If there is one thing about the field of fertility – when one of us gets a good idea – we all get a good idea!!! And that is not a bad thing when it effects patient care in a positive way. Maybe it is what they call a “collective consciousness” experience. The new imperative that we all seem to have at the same time is getting to younger woman that are sitting in a GYN;s office thinking about conceiving a child or trying – and it’s just not working.
Now actually this is not a new idea – the only thing that is different is that we all seem to have gotten off our duffs at the same time to do something about it.
Schering-Plough who many of us still call Organon has had a program called Fertility Journey for a while now. I even worked on it when I was at The AFA – contributing content. Now they are taking a program directly into the GYN office that gives the patient early fertility information, and access to free medication through their doctor. Right now this is a pilot program. But from what I could see of it – this program will help patients get important information that they need – and help in getting it. Yep…I have company on the trail to the gyn office – and while everyone has their own program on how to get to younger women earlier the collective consciousness is at work.
After all the news about there being a female biological clock is not brand new information. From the infamous tee shirt that read “Oh! I forgot to have children!!!” to our aging eggs finding it’s way into movie scripts and television shows. The information that women and yes, even men have a biological clock is out there. The problem has been how to get accurate information into the hands of patients.
An awful lot of what’s out there about fertility and reproduction is pulp fiction. The blurring of fact, opinion, myth and misunderstanding makes for a treacherous misinformation landscape. The knowledge gap has claimed millions of victims, people who learned about the fundamentals of protecting and preserving fertility too late to help them have genetically linked offspring they always assumed would be theirs. Armed with essential and accurate information, you don’t have to join their ranks.
What is still not understood across the board is the time line of the biological clock. And most of us don’t have a clue about our own.
So the big question is – what do you know about your fertility? In Schering-Plough pilot program they are even putting out a great little questionnaire in the GYN offices to help women discern if conception is taking longer than it should.
Most people, don’t know very much at all about their fertility. Just to give you a little perspective, a spate of recent surveys reveals that the overwhelming majority of U.S. women:
· Don’t understand the biological clock – the trajectory of reproductive capabilities from its peak in the early-to-mid-20s to the age of inevitable decline beginning, typically, around 27.
· Mistake overall good health for an indicator of fertility. However wonderfully youthful and fit a 42-year-old might be, her eggs are operating on an independent and fixed timeline.
· Believe they can get pregnant easily until their 40s. The stark truth is women at that age are more likely than not to require medical intervention.
· Are unaware that men, too, carry a ticking reproductive timer.
· Don’t know that lifestyle factors—sleep, diet, exercise and environment, for instance – can have a profound effect the ability to have a child.
Yet this basic information can make a critical difference in the life of every person who dreams of having a child this year, next, or 10 years down the road. If you know about your body’s reproductive lifecycle, you can take steps to protect and preserve your fertility. That way you can have the children you want– if and when you choose. So, this is the information that I am bringing to the GYN’s office – in the hopes of getting it to patients.
Start Where You Are: Get To Know Your Baseline
Statistics and general truths aside, every woman is unique. Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool. Consider an annual fertility evaluation or screening.
Most likely you have never heard of such a thing, and you’re in good company. It’s very likely that even your doctor will give you a blank stare at the mention of a Fertility Evaluation. That’s because it’s a relatively new concept. But don’t worry – the collective consciousness is at work there too – I understand that soon there will be products that will be marketed directly to the GYN that they can purchase to do a Fertility Screening or Evaluation for their patients. But that really is not necessary. The GYN can do this themselves – a low cost – directly in their offices without the purchase of a kit. Simply put, the screening involves a few simple blood tests and an ultrasound to get a handle on your ovarian function. These tests have been around for years, tried and true tools in the diagnosis and treatment of compromised fertility. The piece that’s different is using them in the context of preventative fertility.
Taken together with your individual and your family’s medical histories, the screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there is problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.
More about the nuts-and-bolts of the screening later. First, let’s talk about why the evaluation is so important.
Marking Time: The Biological Clock and You
Let’s start at the beginning. Each woman’s oocytes (eggs) supply is finite. That means the body doesn’t produce new ones. So the 7 million or so eggs each female is born with is all she’s going to have. Ever. By the time the average girl hits puberty, only about 250,000-300,000 oocytes remain in her ovaries. With each menstrual cycle one egg become ripe enough for fertilization and is released. An additional thousand eggs each month are lost through a process called artresia, the natural breakdown of the eggs by the body. After ovulating an average of 400 times through her life, typically around 50 years of age, the store of oocytes is tapped out. That’s menopause.
