My drawing of my mother, Marian Wagner Spiro, suffering from the effects of dementia, wearing the iPod and headphones I gave her. (from a photo taken by my sister, Martha, in the last weeks of mom’s life…)
There is so much to say, and so little that I find myself capable of saying at this time. The loss of one’s mother, no matter how fraught the relationship, is always incalculable, quite literally unable to be calculated. Because of the divorce from much of my family, included the extended network of cousins and so forth, imposed by my father for nearly forty years, I lost many years and many memories I might have made with my mother, and needless to say with the rest of my native family. However, because of this, along the way I learned the value of friendship, not just the emotional support and love from some one significant other, since I had none, but the kind of friendship about which it has been written: Greater love hath no man than this, that a man lay down his life for his friends. I learned what true friends are, and that they can love a person and care about a person perhaps with deeper love and kinder regard even than one’s family of origin.
This is not to say that I do not love and care about my family, of course, but it is my friends to whom I dedicated my newest book of poems and art, my friends both old and new. And they know who they are, I am sure they do. Because I feel it and I know it.
But that much said, I loved my mother, and what is more, I know she loved me and would have wanted me to have these loving friends in my life, especially once she understood that having a nuclear family of my own was not in the picture for me. I do not believe that she cared about whether I ever became a doctor or even a successful poet or artist, but only that I found contentment and love in my life, somewhere, somehow, and that she would be proud of me now, not for my achievements but for all these wonderful friends whom I love and who I know love me in return ( and in return for nothing except being me).
I love you, Mom, and I wish you well on your journey, wherever that takes you…Be at peace and know that all is well.
I wrote this poem, or started it the night of my last visit to my mother, after weeks of not being able to put pen or pencil to paper. My younger sister, Martha and I had been splitting up the time and watch at the Hospice, though Martha had done the lion’s share of everything, living as it were just around the corner, while I needed a driver to get me first to Agawam and then to from Vermont to Amherst each day. In any event, just as I was finishing it, Martha called me with tears in her voice telling me that mom had passed away more suddenly than expected, no time to call me to come down to the hospice to be with her at the end.
HIATUS – June 18, 2017
“Just letting you know I am taking a hiatus because my mother is in the process of passing away and I need to give that my full focus.”
In the snapshot I take, you are almost not there,
barely stitched to your body by broken breathing,
those strands of beads upon which none of us pray
to keep you here, still here, still here…
the seeming years of days and nights
of your going having frayed the long wick of your life
till it seems impossible your heart pulses and breath
still clings to the flesh that clings to your bones.
In the stillness like stopped breath,
as the clock duties our days, from your morphine remove,
you can’t know how we mark a terrible time
while we wait for what is to come,
the inexorable exit-gong sounding: It is done.
All the same, they say life starts over, Mother,
if there is ever any life on earth without you,
as if we believed this day would come, or any other,
My brother visited me recently and for some reason we got into a discussion about whether or not we supported physician-assisted suicide. We differed on the fundamentals: Phil, aka Chip, supports assisted suicide in every sense of the word. He thinks that it should be legal for a physician to prescribe a lethal medication essentially for anyone who asks.
This horrified me. Wait, he went on to explain. In his opinion, everyone should have to push a button upon waking in the morning in order to stay alive. If you failed to push it, you die. Meaning that the day would begin with everyone choosing to live, thus having to take responsibility for making that choice. We would start with the premise that every person who “wakes up alive” has chosen to live and cannot claim rightly to be suicidal…I guess that Chip as a psychiatrist, feels too many of his patients do not want to live, but also do not sincerely want to die, and he thinks that they need to acknowledge the latter. That might be good, but I also know that there are those who are so depressed that in their involuntarily mentally incapacitated state, they might not be able to press the “I want to live” button, and thus would die, even though in a healthier frame of mind, they would have chosen to live…
For me, I agree that when terminally ill, a person should have the right to end his or her life, and should be able to do so without interference from authority, legal or medical. I also think that in certain cases, palliative or hospice care helps with this, and already has done, silently and as it were secretly for years: the administration of a sedating dose of morphine when the time is right goes a long way towards assisting a person’s “dying process.” Not a lethal dose mind you, but a dose to “ease breathing” and one from which the physician and all witnesses understand the person will likely never awaken.
(My friend Joe is another case entirely. They turned off his ventilator and dosed him with morphine after 4 years with ALS. I firmly believe that they murdered Joe outright, against his will…But no more will be said of that at the present time.)
