Recipe for Hope

building facade, Philadelphia

I have a recipe for beef tips. It calls for red wine (it must be a Shiraz, specifically a good Shiraz) and a pound of shiitake mushrooms. This simmers for an hour with garlic, shallots, and beef consume. At the end I stir in heavy cream. Spooned over basmati rice with a serving of roasted broccoli and carrots, it is to die for. No restaurant anywhere can make it better than I can.

Every year for his birthday he would ask for this dish. 

Two birthdays have passed without beef tips and rice. We both skirted the issue. He didn’t ask, I didn’t offer. 

Until now….

He has been over two years sober. So I agreed.

It was the first time I held a bottle of wine in his presence in my own house in over two years. I took a sip straight from the bottle before dumping the remainder down the sink. 

A mouthful of bitterness. So much bitterness for such a tiny, little swallow of Shiraz. Then, again, maybe the lump in my throat made it worse.

The things we give up for something we believe in….

There were plenty of people who said I should leave. And believe me, I wanted an excuse. Any excuse. I hated him more than words can say at that point.

But I didn’t leave. 

I stayed for my kids. Not for him. They needed their dad. I could not watch them suffer. So long as they were safe, I told myself.

Do you love me?

All of this time, I have been waiting for the other shoe to drop. I have watched other alcoholic patients relapse over and over again through the years. Why would he be any different? I gave up more than I can ever say in order to stay. If it had all been for nothing, I am not sure I could bear it.

The things we give up for someone we love.

I used to turn to alcohol a lot more often when dealing with something stressful. I was not an alcoholic, per se, but it seemed at a point that I was having a “stressful” day more and more often as an excuse. Temporary escape fixes nothing. It only makes things worse. If you can escape, even for a little while, you stop trying to fix anything. You just look for ways to get more of that escape.

So I stopped escaping.

My life does not begin and end with you.

Love comes in many forms. I have been blessed to have much love in my life. Different kinds of love. Many kinds of love. I treasure all of them. 

But life is complicated. 

He reads my blog. Every single thing I post here. He reads your comments. He always has, since the beginning. He has been here even when what I write is painful for both of us. When you disagree with me. When he disagrees with me.

He is not intimidated by my ugly bits.

Sometimes life forces you to take the measure of someone. Sometimes they surprise you. Sometimes you surprise yourself. Sometimes, in spite of everything, you find a love that was always there. Sometimes, you even find forgiveness.

It is not a fairy tale. 

It is something more. 

It is hope.


interior of a log cabin, black amd white

Her eyes are bloodshot, burning from the lack of sleep, but she cannot stop. The pressure renders her unable to breathe until she gets them all out of her chest. 


They weigh so heavily there.

They multiply. The pressure builds again until she can no longer process anything else, crowding out every other thought she might want to think, every other feeling she might want to feel.

So many words.

Such heaviness.

Her hand trembles as she writes with his old fountain pen. Ink now runs black through her veins.

I will read them when you are done, he said. 

A promise.

So all she can do is bleed onto the page again and again and again and again while her sanity slips farther away.

Writing has become her disease.

He is her infection and her elixir.

Words written in the dark, flowing so fast she cannot catch them all. 


There is only one cure. Just one.

He holds his hand out to her. This time, she takes it.



 “What do you know about OxyContin?” He asked. I could see pain written all over his face as he spoke.

I knew he had chronic back pain. Multiple surgeries. Injections. Physical therapy. More surgeries. A back stimulator. Nothing had worked.

He was family. 

I always tried to avoid talking about medicine at family gatherings and I especially tried to avoid talking about narcotics with family that was taking them, but something in his eyes made me answer.

“It is a pretty strong pain medication,” I answered. “Supposed to last twelve hours. You’re taking it?”

“I just started it a couple of months ago. I don’t think it’s working.” He paused as the waitress put down his food in front of him, a burger and fries, then placed a salad in front of me, making her way around the rest of the table. “I mean, sometimes it does. But when it wears off, the pain is worse than ever before.” His hands shook as he reached for the burger.

He was suffering. 

His face was gaunt. He had lost weight.

