The other night a man was brought into the trauma bay. He had been shot in the back, just inside his left wing-bone, and the bullet had traveled through his chest and exited just to the left of his sternum. “Through and through,” as we say. It never ceases to amaze me how small the wounds look on the skin. They so small, in fact, that they often fool us into thinking that they are not serious. A large chest tube was placed into his thorax, and two liters of blood rushed out. It was off to the OR.
With the help of a cardiac surgeon, we sawed through his sternum and exposed his heart. It actually looked pretty good – essentially injury free. We looked next at his left hilum, which is the beginning of his left lung and the confluence of arteries and veins there. It was a pulverized mass of destruction, hardly recognizable, with blood pouring out of a gigantic hole. He was dead, even as we identified the fatal blow.
When a bullet travels through someone it makes a track – a simple line of damage along the path of the missile. But it does something else as well. The kinetic energy of the bullet causes a cone-shaped area of destruction which is wider than the simple path. This is called cavitation.
The analogy that is often used is that of the wake of a boat. When a boat travels through the water – let’s just imagine for a moment that it’s off the coast of Maine in happier times – it obviously disturbs the water along its path. But the wake reminds us that the disruption extends much further than we might have imagined.
Personal relationships are the same way. I don’t know if it’s possible to have a serious relationship without cavitation – without that energy reaching far wider and wounding much deeper than imagined. The wounds on the surface may look deceptively small, but inside – right next to the heart – they cause massive, and potentially fatal, hemorrhage.
Saturday, April 2, 2011
Thursday, March 31, 2011
Ischemia
When a patient presents with signs and symptoms of an ischemic limb – that is, an arm or leg which is slowly dying from lack of adequate blood flow – there are a number of simple observations we can make to grade the severity of the disease process. The patient will develop pain and a loss of muscle function; the limb will become pale and cold, and eventually pulseless and avascular. Death. The very first thing to go, however, is sensation. The webbed areas between the fingers and toes will grow numb, and the palms or hands will lose what’s called “two-point discrimination.” That is, if I undo a paperclip and bend it in a “U,” the patient will not be able to tell whether one or both points of the “U” are touching their skin at a given time.
Sensation, we must conclude, is pretty important, because when our bodies are facing anoxia and are threatened, it’s the first thing to go. And failing to process what’s going on can mean serious consequences – like the loss of a limb.
But as important as it is for the doctor to evaluate the sensory capabilities of the patient, the simple act of doing so can be nearly just as important. The osteopathic medical profession places a lot of importance on physical contact – that is, assuring that the patient positively senses us. One of the most common complaints raised against physicians is “he never even touched me.”
I’ve never been a particularly touchy-feely sort of guy. I’ll give anyone I meet a handshake, but when it comes to hugs and long embraces or even a gentle rub of the back – it just doesn’t come that natural to me. I go out of my way to do so, however, because I realize it is important to most people. What I never realized was truly how important it is to me.
Yesterday I was having a terrible day. I just was. I was working with a colleague and apologized to her for how useless I had been over the past few days. She smiled, said not to worry, and very innocently and honestly gave me a gentle rub behind my shoulder. It was the strangest thing in the world – it was totally asexual, yet her hand on my back felt like white lightning. I realized that her touch was the first from a women – other than my mother or sister – that I’d experienced in a long time. I had no idea that that sort of physical contact was important to me.
It seemed I had lost sensation, and after months of gut-wrenching pain had become simply numb. Like an arm whose blood supply was cut off, I was going through the stages of ischemia, starting with the loss of sensation which would have ended ultimately in death. And this gentle touch on my back was the lightning bolt of revelation to the process at hand. It snapped me back to reality, like a rush of oxygen to my brain.
When we re-vascularize a limb – when we do surgery to make sure more blood gets to the arm or leg – it nearly instantly gets more pink and warm. But the sensation is slow to return in full. In fact, where the patient once felt numbness or maybe even nothing at all, he will now actually feel pain. That pain will eventually go away, and morph into normal sensation.
My personal ischemia left me completely numb. Now I am back to feeling pain. I only hope it is on the way towards normal sensation.
Sensation, we must conclude, is pretty important, because when our bodies are facing anoxia and are threatened, it’s the first thing to go. And failing to process what’s going on can mean serious consequences – like the loss of a limb.