On the other hand, let’s face it, if you really want to commit suicide, it is easy to do so if you are able-bodied and not terminally ill: just jump in front of a bus, or out of a tall building’s window. There are a dozen sure-fire ways and they have been used for millennia as an easy way out. The problem is for those who are physically so debilitated that they literally cannot “jump” or swallow the pills or whatever. Yet unless they are forcibly nourished and hydrated through a feeding tube, they can always refuse food or liquid, which it seems is not agonizing after all. That is according to what recent research and personal witness (my own) have indicated. When my friend Lynn L died – essentially from not a refusal to take liquids– she did not suffer acutely from deprivation but seemed slowly to cross into a never-never land. She simply drifted off to an endless sleep and passed away.
The idea that a physician could freely prescribe an overdose of a lethal drug to any someone who came asking for it, that just strikes me as the height of 1) irresponsibility and 2) cruelty, by someone whose job, after all, is characterized by the Hippocratic Oath: primum non nocere or “First do no harm.” If killing a patient is not doing harm, then I do not know what is. I simply do not understand how bloodying one’s hands in the act of killing, no matter how good one’s intentions, cannot but badly affect any so-called healer.
Surely there are other ways to deal with a person’s pain and suffering than to throw up one’s hands and say, well, I cannot help you feel better or live longer, so I will simply shoot or poison or – whatever – you so you feel nothing and don’t have to deal any longer.This completely disregards the inherent value of the struggle itself, and the promise of something worthwhile, if only at the very end at the moment of dying, in having faced the suffering and undergone it fully.
Look, I do not like or want anyone to suffer agony in the last stages of life, and am all for morphine use, liberal or sparing, depending on the patient’s desires and needs. But there is no absolute value in complete suffering or pain relief, not in my book. For me, I insist that I must feel my own feelings, and in that quest, I must decide to feel the pain, emotional or otherwise, rather than dull it with drugs or anything else. Yes, it hurts, but the hurt somehow feels better because it is mine and real, and not the forced dull nothingness of being drugged out of it.
If you have other thoughts about this, do feel free to share them in the comments section. In the meantime, I found this article on the very same subject at Medscape Psychiatry. It was written by ethicist and psychiatrist, Ronald W. Pies, MD and may be found in its original form at this link:
My 89-year-old mother had been losing ground for some years, experiencing what geriatricians sometimes call “the dwindles.” Toward the end of her life, she was beset by a deteriorating heart; an inability to walk; and occasional, severe gastrointestinal pain. My family got her the best medical treatment available — eventually including home hospice care — and she generally maintained a positive attitude throughout her long downhill slide.
But one day, as I sat beside her bed, she seemed unusually subdued. “Honey,” she said, “How do I get out of this mess?” I had a pretty good idea of what she was really asking me, but I deflected her question with another question: “Ma, what ‘mess’ do you mean?” I asked. “It’s all right,” she replied, smiling sadly, “I’ll manage.”
My mother was doing what she had always done: sparing her children from pain. In this case, it was the pain of dealing with the waning days of her life and the frustration of knowing there was no easy escape from the burdens of dying slowly. “Ma, I’ll always make sure you are getting enough treatment for your pain,” I added, taking her hand — knowing that the prospect of unremitting pain is often an underlying fear of terminally ill persons.
Yet, unspoken in my mother’s question was the issue of so-called physician-assisted dying, sometimes called “physician-assisted suicide” — an enormously heated controversy both outside and within the medical profession. In my home state, Massachusetts, the issue has come to the fore, owing to a November ballot initiative for a measure that would allow terminally ill patients to be prescribed lethal drugs. A closely related bill (H.3884) has also come before the Massachusetts Legislature’s Joint Committee on the Judiciary.
Similar to laws already on the books in Oregon and Washington state, the proposed Massachusetts law builds in numerous “safeguards”: For example, patients would be required to submit their request in writing twice, and those requests must be 15 days apart. As reported recently in the New York Times, fears regarding widespread overuse or abuse of the so-called “death with dignity” laws in Oregon and Washington have largely failed to materialize, at least according to some studies.
