A Day Off

What do you do when you get a day off? I always imagine that families in which the mother isn't working weekends are always up to some great adventure. Taking the kids to the petting zoo, or picking berries on the farm, or just inventing clever games at home. You know what I want to do when I finally get a day off? Not a damn thing. I don't *want* to do anything. I want to sit. I want to veg out with a book or movies or my laptop. I don't want an itinerary or an adventure. I just want to be. So of course, then I feel incredibly guilty. Here I get a precious few hours with my darling children, who are growing up faster than I can believe, and I don't want to *do* anything with them.

How are my children going to remember me? Mommy, finally home from work, lying listlessly on the couch, book in one hand, computer near the other? This isn't how I want to be remembered. When I try to go and do kid-friendly activities, I find myself incredibly short tempered and longing for the comfort of home. I know that 4 days off a month is just too little down time, and things will get better once my job situation changes. In the meantime, what do you do with your little ones when you have the time to spend? Any suggestions for low key activities for 5 year olds and 18 month olds? I want to start making some good memories for my kids that don't involve the movie theater. Thank you in advance!

Adoption Journey Part I

So today someone asked me the question I’d been dreading for quite awhile: “So, what’s your husband going to do in the fall when boy wonder starts kindergarten?’
A lump began to rise in my throat.
“Well. Ummm. I’m not sure” I stammered.
We haven’t really discussed it. The truth is that two years ago when we started this adoption journey, I would have never dreamed it would have taken this long. We both assumed we’d have a toddler by now.

Our son has albinism. It is autosomal recessive genetic disorder. Our son is beyond amazing and is barely effected by the condition, however we know that a majority of people with albinism will be significantly visually impaired. When we decided to grow our family, domestic adoption was the path that seemed right for us.

It was exciting at first. We told everyone we knew about our journey, for their prayers and support. Additionally, the books (I’ve read many) suggested to network in case friends/ family knew a potential birthmom. We took classes and filled out paperwork it was a tendious process but at least we were “doing “something.

Then we waited.

We were a year into the process when we met our first birthmom. Things were amazing. We were so excited we could hardly stand it. We knew we should be cautious, but things seemed so certain. Then days before delivery things fell through not because she changed her mind, but because of a strange legal glitch. We were devastated and left staring at an empty nursery.

A few months later we met birthmom #2. She was very young and early in her pregnancy, still she seemed sure of her decision. Plus all the books say the averaged couple has “1” failed adoption. Of course we all know these things don't always follow the books. Four months later she changed her mind and decided to parent. This was hard, but we knew it was a possibility,

Yesterday, I got news that birth mom # 3 has backed out. This was a strange situation and I had little hope of it working out from the beginning. Still, part of me is left wondering, “Um… seriously God. What now?”

The irony being that I deliver babies. Constantly. This of course confuses boywonder. For awhile after the first adoption fell through, he would ask when I went for delivery if “it was our baby” I was delivering. No, not yet. And my heart would break just a little but every time he’d say it. He rarely says it now. So much time has passed. It’s also getting challenging to deal with all the follow up questions from the “zillion” people we’ve told.

At work its hard to be sympathetic to the patients who get upset about an unplanned pregnancy. The worst is people who get seriously upset about the gender of their baby. Honestly, I’ve never been able to muster much sympathy for them. I know that the process has given me a new depth of empathy for my infertilty patients and others going through challeging situations.

I’ve labeled this post adoption Journey Part I as a statement of faith that someday (hopefully soon) I will proudly post adoption Journey part II where I will post pictures of my beautiful child. Until then thanks for letting me vent.

I’m also thankful to fat doctor for sharing her successful adoption story and being so transparent through her process.

The Challenge of Being Pregnant, Mom and Doctor...

It's interesting being a Mom, doctor and pregnant. I often have to choose which hat I'm going to wear to respectfully endure a situation.

Here's an example - my husband's grandmother (Ma) is visiting. She has a very strong personality. I love her and I'm absolutely thrilled that she is visiting, especially for my children. I'm pregnant and have now revealed that I will be having the boy who will carry the family name. (I'd like to believe this is an irrelevant point but given the generation gap, I'm pretty sure it contributes). Very soon after she arrived, Ma gave me a stern lecture about carrying my kids. I have a 2-year old and a 4 year-old. Neither 'have' to be carried but you all know how it is....sometimes they just want 'up' and sometimes you just want to carry them down the stairs because it's SO much faster. I said very little but she had a lot to say. "You're the doctor, you should know that if you carry too much weight, the baby will come out."