But as important as it is for the doctor to evaluate the sensory capabilities of the patient, the simple act of doing so can be nearly just as important. The osteopathic medical profession places a lot of importance on physical contact – that is, assuring that the patient positively senses us. One of the most common complaints raised against physicians is “he never even touched me.”
I’ve never been a particularly touchy-feely sort of guy. I’ll give anyone I meet a handshake, but when it comes to hugs and long embraces or even a gentle rub of the back – it just doesn’t come that natural to me. I go out of my way to do so, however, because I realize it is important to most people. What I never realized was truly how important it is to me.
Yesterday I was having a terrible day. I just was. I was working with a colleague and apologized to her for how useless I had been over the past few days. She smiled, said not to worry, and very innocently and honestly gave me a gentle rub behind my shoulder. It was the strangest thing in the world – it was totally asexual, yet her hand on my back felt like white lightning. I realized that her touch was the first from a women – other than my mother or sister – that I’d experienced in a long time. I had no idea that that sort of physical contact was important to me.
It seemed I had lost sensation, and after months of gut-wrenching pain had become simply numb. Like an arm whose blood supply was cut off, I was going through the stages of ischemia, starting with the loss of sensation which would have ended ultimately in death. And this gentle touch on my back was the lightning bolt of revelation to the process at hand. It snapped me back to reality, like a rush of oxygen to my brain.
When we re-vascularize a limb – when we do surgery to make sure more blood gets to the arm or leg – it nearly instantly gets more pink and warm. But the sensation is slow to return in full. In fact, where the patient once felt numbness or maybe even nothing at all, he will now actually feel pain. That pain will eventually go away, and morph into normal sensation.
My personal ischemia left me completely numb. Now I am back to feeling pain. I only hope it is on the way towards normal sensation.
Wednesday, March 30, 2011
Completion
He looked like any other ICU patient. He was young, sure, but other than that he was pretty typical. The endotracheal tube down his throat was attached to the ventilator, which controlled his every respiration. The Foley catheter drained his urine into a bag at the side of the bed. While he lay still, the leads from the monitors indicated that his heart was beating rather fast, and that his blood carried a healthy amount of oxygen.
The only thing is that there was really very little at all that was healthy about this boy. Because this boy was dead. Brain dead. We were merely keeping his organs alive so that they could be harvested and donated to people currently fighting for their lives. This boy had already lost that fight.
His parents said their goodbyes, and kissed him one last time. We took him to the OR where we made an incision from the base of his neck to just above his pelvic bone, exposing his entire viscera. After some brief blood tests, the process commenced.
First a preserving fluid was infused throughout his body. Then he was exsanguinated. His heart was stopped and then quickly removed in a matter of minutes. The cardiac surgeon cradled it like a baby as he hurried to get it safely packaged for travel. At that point all the monitors were turned off and the anesthesia team left. The typical bleeping of the monitors went silent – it was as if our patient had somehow become more dead.
Attention was then turned to his abdomen. His liver was next to go. The student standing next to me remarked how big it looked – the surgeon had to scoop it with both hands as he turned and placed it on a table behind him. It was big, I thought to myself – until very recently it had been rather busy keeping a young, active boy alive.
His pancreas was dug out from behind his stomach, which had become eerily white now that all the blood had been let out. Finally the kidneys were plucked from the now relatively empty body cavity.
In “Never Let Me Go” Kazuo Ishiguro writes of individuals who are forced to donate their organs to society. It typically takes two or three trips to the OR before the individual finally succumbs, a process he calls completion. We completed this boy in just a couple hours.
It was an odd thing to stand there during this procurement process. In my mind were the horrible scenes from “Never Let Me Go” that turn organ donation into horrible thievery thinly cloaked as generous science. Yet what I was witnessing was truly an incredible gift that would help save the lives of numerous individuals. He was their prayers answered. And for his parents, it was a way to never let go of his precious memory and sense of vibrant life.
Never, ever, let me go. Please. Even when I am gone.
The only thing is that there was really very little at all that was healthy about this boy. Because this boy was dead. Brain dead. We were merely keeping his organs alive so that they could be harvested and donated to people currently fighting for their lives. This boy had already lost that fight.
His parents said their goodbyes, and kissed him one last time. We took him to the OR where we made an incision from the base of his neck to just above his pelvic bone, exposing his entire viscera. After some brief blood tests, the process commenced.