Then there’s the matter of oocyte aging. Eggs age along with the rest of the body. The older oocytes are more likely to have chromosomal abnormalities making them unlikely to become viable embryos. It’s important to note that a fertilized egg with abnormal chromosomes is the single most common cause of miscarriage. A woman in her 20s has only a 12%-15% chance (about one in every eight pregnancies) of having a miscarriage each time she becomes pregnant. On the other hand, a woman in her 40s faces a 50% risk of miscarriage (that’s one in every two).
Despite the amount of ink and airtime that’s been lavished on the biological clock, most women still don’t know about the direct, inverse relationship between age and procreation. The bottom line is the older we get, the less likely we are to conceive and have a successful pregnancy. What’s harder to grasp is that in this context, women qualify for “older” at 27. You read it right. Statistically speaking, when a women hits 27, her fertility begins an exorable decline. When she hits 35, it take a sharp downturn. At 40, fertility falls off the edge of the earth.
Of course, some women in their late 30s and a few in their 40s conceive effortlessly, carry and deliver healthy babies. But the likelihood of that happening without medical intervention becomes more remote with each passing year. For women under 30, the estimated chance of becoming pregnant in any one cycle is between 20% and 30%. When women turn 40, that probability plummets to approximately 5%.
OK, So Now That You Know, What Next?
Rest assured, this IS NOT a push of the panic button. It’s not a call to rush into loveless marriage, or drop out of school and give up your career in order to guarantee your bloodline continues.
Rather this is a call to arms. Women deserve to know the full truth about reproduction so they can take the family-planning reins and make informed decisions. The goal is to help you and every woman of childbearing years make the choices that help protect and optimize fertility.
· The Contraception Contradiction. While all contraceptives prevent pregnancies with greater or lesser efficacy, some actually help preserve fertility. Oral contraceptives decrease the incidence of tubal disease because birth control pills make it more difficult for some infections to grow. They also minimize the growth of the endometrium (the lining of the uterus), reducing the incidence of endometriosis, a condition that can closely linked to infertility. Condoms and, to a lesser extent, diaphragms, protect against sexually transmitted diseases, which contribute to or cause compromised reproductive function and infertility.,
· Weight of the World. When it comes to baby-making, you absolutely can be too thin. Or too fat. A woman’s body is at its reproductive best when it’s within 15% of the ideal weight. And by ideal, we don’t mean runway ready. It’s the weight at which your body and its hormonal systems hum like a finely-tuned Ferrari. There are individual variations, but, many women experience problems when they’re less than 95% or more than 124% of that weight. Using a standardized measure called the Body Mass Index (BMI) you can determine your “ideal” weight.
At less than 95% of the ideal weight, women might stop ovulating, having regular menstrual cycles – or any at all. On the other end of the scale, excess weight is associated with unpredictably long gaps between menstrual periods and superabundance of ovulation-interfering hormones.
· Feed Your Fertility. Eat all the things you know you should but probably don’t, including fruits, vegetables and low-fat protein. In fact, adequate protein is absolutely essential because without it, estrogen breaks down into inactive byproducts more rapidly and menstrual cycles become longer.
· The Drink That Refreshes? Sorry but you’ll have to cap your caffeine and alcohol drinks to one cuppa joe (or latte or cappuccino) a day and maybe the occasional glass of wine. Heavy drinking is a fertility wrecker for both women and men.
· Get Exercised. Regular, moderate workouts are the gift of the fertility gods. They help keep your hormones happy, your weight under control and bring down your stress levels. Heavy exercise, say running 35-40 miles a week, can trigger amenorrhea (no periods), diminish progesterone levels so that an making it difficult for an embryo to implant.
· Smoke Signals. Tobacco is no friend of fertility. It increases susceptibility to sexually transmitted diseases in both men and women, increases the likelihood of tubal pregnancies, cervical cancer and pelvic infection. It’s just plain bad.
· Drug Drag. It’s not just the obvious culprits like cocaine and marijuana that spell trouble. It’s the pharmaceutical that people routine take to treat common diseases and conditions, such as Crohn’s Disease or ulcers or even psychological disorders, that could be problematic. If you’re contemplating getting pregnant in the near future, consult with your doctor.
Fertility Screening for Your Reproductive Life
Knowing what you know, you can actively in shelter your fertility from harm and even get it to optimal levels. Now there’s an important tool to help you identify where you are on your own fertility curve. Perhaps even more important, the screening can help pinpoint women whose ovarian function is on the wane so they can get timely treatment.