I should give more background - back in the day when she was in her 30's and 40's she was a midwife. She continues..."I saw many women who lost their babies because of placenta problems and stress on the body. You must not carry the children! Learn to say know and ask for help"

This is easier said than done. My husband is currently travelling for two weeks, I'm alone with the kids and it's virtually impossible to avoid carrying them for one reason or another. So I continue to carry them, only with the additional voice of guilt from Ma playing in my mind.

On the one hand, I want to respect her experience in life, she's lived many more years than I have. But the doctor in my mind is saying "nowadays, we have ultrasounds so I know where my placenta is and I'm really only putting my own back at risk which is a calculated risk in the moment!"

Perhaps if I didn't know better, I would be more worried about the baby, I'd ask more for help, or arrange for hired help and life would be easier? I can't decide if my medical knowledge is a blessing or a curse.

I've tried to respectfully tell Ma using few words that the baby is not at risk when I carry the kids but she still glares at me when she sees me holding my 2-year old even for a minute...Putting on my Mom-hat, I respectully put my daughter down and look around for help.

Guest Post: iud

Funny #1

Yesterday, four year old Z spied my IUD pin on the lapel of my white coat. “Mommy!” he exclaimed, excitedly. “You have a POGO stick on your white coat!”

I smiled at him. “Why, yes I do!” Four is not age appropriate for methods of birth control. We’ll get there, don’t worry. Besides, why spoil his fun?

“Mommy, you bounce on those!” (Insert joke here). “But, you have to hold on!”

I was laughing so hard I could hardly drive by this point.

“Mommy,” he said, seriously. “I want a pogo stick when I’m a big kid.” Oh, you may get one, Z, but it will probably be a little different than the one daddy bounces on currently.

Funny #2

Today Z and I were talked about how he misheard something I had asked him to do. I said “I think it’s because you have elephants in your ears,” borrowing a joke from his pediatrician.

“I do not have elephants in my ears, I have little drums,” said Z, indignantly. I started giggling and, was of course, looking at his ears and spied a little stray wax. So I started to do the unfightable mom instinct thing and stuck my pinky in there to get it, and Z said “No! Don’t take my drums!”

(Cross-posted at Mom's Tinfoil Hat.)

Membership

When I arrived at my office this morning, I had a walk-in patient waiting for me. In the winter months, it’s not unusual for a parent to try to “jump the line” and want to be seen first thing, and I try my best to accommodate parent and patient. I had promised to do a medicine re-check for my nurse’s child after I made morning hospital rounds today so that we could get her child to school, and my nurse back to work. My partner saw the walk-in who had stalked Lori, my scheduler, at the back door forty-five minutes prior to my arrival, while I saw my scheduled re-check.

Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.

Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.

The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.

Healing at home

My kids' preschool teacher, Miss Amelia, is the kind of mom dreams are made of. She has 4 kids ranging in age from 2 to 10, all of whom are being homeschooled and come with her when she teaches two mornings a week. She lives 2 hrs away in the country but somehow manages to get herself and 4 kids ready and make the drive to school to receive her class of 8 preschoolers at 9:30am on the dot. She is never late. Her 4 kids always have creative, healthy, homemade lunches. They are intelligent, respectful, cooperative, helpful...miraculous. Her 10 year old daughter oozes patience and sweetness and wisdom beyond her years. One morning, my 4 yr old son got out of the car and immediately started wailing because he had forgotten to bring anything for show and tell. My systolic pressure shot up by about 20 points as I tried to figure out how I could end this scene without driving all 3 kids back home to retrieve a dinosaur from our living room. Meanwhile, the 10 year old sweetly said, "I'm sure we have something in our class treasure box you could use for show and tell. Would you like to look in the treasure box? Ok, it will be our secret, but only if you stop crying..." As he wiped his eyes and wandered off with her, walking on a cloud, I stared in amazement. She is her mother's daughter.