First a preserving fluid was infused throughout his body. Then he was exsanguinated. His heart was stopped and then quickly removed in a matter of minutes. The cardiac surgeon cradled it like a baby as he hurried to get it safely packaged for travel. At that point all the monitors were turned off and the anesthesia team left. The typical bleeping of the monitors went silent – it was as if our patient had somehow become more dead.
Attention was then turned to his abdomen. His liver was next to go. The student standing next to me remarked how big it looked – the surgeon had to scoop it with both hands as he turned and placed it on a table behind him. It was big, I thought to myself – until very recently it had been rather busy keeping a young, active boy alive.
His pancreas was dug out from behind his stomach, which had become eerily white now that all the blood had been let out. Finally the kidneys were plucked from the now relatively empty body cavity.
In “Never Let Me Go” Kazuo Ishiguro writes of individuals who are forced to donate their organs to society. It typically takes two or three trips to the OR before the individual finally succumbs, a process he calls completion. We completed this boy in just a couple hours.
It was an odd thing to stand there during this procurement process. In my mind were the horrible scenes from “Never Let Me Go” that turn organ donation into horrible thievery thinly cloaked as generous science. Yet what I was witnessing was truly an incredible gift that would help save the lives of numerous individuals. He was their prayers answered. And for his parents, it was a way to never let go of his precious memory and sense of vibrant life.
Never, ever, let me go. Please. Even when I am gone.
Tuesday, March 29, 2011
Death Actually
It is all around us. This is what happened.
Last night a boy got into a horrible argument with his mother. She had sensed something wasn’t quite right, that they had become distant somehow, and she was devastated. She somehow found a stash of pot in his room. They fought. They cursed. And he left.
About six AM he got into a horrible car crash. At seven AM he arrived in our trauma bay. We spoke to his mother and father at about ten. We told them that he had suffered a massive brain injury and that his chances of survival were essentially zero. The pain and the guilt in their faces were devastating to witness.
The only things left to do were the brain death exams. As a trauma team we tried to elicit pain by pinching his nails; we dripped water into his eyes to see if he would blink; we brushed gauze against his corneas to see if he had any sense at all in his eyes; we blasted cold water into his ears to see if his brain was active enough to sense the temperature change; we turned off the ventilator to see if he would breath. Another physician came and did the same exam with the same results – our patient was dead.
Another women came in a few hours earlier. She was young, too young to have already survived high-grade breast cancer, and the chemo-radiation and surgery and subsequent reconstructive surgery needed to do so. She had regained her life, and was working with mentally challenged adults, helping them get to and from whatever activities and appointments they needed to life a somewhat normal life. The other day a man fell on her, and hurt her arm. Over the next day her arm became swollen and tense. Her heart raced, and her blood pressure dropped. She came into the ER with a very palpable radial pulse – that’s the one you can feel on your wrist just above your thumb. It’s the one people try to sever when they commit suicide. This morning she lost the sensation of that pulse, which meant the internal pressures in her arm were so high that it they were occluding the blood from flowing into her arm. And so we took her to the OR to explore her arm.
Her arm was dead. All of it. Her muscles, her fascia, her nerves, even her veins….all dead. We went into the operating room thinking that we might make a couple incisions and relieve some excess pressure – we ended up disarticulating her shoulder joint and amputating her entire right arm, putting on a temporary dressing, and transferring her to another hospital where they could treat her with hyperbaric oxygen – a last ditch effort to save her life.
Sometimes I feel my own pulse, just to make sure it’s there. I place my left first two fingers on my right wrist and feel the pulsations transferring from one wrist to the other hand. I think that it’s so odd, that here is the place where I (well, where others) would take their life, and it is here where I (yes, I) feel to confirm life.
It’s nice to know I have a pulse, even as death actually is all around us.
Last night a boy got into a horrible argument with his mother. She had sensed something wasn’t quite right, that they had become distant somehow, and she was devastated. She somehow found a stash of pot in his room. They fought. They cursed. And he left.
About six AM he got into a horrible car crash. At seven AM he arrived in our trauma bay. We spoke to his mother and father at about ten. We told them that he had suffered a massive brain injury and that his chances of survival were essentially zero. The pain and the guilt in their faces were devastating to witness.
The only things left to do were the brain death exams. As a trauma team we tried to elicit pain by pinching his nails; we dripped water into his eyes to see if he would blink; we brushed gauze against his corneas to see if he had any sense at all in his eyes; we blasted cold water into his ears to see if his brain was active enough to sense the temperature change; we turned off the ventilator to see if he would breath. Another physician came and did the same exam with the same results – our patient was dead.