Nevertheless, the Massachusetts Medical Society (MMS) has long been opposed to physician-assisted suicide. In March 2012, the MMS President, Dr. Lynda Young, testified before the Joint Committee and did not mince her words. Allowing physicians to participate in assisted suicide, she stated, “…would cause more harm than good,” and she argued that “…physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Instead, Dr. Young asserted, the physician’s role should be to ensure that the terminally ill patient “…continue[s] to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.”
With considerable ambivalence, I agree with Dr. Young. In my view, terminally ill but mentally competent patients should be at liberty not only to refuse further medical treatment, but also to end their own lives — for example, by refusing to accept liquid or solid food. Contrary to a widespread belief, voluntary refusal of food and fluids does not result in an agonizing or painful death, according to a2003 report in the New England Journal of Medicine. Indeed, medical ethicist Dr. Cynthia Geppert informs me that voluntary refusal of food and drink is now considered an accepted approach to dying in palliative care.
As Dr. Thomas Szasz has argued in his book, Fatal Freedom: The Ethics and Politics of Suicide, a liberty is not the same as a right, because the latter entails a reciprocal obligation on someone else’s part. (If I have a right to free speech, the state has a reciprocal obligation to protect that right.) Moreover, the liberty to commit suicide does not entail the “right” to have one’s physician prescribe a lethal dose of medication. Indeed, Dr. Szasz believes that “physician-assisted suicide” is really a euphemism for “medical killing” — more technically, “heterohomicide” on the part of the physician.
While I disagree with Dr. Szasz on many issues in psychiatry, I think his analysis here is essentially correct. Physician-actuated heterohomicide, in my view, is “fundamentally incompatible with the physician’s role as healer.” I believe that permitting physicians to write prescriptions for lethal drugs will eventually erode the trust that all patients should place in their physicians. More than a euphemism, “physician-assisted suicide” may be a contradiction in terms. And in my view, the very concept violates both the implicit ethical contract between physician and patient, and that between the physician and society.
To be clear: None of this means that physicians should collude in the cruel and unnecessary prolongation of dying, as is often seen in hospital settings. As physician and ethicist Dr. Fred Rosner has argued, “To prolong life is a [commandment], to prolong dying is not.” Thus, in the Jewish medicoethical tradition, “removing impediments to death” is sometimes acceptable — that is, discontinuing treatments that needlessly prolong the dying of a suffering, terminally ill patient, but without actively bringing about the patient’s death. (The distinction between “letting” someone die and “making” someone die was supported in the 1997 US Supreme Court case of Vacco v Quill,which upheld New York State’s ban on assisted suicide.)
But what about those suffering, terminally ill, mentally competent patients who will not choose to end their lives by refusing food and drink and instead seek out “assistance” from healthcare professionals? Again, I do not believe that medical professionals should participate in assisting a patient’s suicide. But I sometimes wonder whether society ought to permit somebody to do so.
For lack of a better term, let’s call such a hypothetical individual a “thanatician.” Let’s posit that carefully trained and closely monitored thanaticians would be permitted to provide medically screened, dying patients the same type of lethal medication now prescribed by physicians in Oregon and Washington — under essentially the same restrictions and safeguards.
But wait: Isn’t this proposal a cop-out? Doesn’t it merely place the moral issue of assisted suicide in the lap of the nonphysician, allowing the dying patient’s physician to shuffle off with a clear conscience? Even worse: Would the use of such death-dealing personnel amount to abandonment of the patient, as Dr. Geppert recently suggested to me?
Still other questions arise. As my colleague Dr. James L. Knoll has suggested, might not the training, monitoring, and supervising of thanaticians create more problems and headaches than it would solve? Finally, doesn’t the very notion of “thanaticians” suggest that we have lost faith in what Dr. Knoll rightly calls “the intensely personal journey” of doctor and patient?
I, too, struggle with these questions and find no easy answers. I suspect that at present, the best approach to the dying patient is through the skills of the palliative care physician. Palliative sedation, for many terminally ill patients, may be a viable alternative to managing suffering without ending life. Moreover, a careful psychiatric assessment of patients requesting physician-assisted death is always indicated, because major depression may distort the patient’s judgment as death approaches.
How we deal with terminally ill patients is a painful topic that I never discussed with my mother, who was fortunate enough to have excellent home hospice care in her final days. But I believe this is a discussion we urgently need to have.
Acknowledgment: I wish to thank Cynthia M.A. Geppert, MD, PhD, and James L. Knoll IV, MD, for their valuable comments on earlier drafts of this article. The views presented here, however, are solely my own.