I didn’t know what to say. If OxyContin wasn’t helping, then there was nothing left for him. Nothing at all. I had no idea how to help. So I told him to follow up with his pain specialist pronto and changed the subject.

Several weeks later, he shot himself in the head with a rifle. It was in the early morning hours after a sleepless night, in the shed in his back yard. His wife woke up to the sound of the gunshot and found him there. 


Now, it is known that the manufacturers of OxyContin knew it did not last for 12 hours. It wore off much earlier. The withdrawals were terrible. They deliberately hid this information from physicians, using their drug reps to tell doctors to push the dose higher rather than dose more frequently, exacerbating the highs and lows. Read about it here.

How many other people, faced with this nightmare, also chose to die?

He was a good man. 

He was the victim of a botched back surgery and a greedy pharmaceutical company and it makes me angry. This is one of the reasons I don’t speak to drug reps that come by my office. They may have the best of intentions but they are still just pawns in a bigger game. 

In fact, perhaps we are all pawns.



“The ER doc says he remembers you from when you used to work there.” She laughed. “He liked you a lot, said you were a really good doctor, that it didn’t matter what time of night, you were always dressed up, with flawless make-up.”

It’s true. 

I would sleep in street clothes and make-up when I was on call so if I had a critical patient and had to go in, I was ready. 

Minutes count.

So do appearances, especially if you are a woman. People notice. It affects how they respond to you.

Much of healing has nothing to do with tests and procedures and drugs, as it turns out. A lot of it is showmanship, portraying confidence, treating patients with respect.

The thing is, and I never thought I would say this, I miss the hospital. Her comment made me think and I realized that I was having wistful thoughts. Somehow my hospital work felt more important than what I do now, only outpatient clinic. I feel like I spend most of my time pushing buttons, signing papers, attending this meeting or that meeting, trying to meet various measures. I miss being a stronger advocate, the firecracker spitfire who fought for her patients. I miss the adrenaline. I miss feeling like the sacrifices I was making were worth it.

That part of my life is over, though. There is no going back. It was a necessary thing at the time, stepping back. Now it has been too long. Things are too different. Hospitalists, dedicated inpatient physicians, save hospitals money so there is no role for me in that model anymore.

But I still look back on those good ole days from time to time… And think wistfully.


old tombstone in Bostom cemetary

We were sitting in the dark after the bedtime story and prayers. I typically hold his hand and check blog stats or write the next day’s post while he drifts off to sleep.

“Mommy, I like dreams. They’re nice,” he said sleepily.

“I like dreams, too. Most of the time. Do you ever have bad dreams?”


“Like what?”


“Charlie? Who’s Charlie?” Goosebumps rose on my neck and arms.

“Charlie is my bad dream.” He was matter of fact, no fear in his voice.

Charlie was my own bad dream as a kid. Terrified the hell out of me. I had never told this to a single soul.

“What does Charlie look like?”

“He has red eyes and no pupilaries. Like Deadpool’s but red and not black. He has a bushy beard and one eyebrow that stretches over both eyes. He’s old.”

How can it be possible for your child to have the same, identical childhood nightmare?

“Did I tell you about Charlie?” I asked, my heart pounding, hopeful that he would say yes and I had just forgotten.

“No. But he says he knows you…”

Just So

black amd white gerber daisy
We were discussing her sudden weight loss. Fourty pounds since her last visit just five months before. Very few patients lose significant amounts of weight like that without something else almost catastrophic going on in the background. 

A death. A divorce. An affair. Zombie apocalypse. Or chemotherapy.

For her, I knew it wasn’t chemotherapy. I was pretty sure no zombies were involved, either.

In her case, she told me, it had been her husband. He had died four months before from a massive heart attack, collapsed at the dinner table over a plate of her roast beef.

“I loved him. He could make me so angry. He made me terribly happy. He made me feel things. My first husband never did that. We never fought. Ever. We were good friends who enjoyed hanging out but we were never lovers in the full sense of the word.”

That comment struck me and I have been mulling it over ever since.

Is it possible that we as humans do not crave peace so much as we desire to feel alive?

To feel things.

Relationship dynamics fascinate me.

I have had occasion to consider that more this past week. 