Another women came in a few hours earlier. She was young, too young to have already survived high-grade breast cancer, and the chemo-radiation and surgery and subsequent reconstructive surgery needed to do so. She had regained her life, and was working with mentally challenged adults, helping them get to and from whatever activities and appointments they needed to life a somewhat normal life. The other day a man fell on her, and hurt her arm. Over the next day her arm became swollen and tense. Her heart raced, and her blood pressure dropped. She came into the ER with a very palpable radial pulse – that’s the one you can feel on your wrist just above your thumb. It’s the one people try to sever when they commit suicide. This morning she lost the sensation of that pulse, which meant the internal pressures in her arm were so high that it they were occluding the blood from flowing into her arm. And so we took her to the OR to explore her arm.
Her arm was dead. All of it. Her muscles, her fascia, her nerves, even her veins….all dead. We went into the operating room thinking that we might make a couple incisions and relieve some excess pressure – we ended up disarticulating her shoulder joint and amputating her entire right arm, putting on a temporary dressing, and transferring her to another hospital where they could treat her with hyperbaric oxygen – a last ditch effort to save her life.
Sometimes I feel my own pulse, just to make sure it’s there. I place my left first two fingers on my right wrist and feel the pulsations transferring from one wrist to the other hand. I think that it’s so odd, that here is the place where I (well, where others) would take their life, and it is here where I (yes, I) feel to confirm life.
It’s nice to know I have a pulse, even as death actually is all around us.
Monday, March 28, 2011
Left for Dead
A trauma victim came into the emergency room in the early hours of the morning the other day. He was clearly drunk, mentally challenged, and he had just gotten out of prison. He had been badly beaten – his eyes were swollen shut, he was missing teeth, he had broken glass in wounds all over his arms and legs, and a huge gash in his scalp which was bleeding badly. We stopped the major bleeding, made sure none of his other injuries were immediately life-threatening, and then began the arduous task of cleaning and mending his every laceration.
The most disturbing thing of it all was that, as far as we could piece things together from the police, this assault had happened several hours ago. The police found him unconscious in a pool of his own blood, hours after the nearest bar – which he had been seen at – had closed. It seemed his assailants beat the heck out of him, and simply walked away as he lay on the asphalt, with a slow, dark red pool forming underneath him. He wasn’t exactly dead, they must have known, but maybe, with enough time, he would get there. Fortunately for him he was discovered and brought to us.
I’m not quite sure which is worse, really – the physical abuse of someone, or the walking away. Because walking away necessitates being fully aware of the suffering and therefore fully aware of the solution, and yet choosing to do nothing about it.
When you are left for dead – and I pray it will never happen to you – you end up with a lot of time to reflect. “Time on my hands, could be time spent with you” quoth Sir Elton John. It turns out he knows what he’s talking about.
And what have I done with that time? Gone for walks. Starred out the window. Drank way too much. Had bad thoughts. Drank again. And again. And through it all I keep asking myself – how are you not watching? How is it that I’ve been left for dead? Like that man on the street I lay still, drunk, unable to move, with the blood slowly filling in the spaces between me and the cold pavement. It’s nice to know my blood is so warm.
And all I can do is wait patiently for the police to come, and bring me to some over-worked trauma resident to mend my wounds and stop the bleeding. I hope it happens soon.
The most disturbing thing of it all was that, as far as we could piece things together from the police, this assault had happened several hours ago. The police found him unconscious in a pool of his own blood, hours after the nearest bar – which he had been seen at – had closed. It seemed his assailants beat the heck out of him, and simply walked away as he lay on the asphalt, with a slow, dark red pool forming underneath him. He wasn’t exactly dead, they must have known, but maybe, with enough time, he would get there. Fortunately for him he was discovered and brought to us.
I’m not quite sure which is worse, really – the physical abuse of someone, or the walking away. Because walking away necessitates being fully aware of the suffering and therefore fully aware of the solution, and yet choosing to do nothing about it.
When you are left for dead – and I pray it will never happen to you – you end up with a lot of time to reflect. “Time on my hands, could be time spent with you” quoth Sir Elton John. It turns out he knows what he’s talking about.
