Another Birthday

Today is my birthday.  Yep, today.  On this fourth day of this fourth month of this year, I officially have turned 44.  Should I buy a lottery ticket with these numbers?  Something is whispering to me that if I ever had a realistic chance to win, it would be today.  Nah, who am I fooling--I think I'll just keep that errant dollar in my pocket.

44 is an odd age, though.  Am I middle-age?  Am I the new thirties?  Is my life half over?  Or more than half?  That thought makes me shudder.  I look at some of my patients in the ER, those in their 20's and 30's, and in my mind I am dealing with someone in my own age group.  Maybe they have less wrinkles and a fewer amount of life experiences, sure, but otherwise we are the same, aren't we?  That is until they call me "sir," a word I am growing less fond of the older I get.  And suddenly, I am reminded that no, I do not have as much in common with this college student sitting on the treatment cot in front of me as I might have thought.

Still, birthdays are pretty special when you are surrounded in your life by people who make a big deal of them.  Being one of seven kids, I've already received texts by four of my siblings and some nieces and nephews to "have a great day."  The phone calls will follow tonight, with multiple renditions (mostly bad) of the song "Happy Birthday" sung to the answering machine or myself.  When my mother was alive, she and Dad would always call and sing "Happy Birthday" in harmony from their two different receivers, Mom carrying the high notes and Dad trying to blend his deep, husky off-tune baritone to compliment her.  Since she passed on, Dad still keeps this tradition alive.  It is bittersweet, to say the least, to have Dad call and sing a solo "Happy Birthday" to me.  A big sigh typically follows, and longings for my mother's missed presence follow that.  The beauty in this, though, is that over the two years prior to Mom's lost battle to leukemia, we recorded every "Happy Birthday" sung by them to my family.

My kids and wife, though, are the real reason the excitement level in our house today is immense.  For the past week, there has been whispering between she and my kids that suddenly stops when I enter a room.  There has been hushed huddling in front of the desktop computer, a flurry of hands blocking the screen's view when I walk into the office.  There have been shopping trips to the mall, the kids returning with big grins on their faces and filled shopping bags held behind their backs.  "Don't look, Dad!"  has become the newest greeting in our house.  Tonight I will eat my favorite cake, chocolate from scratch (which includes a cup of coffee) topped with mounds of creamy peanut frosting, made lovingly by my wife from Mom's recipe.

So today, then, is the day.  My 44th birthday.  I was woken up with hugs, warm and heartfelt and accompanied by morning breath.  And chimes of "Happy Birthday, Dad!"  There is no better sweetness in this world than hearing these fluent, tender words from your children's innocent mouths.  Birthday wishes from my wife, too.  A flurry of activity followed as they got ready for school.  A grab of my hand by my youngest, who lead me to the dining room table to proudly show me the presents that await my opening.  Their homemade cards and homemade gift wrap make my smile double.

Then, too suddenly, the buses came to take my kids to school.  My wife left in the SUV to work her school-related job.  And, just like that, all of the excitement contained within our four walls just minutes earlier dissipated, a big balloon of happiness and anticipation popped... to be filled up again upon their return.  I go to sit alone in my office.

I have the morning and afternoon off, but work an odd evening into morning shift tonight.  So I sit here in my silent home, giving up the hope that cranked techno music from Robyn on YouTube will bring back all of that excitement.  It didn't.  Instead, a life lesson smacks me in the ass.  Hard.

My birthday and this swirling excitement that comes with it is not just because of the day.  Or the cake.  Or the presents.  It is because, simply, on this day, I am reminded of just how blessed I am to be surrounded by so many people in my life who love and care for me.  The simple texts, the emails, the phone calls, the snail mail birthday cards--all warm hands coming from near and far to wrap themselves around me on this day.  There are no better birthday gifts...

Sitting here, introspective and reflective of my life so far, I find that I am beyond grateful.  Grateful for it all.  The family.  The siblings and parents.  The nieces and nephews.  The cousins.  The friends.  I am a lucky guy.

After all of this, I looked at a brown envelope sitting on my desk, sent to me by one of my best friends through medical school--KT.  To know KT in this life, to have her friendship, is one of those precious gifts I sometimes take for granted.  She is, after my wife and Mom and sisters, one of the most remarkable women that I will ever know.  Her kindred spirit and friendship is unmatched.  And besides, how many other family physicians do you know still make social calls to their patients' homes?

What follows is a cursive note she sent (along with a beautiful book and two birthday cards).

Dear Jim,

     My friend, my brother...how does it feel to you to be celebrating a life so full?  I am acutely aware of the significance this year of similar double digits!
     At 11, I was hiding in the woods with my friends, telling secrets, crushing on Bobby Joe across the street (be still my heart!)  I was a child in a giant's body!
     At 22, I owned the world...I was a college graduate and I was going to medical school!  I was sizzling!  Life was mine to take!
     At 33, I was a mother, in love with my girl, struggling to mesh my original dreams of being a doctor with my dream, unexpectantly better, of motherhood.  I couldn't get enough of my daughter if I ate her!  She was and still is a force in my world!  What a ride I got, eh?
     At 44, I know contentment, really and truly.  But I also know worry...  My life and love has blossomed as my family came to be--a daughter, a son, a dog, and oh yeah, a husband.  I know I am not invisible--my achy hips let me know that every day!  But I am more alive now than ever before.  I have loved, lost, given and gained...
     What will the next half bring?  55?  66?  77? 88? And, oh yeah, I plan on doing 99.  You too?
     So, my brother in this walk...I wonder what you would say about 11, 22, 33, 44?  I think I can guess a few of the emotions.  We have been blessed in love and in friendship, haven't we?

Big hug, Jim!  Have an awesome birthday!  KT

How's that for a birthday gift?