I was in hospital for a month, the decent hospital but a bad time. The day I was discharged a good friend of mine died two thousand miles away and two days after I was discharged my beloved father died in the Connecticut Hospice after a brief unexpected illness. I am bereft and distraught, and don’t know what to do…Terrified that I cannot live or survive without the person who, for the last 7 years, seemed to me to keep me together. Not my twin (HAH!) not my other family members, but my father, who after 30 years of silence returned to me and spent 7 years trying and largely succeeding in “making up for lost time.” I will write more later but right now I have to get through the memorial service on March 24th (next Saturday).
Here is the official obituary which should come out today in various nation-wide papers.
Howard Marget Spiro, MD, 87, of New Haven and Madison died on March 11, 2012 at the Connecticut Hospice after a brief illness. Dr. Spiro was born in Boston, MA on March 23, 1924 to Thomas and Martha Spiro. He was raised in Newton, MA, attended Harvard College and Harvard Medical School and married his wife, Marian, in 1951. He spent two years in the Army and subsequently moved to New Haven in 1954 where he was asked to establish and head the division of Gastroenterology at Yale Medical School. After writing a major textbook, Clinical Gastroenterology, Dr. Spiro became an internationally recognized clinician and travelled extensively, teaching other doctors not just the science but the art of clinical medicine. In 1982, Dr. Spiro stepped down as Chief of Gastroenterology and took a sabbatical at Stanford’s Center for Advanced Studies in the Behavioral Sciences, a well-deserved respite which reminded him that physicians are above all human beings. After he returned to Yale in 1983 and founded Yale’s program on Humanities in Medicine, perhaps a natural move having majored in English in college, he wrote several books in which he attempted to bridge the divide between the humanities and clinical medicine. These books covered such diverse topics as the placebo effect, doctors’ experiences with their own illnesses, empathy in medicine and medical history. An active clinician and educator, Dr. Spiro continued to teach and see patients until he formally retired in 2009 at the age of 85.
Respected for his scholarship and admired for his optimism, Dr. Spiro was also known for his wit, maverick opinions and love of repartee. One notable if uncommon position he held was that knowledge of organic chemistry is unnecessary to enter medical school. He once claimed, “Neurobiologists are convinced they’ll find everything if they measure everything and chase down everything. But will they find ambition, will they find greed? How are we going to explain the seven deadly sins by the biology of the cell?” He will be missed not just by his family, his co-workers, his students and his patients, but by the international clinical community.
Dr. Spiro is survived by Marian, his wife of 61 years and his four children. He also leaves six grandchildren, a sister and two stepsisters and several nieces, nephews and cousins. [I took out their names for privacy’s sake]
A memorial service will be held at 11:00 on Saturday March 24, 2012 at the Unitarian Society of New Haven on 700 Hartford Turnpike, Hamden, CT. A reception will be held at the same location following the ceremony. In lieu of flowers please make donations to the Howard Spiro Fund for Medicine and the Humanities at The Yale Medical School.This fund is dedicated to continuing Dr. Spiro’s dream of marrying the humanities and clinical medicine in order to improve patient care.
I will write more as soon as I am able, but for now I cannot do much more than alert you to why I have been absent lo these long 4-5 weeks. I promise to get back to writing, but I suspect that may not be for another week or two.
My longtime dear friend, Joe Cornelio, died at the end of April, after living with, and I mean, living with, ALS (Lou Gehrig’s disease) for five years. Although he spent the last four of those years in a chronic care hospital on a ventilator and virtually helpless, he never once gave up on life or stopped loving it. He was a miracle of a man and even at the end I believe he would have continued to fight to live, even if all he could do was move one eyeball to say yes or no. It is entirely possible that he would have wanted to live even without that ability, but we will never know.
It is difficult for me to write about the day he died, or about how it came to pass that he was removed from his ventilator, but if you will bear with me, it may do some good (for me at any rate) to put the pieces together and get it onto paper.