And what have I done with that time? Gone for walks. Starred out the window. Drank way too much. Had bad thoughts. Drank again. And again. And through it all I keep asking myself – how are you not watching? How is it that I’ve been left for dead? Like that man on the street I lay still, drunk, unable to move, with the blood slowly filling in the spaces between me and the cold pavement. It’s nice to know my blood is so warm.
And all I can do is wait patiently for the police to come, and bring me to some over-worked trauma resident to mend my wounds and stop the bleeding. I hope it happens soon.
Tuesday, March 22, 2011
Going Back
Not too long ago we had a terrible trauma. A teenage driver lost control and wrecked his car, and in the process killed his best friend who was riding in the passenger seat. I wish this sort of thing didn’t happen very often, but sadly it does. The boy’s recovery was a long one. He had to have multiple surgeries to repair his many fractures, and he needed intense therapy to re-learn how to walk.
He also had difficulty with his brain. Diffuse axonal injury – or DAI – is a condition that happens in many trauma patients. In short, it is tiny foci of injury that happens to lots of areas of the brain all at the same time. It occurs most commonly in car accidents, when the rapid deceleration causes the brain to strike the inside of the skull and rattle around like a tennis ball inside a shoebox. It causes people to be incredibly slow to wake up, and to profoundly affect their behavior when they do wake. In our patient, it altered his memory. It altered it in such a way that he would forget the accident and his role in it and his dead friend – he would “remember” it, as if for the first time, every morning for months. It was like some perverted, new brand of torture.
Or was it? Maybe it was just his way of going back to that moment as often as it was necessary for him to come to peace with it. CS Lewis writes of sin in this way by making the analogy to a lengthy math problem, with several steps, each building upon the last. If you happen to make a simple error in step number two, obviously the final answer – even if you performed the next twenty steps correctly – will be wrong. Pushing onward, despite doing so perfectly, will never get you to the right answer. In fact, the only way to ever find the correct solution is to go back, all the way back to step two, and make the correction, and then complete the rest of the problem.
The boy is doing well now, I’m told. He’s been able to move on. And in a certain sense I think it’s because he had to go back to that moment of the accident and figure out a way to confront it head on. He didn’t just push forward with this tragedy in his past – he went back, found peace, and then moved on. It doesn’t mean he forget the accident or in anyway feels less pain – it just means he found a way to live with it, and not blindly go forward.
It is Lent now – a time of self-examination. I am daily trying to go back, find my errors, correct them, and find peace so that I too may move forward.
He also had difficulty with his brain. Diffuse axonal injury – or DAI – is a condition that happens in many trauma patients. In short, it is tiny foci of injury that happens to lots of areas of the brain all at the same time. It occurs most commonly in car accidents, when the rapid deceleration causes the brain to strike the inside of the skull and rattle around like a tennis ball inside a shoebox. It causes people to be incredibly slow to wake up, and to profoundly affect their behavior when they do wake. In our patient, it altered his memory. It altered it in such a way that he would forget the accident and his role in it and his dead friend – he would “remember” it, as if for the first time, every morning for months. It was like some perverted, new brand of torture.
Or was it? Maybe it was just his way of going back to that moment as often as it was necessary for him to come to peace with it. CS Lewis writes of sin in this way by making the analogy to a lengthy math problem, with several steps, each building upon the last. If you happen to make a simple error in step number two, obviously the final answer – even if you performed the next twenty steps correctly – will be wrong. Pushing onward, despite doing so perfectly, will never get you to the right answer. In fact, the only way to ever find the correct solution is to go back, all the way back to step two, and make the correction, and then complete the rest of the problem.
The boy is doing well now, I’m told. He’s been able to move on. And in a certain sense I think it’s because he had to go back to that moment of the accident and figure out a way to confront it head on. He didn’t just push forward with this tragedy in his past – he went back, found peace, and then moved on. It doesn’t mean he forget the accident or in anyway feels less pain – it just means he found a way to live with it, and not blindly go forward.
It is Lent now – a time of self-examination. I am daily trying to go back, find my errors, correct them, and find peace so that I too may move forward.