Growing up I witnessed the bull in the china shop kind of rage in my house. My father, mad at the slide projector, would lob it across the room to shatter on the floor. He broke a coffee table once right down the center. I see that in myself only I don’t throw things. I throw words. Words are my violence. I can use them to hurt you more than my fists ever could. You hurt me or someone I care about, I will lash out until the fire burns down and I can finally stamp it out. 

The thing about anger and fighting is that when it is someone whom you care about, their opinion matters on a level so much higher than anyone else’s.

A patient can tell me my breath stinks and duck their head and I can laugh it off and move on after a breath mint. If my lover were to say the same thing in the same way, perhaps in the context of explaining why he did not want to kiss me right then, it might dig itself into my heart and lodge there like broken piece of glass. It would mean so much more coming from him.

There is so much power there. Power to tear down and hurt and destroy. How can you contain that? How do you have enough conflict to feel alive without burning down the house while you are at it?

I watch my daughter’s rages and see myself mirrored there as she is flailing about, kicking, hitting, and scratching anything that gets too close to her.

Oh, baby girl. 

I am afraid she is going to hurt herself if I cannot teach her how to control her emotions. I pray every day that she finds someone who loves her enough to have the strength to stand up to her onslaught.

Meanwhile, I continue to work to recognize my own shortcomings….

Flashes of Understanding

worn green interior of an old train car

My hands ran over the surface of the baby swing, clearing off the layer of dust. It had been in storage for a few years. Only now, as I was pulling things out for a yard sale, had I seen and touched it again. What I felt, what I saw in my mind, made me pull back in shock.

Memories. Feelings. But not good ones.

I had expected happy, nostalgic baby thoughts to come flooding back. Not this. It is strange and uncanny, how much emotion an object can carry. An inanimate thing creating such a visceral reaction. Boggles the mind.

I am so glad that is over.

It struck me then, right there in my driveway, five years later.

Postpartum depression?

Or something. 

I was not right in the head, I do know that. 

Could it be possible?

I think back on that period now and the stress was overwhelming. I had a locum that was barely competent covering my new practice while on leave. Maternity was going to put my clinic tens of thousands of dollars in the hole. Then, I hired the partner from hell who made every day back a living nightmare until she finally left a year later. Family and social stresses were beyond measure. I remember how erratic and sometimes irrational my behavior was at the time but in the midst of it I truly believed that everything I was doing seemed reasonable and right.

Truthfully, I consider myself to be a fairly strong person. I never even entertained the possibility of something wrong with me emotionally. I am not weak. Nothing like that could ever happen to ME, you understand…..

Which then makes me wonder, who steps in to tell the doctor that she needs help? People around me thought I was crazy, I am sure, but no one took me by the shoulders, looked me in the eye, and said, “Hey, you need help.” 

Would I have even listened?

And, just so you know, in case you were curious, I’m not talking about the colic baby. She came along after, but most definitely before I had “recovered” my faculties. THAT prolonged my issues for sure.

What had I been thinking, believing I could have two under two? How do women with twins survive? I cannot even imagine.


Here we are. I am in a much better place now. Probably. At the very least I am less crazy and that is a thing of beauty.

Let’s see if I can get $5 for that baby swing… To be honest, though, I would be willing to give it away. I don’t ever want to see or touch it again.

A Denouement (Part Four, The Final Chapter…. For Now)

“What do you tell people about me?” she asked. And more importantly, “Why does she have to hate me?”

Silence. As there should be.

As there must be.

We all rewrite our difficult pasts, rearranging until we find a version that allows us to live with ourselves.

Can she even trust her own memories now? She is not entirely sure.

More than twenty years of him.

She wonders if traces of her still live in his house.

The antique medical books. The leaflet from an illuminated book of prayers. The collection of poems by Elizabeth Barrett Browning. The gilt copy of Tristram and Isolde. The earring she lost that he said he would keep safe for her but never gave back. The chest of drawers he bought because he thought she would like them. 

That kitchen floor.

Is his dog still alive?

Has his long appendectomy scar healed the rest of the way? Her fingers traced that line while it was still angry and red. 