I believe that Joe was misdiagnosed for many many years with schizophrenia, when in fact he had had Asperger’s from childhood. Now, that’s a long story in itself and though I could make a case for it, I cannot prove it. But I am not the only one who knew him well to notice that he never once exhibited signs of psychosis or even real delusions or true paranoia. Furthermore, from what I gather, the only reason the diagnosis came about or “took” was because he was put on Trilafon by a well-known psychiatric incompetent who was later “defrocked” and when Joe looked the drug up in the PDR and read what it was used for, he concluded that that meant he must have schizophrenia. From then on, so his story was, he told subsequent doctors this diagnosis, and apparently they simply took it on faith. In fact, for all the years thereafter until his terminal illness of ALS, the one doctor he saw not only never questioned this, but also never even reconsidered his absurd concomitant Dx as bipolar, even though Joe clearly had one of the most placid temperament possible and certainly wasn’t the slightest bit moody. No one so far as I know ever even considered that there might be something else going on. Even when I once went with him to see his non-medical therapist, did she really seem even to want to think about the possibility, as if it might be too much trouble…Perhaps, though I cannot recall, it was too late, if in fact this was after Joe’s ALS diagnosis.
But as I said, that is a long story, and not being a doctor, I suppose I can’t make the diagnosis, except that as his closest friend, I do and I feel that a great injustice was done. Not only was he saddled with a serious psychiatric diagnosis, and a stigmatizing one at that, but that particular neuroleptic medication rendered him much too tired to work as an engineer. All his adult life that was what he really wanted to do. Work. But the drug sapped his stamina…Worst of all, although eventually on Zyprexa which helped what might have been poor social skills due to Asperger’s, after he had been on it for years it caused the diabetes that ultimately cost him his life.
Speaking of engineering, all the years I knew him, Joe thought, breathed and ate engineering in one fashion or another. It is not that he was an automaton or a bore so much as that he applied engineering thinking to every problem that came up in life, even to our quarrels. Or better to put it, to my various emotional upsets. Whenever I got in some sort of “state” his approach was always to remain calm and to break things down into little pieces and to try figure out, or to help me figure out what was wrong and (just like a man) how to fix things. The beauty of this approach was that it so often worked! He never fed the fires, and he never took things personally, which was pure magic. Sure, he could be irritating for the same reasons, since when he was the source of my irritation, he rarely responded and he never listened to anything I had to say, unless someone in authority said the same thing, and then they got the credit. This hurt my feeligns time and time again, for I felt that he never took me seriously, and discounted everything I said as being worthless for my lack of degreed expertise. However, I came to accept that and by the end it was just a joke between us. I would find him a real expert to tell him what I already knew, just so he would believe it.
Anyhow, for all his faults, and even the dead are not blameless, he managed his last illness with amazing gracefulness and not a word of complaint. The day before he was hospitalized with the pneumonia that put him permanently on a ventilator, he saw a new doctor, who actually gave him a clean bill of health, so to speak, and said his lungs were clear! Joe came away from that hour and a half appointment not saying a word, even though he could not breathe well, and had been to see him because of it. The doctor must be right, no? After all, he was a doctor. (So much for medical degrees and expertise…) It was only later that evening when he went into a breathing crisis that Karen drove him to the ER where they found him suffering from aspiration pnsumonia, a common result of ALS when the throat muscles are too weak to prevent saliva and food and liquid from entering the lungs. He was immediately taken to the ICU and spent 3 months there, first with the aspiration pneumonia that almost killed him, and then, just as he was being weaned off the ventilator, with 2 more cases of hospital acquired bacterial pneumonia, which made it impossible.
After that, it was four years in the Hospital for Special Care in New Britain, where the care was indeed special. They were wonderful to him there, and I believe he would never have survived as long as he did without them. But in the end, Zyprexa had caused diabetes, which he did not even know he had until the ICU tested his blood sugar, and it was uncontrollable even during the years at the HFSC. During the final year the tissue around his tracheostomy started breaking down and would not heal, which is not unusual in diabetic skin wounds. Eventually the hole that held the tube grew so large that the air began leaking so much that he was not getting enough oxygen without the pressure beign increased dangerously, and during his last week, his lungs began to bleed, probably as a result. He went in and out of consciousness, according to whether or not he had had a transfusion.
Amazingly enough, though, one of the last times I saw him completely alert, conscious and able to communicate, he told me by moving his eyes and indicating letters on a letter board ( he had lost the ability to control his computer, which for years had spoken what he spelled with the gaze of his eyes) that he was “still chugging along.” When I asked him if his life was still worth it, and if he was still happy with it, he answered without hesitating, YES.
He knew he was dying, but he begged me to make sure no one killed him, that no one just pulled the plug on him or let him die through neglect. I promised him that, and asked his cousin, who was in charge of funds to hire an aide, just for someone to sit with him during hours when the hospital might be short staffed. This man, Ben, turned out to be an angel in disguise, apparently, though I met him only on the final day.