The screening itself is fairly low-tech. Part one consists of four blood tests to check the levels of FSH, estrodial, MIS (mullerian inhibiting substance), inhibin-B, all critical to conception and pregnancy. Ideally this is done on the third day of your period. Each blood factor is an indirect assessment of ovarian reserve. Any one of them is helpful. But the combination of all four allows for much greater precision in identifying potential problems.
Part two is a vaginal ultrasound to count the number of antral follicles in ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least eight antral follicles per ovary.
What you and your doctor are looking for is a dramatic shift in values from one year to the next.
Although none of these tests is in of and of themselves an absolute predictor of ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a sit-down with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.
It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better have the corrected sooner rather than later when the becoming pregnant is an urgent matter.
Precisely because your fertility profile is as singular as your fingerprint, it’s important to get a baseline as early as possible. Currently, specialists recommend that annual screening beginning at 21 years of age would be most helpful in establishing your own benchmark. If you are not 21 – don’t lose sleep. Remember that these Fertility Evaluations are a new concept. If you are concerned about your ferility at any age – you can go find out the facts by having these simply tests performed.
Fertility Preservation: The Egg Freezing Revolution and The Biological Clock
As so many women discovered late in life, procreation is a far more delicate and complicated process than most of us ever suspect. After all we spend so much time trying to avoid pregnancy, it never occurs to us that we may not be able to when we want.
So what do you do if you are in the midst of getting your degree or your career is on an upward trend that you don’t want to derail? Until recently, the options were few and unreliable.
But the recent breakthroughs in egg freezing gives young women the opportunity to put the best of their oocytes into a safe deep freeze until they’re ready to use them. .
A new technique, CGH, screens the eggs for chromosomal abnormalities prior to freezing. That allows fertility specialists to cryopreserve only those with a full complement of chromosomes. And those are the ones most likely to become healthy embryos once fertilized.
For the first time, women can be fairly certain they will be able to have their own biogenetic children when their life circumstances allow them to provide the best upbringing possible.
With careful attention to fertility protection, a program of annual fertility screening and the egg freezing option, for the first time young women really do have reproductive choice. Not just the promise but the real thing.
And right now – there is a huge group of us – trying to get this information to the women who need it…you know…the ones sitting in the GYN’s waiting room!
PS…If you really get a blank stare from your GYN – Please visit SIRM on line – there are centers all across the country – and we can hook you up with a Fertility Evaulation – as soon as possible.
Posted under Advocacy, Biological Clock, Fertility Education, Fertility Journey, Infertility, Organon, Schering-Plough, fertility evaluations
This post was written by pmadsen on December 5, 2008
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It’s Time to Think About Annual Examines and Second Opinions!
I usually get the notice from my gynecologist in December. It’s not too late to come in and get my annual exam and take advantage of the deductible on my insurance for 2008. My doctor reminds me that it is a great time for my pap smear and to book my mammogram. Often people who are struggling with infertility skip all of the routine care that they would normally get. After all, they are in the doctors office so much – they forget about general health maintenance. And it is not just the annual paps that go astray….it can also be visits to the dentists and the eye doctor. So, if you are in the midst of treatment – take this as a gentle reminder – take care of all of the rest of you too!
The new year is coming….it is time not just to take stock of your general health care – but it may also be time to think about where you are in your treatment. Have you had two or three failed IUI’s or IVF Cycles? Perhaps it is time to explore some of the newer technologies that are being offered such as CGH. Or perhaps it is just time to get a copy of your records and let a new pair of eyes look at them. This is a perfect time of the year to do that too.
SIRM is extending their offer of free consultations all over the country during these times of economic stresses – so that you can get that second opinion at no cost to you. Visit SIRM’s website and find the center nearest to you and call.
It’s the time of year to do more than talk about starting that new diet on Januarty 1st. It’s take to really take care of yourself and create the life that you really want to live in 2009.
Posted under Alex Kuczynski, Fertility, Fertility Support, IVF, second opinions
This post was written by pmadsen on December 3, 2008
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The Child Imagined….
I never envisioned myself the mother of boys. When I used to imagine my child, I would picture a little dark haired girl. Sometimes, I would see her in glimpses, holding someone else’s hand. She would have a page-boy hair cut and look a little Asian. I had a long time to imagine and long for this imaginary child.
During the height of my infertility, I used to picture this little child, and tell her why I wanted her so much. I told her what a good mother and father she would have, if she would just be born. I shared my dreams with her. I looked in shop windows at little pink things that I might buy for her. She was my child of hope.
I came across a passage in a novel I was reading recently. It struck an unexpected chord in me, and I was reminded of my “infertility child”. Scottish sisters-in-law who lived in the 1700’s are talking late at night. One is a new mother, with her child at her breast. The new mother was explaining to her sister about how she talked to her baby before the child was born.