Are the dishes she cooked with, the glasses she drank from still in the cabinets there? Is the dining room table still set with the same plates, still covered with its layer of dust? She used to write messages to him in that dust. 

Is the coconut rum still in the fridge with the giant bottle of lemon juice?

Is the bed the same one she slept in? The one they made their dreams in? 

The dreams that were flushed away.

Does he ever think of her now? 

Every day she wonders, some days more than others. She wishes she could be more than just a ghost. But at the end of the day there is a child in need of a father, a father in need of a child, and she cannot write herself out of that story line.

So she lets the loneliness lift from her shoulders again, knowing that after twenty years of her there will always be some part of her with him. How he feels about those bits and pieces, what they mean for him is another story. 

His story. 

Not hers

Now, she realizes, it is no longer about trying to erase the past. She is writing the future.

What is truth and what is fiction? 

Does it matter?

Only the heart knows.

The Rewrite (Part Three)

She did not know why she had lied about it.

Perhaps because she was trapped?

The man held her down, his breath stinking of alcohol. It made her eyes burn as he panted and grunted so close to her face. She had no more fight left. So she let him do what he had to do. When he passed out she locked herself in the bathroom and cried. Her hands shook as she tried to clean his seed out of her.

Please, God.

But her mother always told her that God does not listen to harlots. A month later there was a thin blue line next to a pink one. 

What is more shameful? Carrying the child of a man you did not love or carrying a child conceived in such a way?

She lay next to him in the dim light of evening and wove her words around the lengthening shadows. She rewrote her story. She lied to the man she did love. She lied about what had happened that night.

She had too much to drink and drowned her sorrows in another. It was a bad choice, a wrong choice, but it was her choice.

The instant she said it to him, she wished she could take it back. His eyes flashed with pain that lived there from that moment on. 

She expected him to leave her.

But he did not.

She wanted him to know that she had imagined her body as a temple, a shrine to him, but it had been desecrated and defiled. The words never came. She buried them deeper.

And then she lied to herself. She lied so often that she started to believe it…

You don’t deserve happiness. You don’t deserve joy. You don’t deserve love.

Sometimes, she found, you are so far down the path of fiction it feels there is no possible way to redeem yourself. How do you find the truth again?

But in that baby’s eyes she found it.

Babies transcend all evil. They are the hope of love, our rebirth from the ashes. They have the power to save us all.

Then she knew….

With every truth there is pain, with every lie there is a price that must be paid, and by its nature death always follows after life.

The truth was she had something else to live for now.

Writing Fiction (Part Two)

Hawaiian beach at sunset
When she had told him the news he kissed her with a kiss that took her breath away then made love to her right there on the kitchen floor.

No words. 

Just love.

They had a list of names. 

Beautiful names.

But names are only words and words are lies. She understood that soon enough.

Up all night with a critical patient in ICU, the cramping had started.

It never stopped.

Red blood and red wine. She tried to wash away the one with the other as she flushed their dreams away. Just a bit of macerated tissue. Why did it have to hurt so much?

He was on call. So far away, saving lives. But he could not save this one. 

Please come back to me.

She would not ever tell him, she vowed. Never. She would not give him that burden to bear. She would make up her own story to tell for another day.

Just hold me.

An empty bottle, fear and loathing. 

She wanted to hate him but could not so she hated herself and she fought and bit and spit to drive him away. 

But he would not go.

She had failed at the one thing she was made to do, the one thing she wanted to succeed at more than anything else in the whole world.

To be loved. 

So she sat on the floor in the bathroom alone and cried enough to fill the tub, remembering his kiss. That kiss. She bathed in her sorrows, the salt burning all of her wounds until she was numb. 

Finally she was numb.

Then she rewrote her own story…

Deeps in the wilds of the Amazonian rainforest, she shouldered her rifle. Her eyes stung with sweat. She wiped her brow as she surveyed the tree line up ahead. It was lurking there, just beyond the shadows….her demon. She could feel it its gaze upon her, watching. It always surprised her, coming when she least expected it. Her finger rested calmly on the trigger, even as her heart pounded loud in her ears. She would be ready this time. There would be no sleep for her tonight.