A few days later, I decided to take stock of how I was doing as a mom by sitting back and observing my own kids' behavior. Unfortunately, in the span of an afternoon, I heard my 5 yr old son telling my 3 yr old daughter, "I am closing my eyes and counting to 10. If ALL of those toys I just cleaned up aren't back in the toy box again when I open my eyes, we are not going to California next month..." or worse, my 3 yr old telling her teddy bear, "No, I can't play right now. The house is a mess, and I am busy!" with a familiar tone of irritation. Yikes! I think this reap what you sow business is the real deal.

This past weekend, I came down with a terrible cold. My kids had a friends' birthday party to attend. They had been looking forward to it all week. As I sat there coughing and feverish on the couch, I had to tell them I couldn't take them to the party because I didn't want to get all of the party guests sick. I braced myself and prepared for the fallout--here come the tantrums, I thought. They looked at each other, then walked out of the room silently. Two minutes later, they reappeared. My 5 yr old son was lugging a huge flannel quilt and a cup of water, and my 3 yr old daughter came bearing her favorite stuffed animal and her blankie. Together they worked, their tiny faces concerned but reassuring, their body language unhurried, gentle, and kind, to wrap me in the king-size quilt. My daughter put her bear and her blankie under my chin, and my son pulled the coffee table a little closer so that I could reach the cup of water without having to get up. Then before going off to play quietly with her brother, my daughter kissed my hot forehead and said, "Shhhh, I love you. You'll feel better soon."

And she was right. I did feel better. For all my shortcomings as a mother, and there are many, I am teaching my kids by example to be healers, at work and at home. For that, I am grateful.

The doctor children's book I'm loving

My daughter is 3 1/2 and we're having fun exploring children's books, now that she can actually appreciate the written word. We have successfully graduated from books-as-teethers, books-for-shredding, and books-for-rapid-page-turning.

It's also much more enjoyable for me as the reader since I'm not as often bored out of my gourd.

We have a couple of doctor-themed books in our house, hoping to give her a better idea of what mama does when she goes to "work." The books are okay, but rather uninspired. Yes, they have protagonists who are doctors, but that's about it. Neither she nor I is excited to read either of them.

But, then we found Doctor Ted by Andrea Beaty and Pascal Lemaitre. It is adorable. Funny. A great cadence to read aloud. Well-illustrated. It has quickly become one of Jolie's (and my) favorites.

Ted is a bear who wakes up, bumps his knee, and decides he needs a doctor. In the absence of finding one, he becomes one. The story follows his adventures of doctoring the people around him at school and at home, brilliant diagnoses included.

An excerpt:

His mother was in the kitchen.

"You have measles,"
said Doctor Ted.
"We should operate."

"Those are my freckles,"
said his mother.
"Eat your breakfast."

Loving this book.



*I received no compensation for this! I just adore this book and thought other Mothers in Medicine might too.

Learning Lessons and Lessons Learned

Son, born eight weeks early, spent the first four weeks of his life in the NICU. When he came home, I had to consider his prematurity when looking at his motor development. Some things that happened late, like sitting, standing and crawling, were OK when adjusted for his prematurity. Other milestones were relatively early when adjusted, but some were just plain off the chart delayed (eating solids, for example).

Daughter, on the other hand, is a healthy full-term infant and she is waking up.

Now two days shy of six weeks, she smiles. Usually this happens in her sleep and it is fleeting at best. Occasionally, I catch her smiling when looking at someone or something, but when I call someone over to see it, the smile disappears. She doesn't have a responsive smile yet, but it is so beautiful when it accidentally happens. You may call it gas, but her "gas face" is decidedly unhappy.

She can push her head up when on her tummy and when she is on her back she rolls almost onto her side.

If she could, she'd be held 24/7. She balks at the swing and bouncy chair, but after she cries a bit she seems to realize, "Hey, I like this!" Mama loves the swing and bouncy chair so she can get things accomplished around the house check e-mail and blog.

This morning, at Son's ophthalmology appointment, she picked up on my tension as Son wasn't 100% cooperative with the exam. I picked my screaming daughter up from her carseat and held her against my chest as I willed myself to relax. I felt us both melt into each other and, as we both grew calm, so did Son.