Tuesday, March 15, 2011
Forgive and Remember
Last night two trauma victims came into the trauma bay in rapid succession. The EMS gave a quick report on the first one: a woman, sixty, pedestrian, hit by a car and thrown roughly fifty feet. Her right leg was snapped right below the knee, and her tibia was sticking through the skin. Her left leg felt like jelly. Her pelvis bone – which normally is solid as a rock – was a loose, broken mess. Her right shoulder had bad bruises on it, and there was a large amount of blood coming from the back of her head. We started to work on her. Her eyes were open, and she as moving, but that was it. We got IV access, and intubated her for her own airway protection. I drew some blood from a vain in her groin and handed it off to the lab tech to get us STAT labs. But…we couldn’t get a blood pressure.
At that point the second trauma came in. A male, twenty-five, with an obvious deformity of his right lower leg. The bone wasn’t sticking out, but it looked pretty bad. Other than that he seemed to be OK. He looked up and asked “how is my mom?”
We got him out of the trauma bay right then – he didn’t need to see or even hear what was coming next.
His mom didn’t have a pulse. CPR was started. In trauma patients, sometimes this is caused by something called a tension pneumothorax, which is a collapsed lung that is pushing against the heart, rendering it useless. We placed large needles in her chest followed by large chest tubes to decompress the chest cavity. Still no pulse. We put a huge IV in her neck vein and transfused her massive amounts of blood. We ultrasouded her abdomen – all negative. I took a scalpel and made a 3 cm incision below her umbilicus, and gently placed a catheter into her abdominal cavity, looking for blood or any other signs of where the trouble might be. Nothing. Her pupils became fixed and hugely dilated – her brain was literally herniating down into her spinal column. She was dead.
The placed looked like a war scene, with blood and gowns and gloves and needles everywhere. And when it all stopped – when the code was “called” – the room was silent, and everyone slinked away, defeated. And she just remained on the table, lifeless, and cold. But yet, after that last hour of hell, she finally looked at peace.
I’d almost forgotten what it was like to lose someone that quickly. What a horrible thing to say! I’d almost forgotten what it’s like to stop, take off my gloves, and stand there quietly, listening to my racing heart and panting breath as I stood over death. There is a prayer I always say in this situation:
Dear LORD, have mercy on us all who tried to help. And have mercy on your servant who passed away. Hasten your angels to this bedside, and usher her into your presence, that, if it may please you, she may this day be with you in paradise. Amen.
In this season of Lent, we hear so much about forgiveness. What I’ve learned recently is that forgiveness should not be confused with forgetting. Forgive and remember, I say. Remember the pain, the suffering, the neglect – but forgive. For it is only in that forgiveness that we might find peace.
I pray now for both forgiveness and that peace.
At that point the second trauma came in. A male, twenty-five, with an obvious deformity of his right lower leg. The bone wasn’t sticking out, but it looked pretty bad. Other than that he seemed to be OK. He looked up and asked “how is my mom?”
We got him out of the trauma bay right then – he didn’t need to see or even hear what was coming next.
His mom didn’t have a pulse. CPR was started. In trauma patients, sometimes this is caused by something called a tension pneumothorax, which is a collapsed lung that is pushing against the heart, rendering it useless. We placed large needles in her chest followed by large chest tubes to decompress the chest cavity. Still no pulse. We put a huge IV in her neck vein and transfused her massive amounts of blood. We ultrasouded her abdomen – all negative. I took a scalpel and made a 3 cm incision below her umbilicus, and gently placed a catheter into her abdominal cavity, looking for blood or any other signs of where the trouble might be. Nothing. Her pupils became fixed and hugely dilated – her brain was literally herniating down into her spinal column. She was dead.
The placed looked like a war scene, with blood and gowns and gloves and needles everywhere. And when it all stopped – when the code was “called” – the room was silent, and everyone slinked away, defeated. And she just remained on the table, lifeless, and cold. But yet, after that last hour of hell, she finally looked at peace.
I’d almost forgotten what it was like to lose someone that quickly. What a horrible thing to say! I’d almost forgotten what it’s like to stop, take off my gloves, and stand there quietly, listening to my racing heart and panting breath as I stood over death. There is a prayer I always say in this situation:
Dear LORD, have mercy on us all who tried to help. And have mercy on your servant who passed away. Hasten your angels to this bedside, and usher her into your presence, that, if it may please you, she may this day be with you in paradise. Amen.
In this season of Lent, we hear so much about forgiveness. What I’ve learned recently is that forgiveness should not be confused with forgetting. Forgive and remember, I say. Remember the pain, the suffering, the neglect – but forgive. For it is only in that forgiveness that we might find peace.
I pray now for both forgiveness and that peace.
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