately prior to the visit today, like a tomcat.  What I didn't tell him is that while her pelvic area is perfectly groomed,  her legs have yet to see the 3 minutes of attention they have deserved this month.  I also notice her $700 Coach bag, but 6 month old pedicure.  I see the big bruise on her knee... From the fall "last week" I assume.  I see him aggressively trying to look over my shoulder, and I'm doing my best to preserve what's left of your dignity.  Why won't he leave you alone for 90 minutes for a pedicure?

I continue to engage him, attempting to earn his trust.  Offer to draw labs as a biochemical explanation for your perceived shortcomings.  I believe none of it, but I want to have him think he's got me fooled.  Fooled enough that he will let you come alone next time, so I can really look into the window of your soul and extend my hand as a safe rope .

My student emerges and I ask her what she noticed about you.  "Pretty, thin, quiet and very polite."

"Why is she here today?", I ask.

"Just for an annual. No issues."

"None?", I inquire?
"Tell me about her hands, her forearms.  Did she wear nail polish?  What does she do for a living?
Where was that dysplastic looking mole?"

"Well...I was typing her info. She's v70.0 and 627.2, needs screening Mammogram."

I ask, "What color is her hair?  Tell me something about her husband."

Awkward silence...

And, so now, I spend the next 20 minutes teaching a medical student how to look at her patient, and how to manage controlling husbands, identify signs of abuse, and how to delicately document these observations in a computer medical record that will be eventually accessed by the world at whim.

My patient did come back. He stayed in the lobby on wifi.  She said, "It's not happily ever after, but it's what I signed up, for." I then gently asked if he was always that protective when she went to the doctor. I told her that I knew her bruises were recent and not a result of last week's ice storm. Through tears, she said, "I thought he had you fooled.  He set you up to never believe some of the crazy stuff I could tell you."

I assured her we will check in once a month to address her "hormones".  I also assured her that violence only breeds more violence.   And, that maybe it was time for her 16 year old to come in for a visit as well.

She needed her pap done, but it was about much more than that.  I know that I can't save anyone that doesn't think they are worthy of a better life, but I pray as we build a relationship, she will slowly learn that not only is she worthy of respect, but that her children are learning by their examples how to treat others and what kind of behavior is acceptable.  The cycle of violence and control has to stop, and I will fight it as long as God gives me the grace and the guts to do what it takes so that no one else ever has to experience the gut wrenching anxiety every time they turn the knob at the back door.

I had an attending tell me more than a few times, "God gave you 2 eyes, 2 ears, 2 legs to get to 'em and 2 arms to hold them, you've only got 1 mouth, so listen more, hug more, do more and talk less."  What you give to your patients daily is your vocation, their trust in your care is your salary.

Love is an Iceberg?

Every year I think I'm gonna be less sappy about my son’s Christmas birthday, and it just gets worse by the year.  My children were all conceived with the miracle of in vitro fertilization and I've blogged that already.  (See "The Unplannable Planned Pregnancy" Feb 22, 2013)

The Sunday before Christmas our Priest had announced that a family had lost their son in a tragic car accident while he was retuning from a ski trip. It sounded as if the family was young, and really devastated.  He was asking as many parishioners as possible to go to that Monday mass. My husband and I exchanged looks, saying a whole conversation in a minute.  His dad was killed in a car wreck when Chris was 11. He's never gotten over it, I suppose you never do.  His pain has been so palpable at times, that it can still dissolve him into tears to this day.  Initially, I thought I would try my best and go to this funeral for this family. We had gotten an email about it as well with their name, I didn't know them, I thought to myself, and if I had time I'd go... But we were gonna be at Church Tuesday from 4pm until after midnight all told.  I decided that that was enough.

It was Christmas eve.  My daughter sang at the 5pm mass, and we all came back at midnight to hear my husband play trumpet at the midnight mass.  We came early. Sat in the 2nd or 3rd row closest to the trumpets in the left side of the church. (Most Catholic Churches are in the shape of a cross, use your imagination). Jonah was clearly asleep and not waking anytime soon and Jake and Jordan sat on either side.  I checked my Facebook and thought I'd show Jake my "note" about him and just how much I love and value him and why I get so teary eyed every birthday.  He read it and whispered an exasperated "Oh, Mom!".  The music began.