Why the final day even came as it did I will never know, I suppose. I still do not understand the rush, when the very day before from all reports Joe had been quite conscious alert and seemingly content. All I know is that I got a call the next morning that he was going to be taken off the ventilator that afternoon. I asked first if he was unconscious, and was told, um, yes…but it didn’t sound convincing. Then I asked if this was his wish. The response was that it had been pre-arranged back when he had first become ill.
I wanted to say more, but I was up against two strong men, his cousin and the doctor. And under the pressure of the moment, I forgot that I had any rights in the matter, if I did still. I forgot that at least in Joe’s living will I had been designated at one of the medical representatives, and that the cousin was supposed to consult with me before making any end of life decisions for Joe, and then only if Joe were in a persistent vegetative state or completely and permanently unable to communicate. But so far as I could tell, neither of those conditions were true, had not been true up until now and could not be shown to be true within the space of one day. Yet the announcement was so sudden and so abrupt and definite, that I had no chance to say, Wait a minute, what is the rush?! I simply stammered that I would be there asap. I now wish to god I had stood up for Joe. I know he was conscious when I got there, I know that he could have communicated with me and probably have indicated whether or not he wanted this done. But I didn’t dare ask him, or even bring it up, lest they kill him anyway and my letting him know in advance only increase his terror…Would they have done it expressly against his will? I had no idea! I was terrified that indeed they would have. I didn’t know what to do… I had brought in music for Joe to listen to, because I thought that he was unconscious, but he didn’t seem so to me and though he couldn’t respond, he did seem to see me. And even his cousin talked to him with the same apparent understanding.
But it was all grotesque, because I knew what we all did, and were dancing around not saying, which was that Joe was going to die within the next ten minutes. NO one even said a word. (I admit that I did, privately, indicate to Joe when all were out of the room, that I would be there all of the afternoon, for as long as he needed me, but I didn’t tell him exactly why. Well yes, I did say that the plans he had agreed to at the start of his illness– I cannot recall what I in fact said, but I let him know as gently as I could what was going on. Was I cruel, unintentionally? Well, get this: The doctor who was going to pull the plug came in and in front of Joe, as if he could not hear him, told us all what was going to happen, how he would make Joe unconscious with morphine and then turn off the ventilator, and related each stage that Joe would go through as he died…He told us this blow by blow right in front of Joe, right as I am sitting there at Joe’s side. But when I asked him to speak directly to Joe, he said, “No, not in Joe’s frame of mind, that wouldn’t be helpful.”
HUH????? What was that supposed to mean?
I will probably be asking that for a long time. Why did he not act like the compassionate physician he was supposed to be? Where was any shred of compassion? For god’s sake, if he was “helping Joe not suffer” where the hell was his empathy for his mental suffering? Did he think that just killing him was not going to cause suffering? I mean, what the hell?
Well, I cannot go further with the details, except to say that I left after Joe was essentially no longer Joe, once he was in a coma. All through his illness, Joe had never seemed any different to me, had never looked or become anyone any different from my old friend. But at the moment I looked up from his hand as I stroked it, I realized that he was gone (though technically alive) and that Joe was not there. I bolted then and there, realizing that I wanted not to see anything more.
Joe is gone now, and I had a really hard time for several weeks. The funeral was held very quickly an hour away in his home town, so few of his friends who had stuck by him could go, if any. However, a few weeks later, we had a memorial service for him in the hospital, a service I personally found somewhat hurtful, but that is another long story. In any event, I wrote two poems for him, which I read for it. Only one can I print here, as I hope to publish the other before I put it in my third book.
for Joe Cornelio
When you die,
let there be lightness in your limbs, so they can rise
to lift you from your bed.
May there be clarity in your speech
so your tongue can once more speak the names
of those you love. Let those syllables wash
your tired face. Take up your hands, reach for mine.
You can wipe your eyes now.
Let your smile widen and shine as it can.
When the perigee moon rises above the water
let it pour gold through the trees,
let the fish leap in the blue ripples of evening
and the frogs that are left sleep in the cool mud.
Wherever you are, may you remember
both the friends who stayed and the friends
who scared, for all of us loved you,
blankets to your chin, and let that warm you.
And should the light fail at the end of the tunnel,