The doctor told us his exotropia is gone and his astigmatism is improved. She said we can reduce the patching to 3 days per week. I realized I was upset not that Son wasn't a perfectly behaved preschooler, but that he might have a vision deficit.

I still have numerous mothering lessons to learn, and this baby of mine is going to help me along the way. I wish I'd had the maturity to realize when Son was teaching me his own lessons. In hindsight, there were many.

Med school, schmool. I'm getting the best education in human development from mommyhood experience.

*cross-posted at Fat Doctor.

Baby fever

One of my jobs as doctor is to hold the head of a spinal cord injured patient while X-rays are being taken with their neck brace off. Nobody else can do this job but the MD. Holding a patient's head in place during X-rays takes all my cumulative eight years of medical knowledge.

My attending is super nice and when I told her I had been doing this yesterday, she commented, "Oh no! But you could be pregnant!"

"Uh, no," I said. "I couldn't."

"Are you sure?"

"Very sure."

She contemplated this for a moment, then asked, "Well, why not?"

I'm not sure why it's so shocking that I wouldn't want to be a resident with two babies. I don't hate sleeping that much. Do I look too relaxed?

During my first few months of motherhood, I couldn't imagine how ANYONE would EVER even consider having a second child. Every time I put on my non-maternity clothes, I cried with joy. But now, almost two years later, I feel the baby fever starting up again. Babiez r cute. So tiny and helpless. And breastfeeding was such a good way to lose weight.

And there's peer pressure. Tremendous peer pressure. Everyone seems to be having their babies two years apart. That way, the babies can be friends? All the women I know who were pregnant when I was are now pregnant again. Now is the time. Everyone is doing it!

My frontal lobe is still in charge for the time being. I love the fact that my daughter sleeps through the night and is more interactive and fun. I love that I still get to have some time to myself. If I had another newborn, my life would get crazy again. They say that a second child quadruples your work. If I were pregnant, I'd probably be too fatigued to be as good a mom as I want to be. And I'm not even 30 yet, so theoretically I've got a little time left on the old biological clock.

In the meantime, I've got to get myself a niece or nephew or something. A newborn that I can cuddle with for a short time then give him back.

Cultivating Friends While Raising Children

The request for reading suggestions got me to thinking about the problem of finding time for adult pleasures when life is filled with work and children. Although we see plenty of people in our work settings, that is different from having friends. We are necessarily reserved with patients, and we tend to be (or struggle not to be) competitive with colleagues and directive with staff.

It takes a conscious effort for working mothers of any stripe to maintain or seek friendships. On the one hand, our children’s activities bring us together with parents of children of similar ages. Some of the best friends I have made as an adult are women I met that way: in a prenatal exercise class and the mothers of my daughters’ close friends. Even the girl scouts have provided some great connections (though with continual dodging and weaving to avoid being the cookie mom). But it is not always easy to find common ground outside of parenting, and when children change their friends or their activities, these ties can easily fray.

I have tried lots of other ways, including book clubs (but then you have to read the books), exercise classes (never a good bet for an unathletic soul like me) and various volunteer activities. What has worked best—and sometimes wonderfully—has been to get involved with things I love for their own sake, to which I can bring a child sometimes. The real lifesaver was finding an opera company that had chorus parts for adults and children. I brought along two of my daughters, and while I never graduated above second alto, the experience brought out my daughter’s latent musicality and has formed her career as an adult.

It is important to find something that is more than a single time event, that offers both continuity and flexibility. The Sierra Club, with its multiple local outings, can be great for that. The other thing I have learned is that with effort, one can learn not to strive for excellence in everything. We have been such achievers, it can be a surprise to realize that a fifth rate production of one act plays is still fun and that other harried but interesting people may be drawn to similar things.

And of course, my lifelong addiction to books with series characters—from Nancy Drew to Harry Potter and mystery series too numerous to mention—means that whenever I want to visit an old friend, someone completely undemanding is always at hand.

Do others think about this? How do you stay yourself while taking care of so many other people?

Seriously, I wanna know...

Have you read any good fiction lately? Do you have time or the desire to read outside of your profession?