A family walked in shortly before mass, a fairly big group, with many extended relatives. Then I saw her. They were sitting down directly across from us.  Grieving mothers all walk the same, bent over from the weight of it, holding on to her husband on one arm, and her oldest son in the other, trying to control her sobs. There we were. 10 years from now. The mother and father looked to be in their mid fifties, the oldest looked about 20, the daughter 17-18, and a missing son.  A father, clearly broken and trying to control his emotions so hard he had his hand clamped across his mouth.  The daughter cried audibly while hugging parishioners as she followed closely behind.

The mass begun.  I don't remember a word of it.  I thought of my friend who was trying to make sense of her life after loosing a daughter (my sons age) in the May 20 tornado.  I thought of this mother across from me.  I thought of Mary, the mother of Jesus, and that walk.  I thought of myself. Tears uncontrollably poured down my cheeks.  Jake leaned over to me and said, "That's that family, isn't it, Mom."  I nodded.  He kept watching.  I said quietly in his ear, "That's what grief looks like, Jakey.  That's how much she loves her son." He put his head on my shoulder and covered it in quiet tears.  The daughter across from us had done nearly the same thing.

Now, my daughter pulls my ear down, and says "What's wrong with that family? Mommy, why are you and Jakey crying?" All I could say is, "That is how much your mother loves you. If you were ever taken away, it would destroy us, just like it is them."

"It's that family, Mom."

Nodding, yes.

"So then there were 2 boys and 1..."

Nodding, yes.

She grips my hand super hard, starts crying and doesn't let go.  My mind has now drifted to my husband up there trying to play some pretty difficult material while 1/3 rd of the church is now crying, wondering if he's figured out what we had.  Mass has ended.  It's Christmas.  I have my gift, that woman doesn't.  Jordan takes off across the church making a bee-line for this grieving mother, whom I've never met, and I'm panicked about what could come out of an 8 year old mouth at a time like this.  I left Jonah sleeping with Jake and I tried to catch up to her as she approached this family.

She said, "I don't know you.  My mom doesn't even know you. I'm so so sorry about your son. (At this point, the father takes his hand away from his mouth and strokes her hair.)  We will pray for you so much." And concluded her simple, yet heartfelt sentiment with a great big bear hug to this mom, and the dad joined around them in a group hug. We all cried.  I think I mumbled something to her as well, but she won't remember me.  She will remember that little 8 year old girl who left them and went straight to the feet of Mary, lit a candle and prayed earnestly for them.

I gathered my family. Tight.  I approached my husband tentatively as I had moderate control of myself by now.  He looked at us inquisitively, and Jake threw his arms around his dad and all he could get out is, "It's all so overwhelming."  Fortunately, Chris was oblivious to all of what had occurred in mass.  Jordan told him through tears and we left.

I had all three kids in the van, and trying to lighten the mood, somewhat, had put on some Christmas carols.  I asked the kids what they were hoping to see under the tree when they wake up.  I got various answers and said in an effort to try to connect what they had witnessed earlier, "Tonight you saw a very hard, and painful, dark side of love, tomorrow, you will be surrounded with laughter, surprises, love and friends, and thoughtful gifts given to you by people who love you very very much. You thought you knew what love was, what it felt like, now you now love on a much deeper level."

At which point Jake responded, "I've been reading about icebergs and ships running into them because they didn't know they were there.  Like, you only think you know what an iceberg looks like, but it goes deeper and wider than you think."

"Exactly."

"So, Mom, love is an iceberg."

"Well,  Jake, someday it will be a battlefield, but that's not for about 6 years or so.  But tonight, yes, love is an iceberg."

"Mom, I love you deep and wide and more than you can see. Oh, and hey, what do you want for Christmas?"

Not a single thing.