May everyone have a birthday like mine today, where they are reminded of the beauty of the people in their lives.

Now, where are my presents???

As always, big thanks for reading.  May KT see the beauty and specialness in her writing voice here today.  To my family and friends, especially my wife and kids, thanks for making this a special day...I am smiling here.

No Baby Yet

Despite the weighted concern and anticipation that enveloped Room 21, I was greeted with two genuine, hopeful smiles. Innocent smiles, actually. Smiles that unassumingly revealed a faith and confidence that life would be fair and good to them.

From the moment of our introductions, I liked this youthful couple, both just entering their twenties. She was the patient, sitting upright in her treatment cot, her legs fully-extended in front of her and nervously crossed at the ankles. She was thin but strongly built, her athleticism exposed by her muscular tone. Her angular jaw and full cheekbones were framed by the pixie-cut of her light brown hair. Her blue eyes sparkled.

He stood beside her, to the right of her cot, holding the hand she offered him. He was tall and pudgy, several times nervously swiping at the sheen of worry revealed by his forehead. His blondish hair was haphazard and messy. His face was average, muted, nothing quite as striking as his girlfriend's, and yet his brown eyes burned with a fierce intensity.

They had presented to our ER with a a significant concern. The patient was pregnant, barely nine weeks, and had started having abdominal cramping and vaginal spotting approximately thirty hours before they arrived. "Now I am bleeding so much, it almost seems like a period," she shared, looking from me to her boyfriend before looking back to me again. Her face was expectant, almost willing me to tell her that everything would be fine. That this bleeding and cramping was not out of the ordinary.

Unfortunately, I couldn't speak those words.

"How far along are you?" I asked them. "Nine weeks and two days," the boyfriend answered. Such exactness already answered my next question. "Is this your first pregnancy?" They both nodded yes. The excitement and magic that accompanies a first pregnancy is unbridled and elicits many memorable moments--including ticking off each day of the forty weeks. I could picture this couple's calendar hanging on the wall in a small, canary-yellow kitchen with old white appliances, an "x" drawn through each passed day.

"You really want this baby, don't you?" I asked, trying to learn about this couple, after I had finished with my pertinent medical questions.

The patient answered. "We do. We've faced a lot of opposition from our families and friends. And this pregnancy certainly wasn't planned." She paused here, looking up at her boyfriend, before continuing. "But, we are both certain we want this."

"And," the boyfriend added, "we just got engaged last week. We might just be throwing ourselves a wedding in the next few months, too." Without letting go of his fiance's hand, he continued to explain that they had dated since their sophomore year in high school. They were certain they had both found their soul mates.

I congratulated both of them on their happiness. Through work, I have seen every imaginable angle that accompanies an unplanned pregnancy and, although their story wasn't new to me, their can-do spirit and enthusiasm for one another and their situation made me think, just maybe, that, with or without this pregnancy, this was a couple that could endure and thrive on their life journey together.

Trust me, though, when I say that I don't get this warm and fuzzy feeling with every unplanned pregnancy. Their commitment was refreshing, plain and simple.

I called in their nurse, Carla, and we performed a pelvic exam. Unfortunately, the patient appeared to have some active bleeding that resembled a typical period. On her bi-manual exam, the opening to her cervix (the lower part of the uterus), which is usually tightly closed during this stage of pregnancy, was loosely open. Things did not look good.

"What do you think, doctor?" the boyfriend asked, unsure where to direct his nervous energy.

I needed to ask one more question before explaining the exam at length. I looked to the patient. "Have you passed any small clots or anything unusual with this bleeding?"

She hesitated somewhat before answering me. "Yes, this morning. That's not good, is it?"

Quite honestly, no--it wasn't good. Not only had her exam concerned me, but her quantitative hCG hormone level, through blood work, had come back barely traceable. Again, at this stage, the level should have returned significantly higher. Every indication was that this patient was not going to have a healthy, full-term pregnancy and was, in fact, actively miscarrying.

"No," I said softly, answering the patient's question, "it doesn't look good. I'm sorry."

It was important for this couple to start connecting the dots on their own terms. Inherently, I had to believe that they knew she was having a miscarriage, and just needed a little guidance and coaxing from my part to start accepting this reality. So I sat there on my stool a minute, silent, absorbing their response.

They both grew glassy-eyed right there in front of me. Remarkably, though, in that split moment where life can make you angry, or defeat you, or make you question everything about yourself after you've received unfair, upsetting news, this couple did an amazing thing.

They didn't get angry. Instead, they wiped one another's tears with caring thumbs. Tenderly. Sweetly. With a maturity and naturalness that belied their years. And, when they were done, they feebly smiled at one another before the boyfriend bent down to envelope his fiance' in a genuine, heartfelt embrace. He whispered in her ear and she nodded at his words.

I looked to Carla, who was watching the couple with the same wistfulness that I felt. One simply could not help but cheer for this young love. Nor could one be in that room and escape the emotional intensity of their love. Despite their youth, they were demonstrating the stuff of which people spend years trying to instill in their own relationships.

When they had collected themselves, I explained everything at length. The patient would need to get repeat blood work in two days. If the hormone level hadn't doubled in that time, or had stayed the same or even dropped, it would be confirmation of our suspicions. Suspicions that were extremely solid, already.

Sitting at my computer station after treating them, out of sight, I heard their familiar voices speak to our secretary on their way out of our department. "Please tell Dr. Jim and Nurse Carla that we appreciate all they did for us today." I rolled my chair through the doorway into their view. "Thank you," I said. "I hope you both have a fantastic future together. You deserve it."

And I meant it. They did deserve a bright future.

As always, big thanks for reading. I hope this finds you all enjoying the last days of summer...