Reflections

The beginning of a fresh new year always seems to inspire grandiose dreams and aspirations of what we may want to do or who we want to be in the coming twelve months. I also try to take this last day of the year to reflect on all that has happened. I'm finding that my more generic "lose weight, get organized, attain perfection" resolutions are always at the forefront of the year, whilst the unexpected and mundane moments seem to occupy the latter portion of the year. This year my daughter turned four, my son turned one, I stopped breastfeeding, I found a new job, my husband quit work (for the better of the household), I delivered 120 babies, and I passed the board exam. I didn't lose much weight, I didn't stop drinking wine, and I didn't stop being snarky (go figure).

In the year 2009, I will have been graduated from high school for 16 years, graduated from college for 12 years, graduated from medical school for 8 years, married for 8 years, and a mother for 5 years, and graduated from residency for 4 years. I can't believe it. I turned around, I blinked, and the time was gone. I read once that as we get older, one year of life statistically becomes shorter. For example, at 2 years old, 1 year is half of your life, at 50, I year is 1/50 of your life. I do know that the coming year holds a big move, hopefully a sale of a house, the start of a new job (and with it a new lifestyle), kindergarten for CindyLou, and a multitude of other wonderful things that I couldn't even imagine. And it will feel like just a minute ago, but 2009 will be over, as well. My father always says that "These days *are* the good old days." I know one day I will look back at myself at 33 and laugh at how "young" I sounded. So my resolution for 2009 is to take each moment, the stressful and the relaxing, the harried and the hopeful, the highs and the lows, and remember that it is but the most fleeting moment in time, and from that, may I, may we all, find peace in truly living each moment in the coming new year. Happy New Year, Mothers in Medicine!

Resolved:

We're coming up to the new year, traditionally a time for resolutions to be made - in jest (I resolve to never drink so much spiked eggnog ever again) or in a real effort to better ourselves (I will keep up with all of my paperwork in the office every day). What are some of the resolutions you've made in the past, or are planning to make now?

To get started, my resolutions are the same ol' boring resolutions I make every year: 1) get the home office cleaned out and usable! 2) be a better [enter one, pending day and mood: wife, mother, doctor, friend...]. 3) Exercise regularly.

NOTE: If you're worried about being held to your resolution ('cause I'm going to follow up in August!), leave a comment anonymously...

A

image credit: www.buycostumes.com

Moms: Adopt a resident today!

Quick public service announcement:

The wintertime, especially around the holidays, is a really depressing time for residents. Especially interns. There's nothing like being on call during the holidays, driving to work while it's still dark and knowing you'll be up all night and won't be going home till the next day. That you'll be away from your family, your spouse, your child on a holiday that's all about togetherness. It's a time when a lot of sleep-deprived interns are pushed to their breaking point.

So if you're someone who works in a hospital as a doctor, nurse, or professional patient, do something nice for one of those depressed residents stuck in the hospital through the holidays. A few kind words, a cookie, a much-needed hug, etc... it's all good!

Getting in the sterile field

This is an old story, very unexpectedly resurrected by a near-stranger. A few years ago, as an oncology fellow, I was on an outpatient "float" rotation over the Christmas holiday week. What I thought this meant was short hours, no call, and no eternal rounding on the inpatient service. Hooray! What it actually meant was that all of the attendings were on vacation, so I was double-booked or triple-booked with procedures on their patients to be done--tapping malignant effusions from this space and that one and instilling chemotherapy in some of them--and that I wouldn't eat lunch or usually even get to the bathroom during my workday for the entire week.

One of the patients I met that week was a woman I'll call Sara, a nonsmoker in her 40s with lung cancer and carcinomatous meningitis. She was getting intrathecal chemotherapy instilled into the Ommaya reservoir in her brain three times a week...and this week, while her attending was skiing in Colorado, it was my turn to do it.

As you can imagine, putting chemo into someone's brain is a tad unnerving. The sterile field is no joke. Enough said.

Sara was a delightful young woman but very scared of needles. Sara's husband was an extraordinarily hairy, extraordinarily affectionate guy. Though I had never met them before, it was obvious they were MADLY in love. They had been married for 7 years, as they told me in a giddy voice at some point, but they looked like honeymooners--nuzzling noses, rubbing each other's shoulders. It bordered on inappropriate for a clinic waiting area, but I figured: hey, she's got metastatic cancer; they can do whatever they want. I certainly wasn't going to say anything about all the physicality....

except that it was almost impossible to administer her intrathecal chemotherapy. Over and over, I would sit her up and prep and drape her upper half. At the moment of truth, dose measured, name and history number of the sticker double-checked against her hospital bracelet, syringe full of chemotherapy approaching, his big hairy hands would grip her cheeks through the drape, and he would plant a big kiss on her forehead and say, "It's just one more small needle, hon, and it'll be over in a few seconds" or "I love you so much. You are the strongest woman I know." On more than one occasion, he actually lifted the drape with those big furry hands and said, "Baby, how do you manage to look so beautiful without a single hair on your head?" He looked lovestruck every single time I saw him, as though he would die if she had to be draped and therefore out of his sight for another minute. Over and over, I explained that this was the brain we were dealing with. Over and over, I explained the sterile field and how you really couldn't get in it, seriously. Over and over, he couldn't resist--or, more precisely, couldn't resist her. Every single time I saw her that week--three visits in all--it took at least 3 tries to seal the deal and instill the chemotherapy into her brain. Though I will admit that it drove me crazy at the time, particularly on the busiest days, I always walked away from those visits kind of smiling to myself.

I learned 2 or 3 weeks later from Sara's attending that she had passed away. She was sitting on the toilet one morning and just fell over dead. Her husband was so grief-stricken by the realization that she was gone that he just held her on the bathroom floor until she was cold and it was dark outside, and then called 911. By the time the ambulance came, she was clearly long-deceased, and they did nothing more than give her (and him...in the back, lying on the stretcher with her) a ride to the hospital. Apparently it violated their policies, but apparently they couldn't say no to him. Huh.

Though I didn't know either Sara or her husband well, I was absolutely overwhelmed by their love. I have cared for a lot of cancer patients and their families at the end of life and witnessed love under the magnifying glass of impending death more times than I can remember. But Sara and her husband were different somehow. Their love was truly unconditional, timeless...raw and unstoppable.

I'm not sure why, since I really didn't know him, but I decided to write him a quick condolence card. It was a completely nondescript card from a box of generic condolence cards--a sad reality of life as a medical oncologist that we buy the bulk condolence cards in packs of 10 or 25 the way others buy their generic thank you cards--but it's the thought that counts, right? As I wrote and reflected on why I had been driven to write to this near-stranger, the words just kept coming. It ended up having 2 or 3 extra pages (all on basic white paper from a Staples 500 pack) added, folded up inside the card. Unleashed, the letter morphed out of my control--as I recall, there was talk of great loves and young life inexplicably cut short and spirituality. I never got any reply. I hadn't really expected to, but I nonetheless wondered if I had overwhelmed him (did he even remember who I was?). Eventually I let it go and kind of forgot about the letter and Sara and him in the deluge of loss we face in oncology.

Years passed. On a random busy December day, I was in clinic and one of the front office staff came to get me, saying I had a visitor. It was Sara's husband. I didn't recognize him at all at first. He had cut his previously longish hair very short and shaved off his full mustache and beard since I last saw him. He looked tired and old for his apparently middle-aged age. As I approached him, I searched his face for clues of who he might be, not wanting to deal with the awkwardness of confessing I had no idea who he was. Then he stuck out his hand--the hairiest hand I have ever felt--and it all came rushing back. "You're Sara's husband. How are you doing? I hope you're not here as a patient..." (it is a Cancer Center after all).

He proceeded to ramble, standing right there in the lobby, how much he had loved Sara, how much he treasured that letter, how much it had quieted his mind that a stranger could see how much he loved Sara, reasoning that if a stranger could be so moved by his love for her, then surely Sara must have known how much he loved her, and how that was all he could ever ask for on earth. Then he said, "We always had a bunch of photographs and knick-knacks on our hearth. After Sara died, I cleared them all off. The only thing up there now is the urn with her ashes...and your letter. Anyway, I just came to tell you that." Then he turned and walked right out the front door.

I was too dumbfounded to say anything or walk after him, but in mind, I said to him: You just got in the sterile field all over again.