“You can talk to a babe, you know. You can tell them anything. You can pour out your soul to them without choosing your words or keeping anything back at all. And that’s a comfort to the soul. I have often wondered if that’s why women are so often sad, once the child is born,” she said meditatively, as though thinking aloud. “Ye think of them while ye talk, and you have a knowledge of them as they are inside ye, the way you think they are. And then they’re born and they’re different – not the way you thought of them inside, at all. And ye love them of course, and get to know them the way they are… but still there is the thought of the child ye once talked to in your heart, and that child is gone. So I think it’s the grievin’ for the child unborn that you feel, even as ye hold the born one in your arms.” And she paused and kissed the downy head of her daughter. “Yes, before….it’s all possibility. It might be a son, or a daughter. A plain child, a bonny one. And then it’s born, and all the things it might have been are gone, because now it is. And a daughter is born, and the son that she might have been is dead,” she said quietly. “And the bonny lad at your breast has killed the wee lassie ye thought you carried. And ye weep for what you didn’t know, and that’s gone for good, until you know the child you have, and then at last it’s as though they could never have been other than they are, and you feel naught but joy in them. But until then, you weep easy.”
The child unknown is an issue for many of those struggling with infertility. The child of infertility for you, may be the child you lost through miscarriage or stillbirth. The child you talked to in your heart may be the one you have to say goodbye to before you are able to pursue adoption or third party reproduction. And like me, you might be surprised to find that you did not or might not, give birth to the baby you were talking to for so long.
I sit on my couch, and watch an old family video of my little family when they were younger. I see two beautiful blond haired boys. Not Asian in appearance, but rather Nordic. Tyler the five year old is actually hugging his little brother and shouts “Family Hug Time”. I watch myself in the video, gathering my treasures in my arms.
Treasures that were buried deep and almost lost. I sniff their hair and kiss their eyelids. I can see the look of wonderment on my own much younger face…it is as though I am thanking the heavens for these boys that are are so real and finally here.
I am caught by the thought of that little girl, so different, that child of my infertility dreams. I think of her, as I watch myself in the midst of solid, sturdy arms wrapped tightly around my neck. And I bless her for keeping me company and giving me hope. Her image challenged me to find some inner strength. In my mind’s eye, she asked me to find her. And I did. In two little boys.
Posted under Fertility, Fertility Coach, Long Awaited Children, Parenting After Infertility
This post was written by pmadsen on December 2, 2008
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When Someone Else Carries Our Babies…
In yesterday’s Sunday NY Time’s Magazine Section – there is an excellent piece on one woman’s experience having her son through gestational surrogacy entitled Her Body, My Baby. The author, Alex Kuczynski painted an accurate and unflinching account of her experience as a fertility patient. I loved her descriptions from the “Emerald City” to the culture of secrecy. My heart broke for Alex, at the unthinking words that sometimes come out of our care givers mouths. What were they thinking? Oh…they are not. How could they be? How could someone simply turn to a woman and say – that dark spot used to be your babies heart? As if they were pointing out an aerial view of the George Washington Bridge? How could someone say – in case your care – your baby was a girl? I have no doubt that Alex’s reporting is accurate. So many of us have been there. And we have been in places, centers, offices, where you would think that they would know better. But often they do not. I felt this feeling of embarrassment and shame for the entire field as I read Alex’s accounting. As if by simply being a part of the community – I held some responsibility for her pain.
I appreciated the candor of the piece – the stark honesty on everything from costs, to what motivates the surrogates – and the loss of not being able to carry her own child. And the honest expressions of fear about being her babies true mother. And I just couldn’t stop flinching – the Pastor who told Alex “That the Church frowned on Science Babies.” If that doesn’t suck the air of your lungs – I don’t know what will.
So many times articles on infertility are politically correct and skirt so many of the issues that this community truly faces. This piece is brave. Take a read. And if you are exploring surrogacy – here are some helpful names and links:
Shirley Zager, director of the Organization of Parents Through Surrogacy
Melissa Brisman, Esq – Surrogacy Lawyer
Surrogacy 101 – which has a great piece today on Surrogacy whether to stay in the relationship after the child is born or not…..
Posted under Alex Kuczynski, Her Body My Baby, IVF, Infertility, Melissa Brisman, My Baby, Organization of Parents Through Surrogacy, Sharon LaMothe, Shirley Zager, Surrogacy, Surrogacy 101
This post was written by pmadsen on December 1, 2008
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A Change of Seasons..
Fall colors begin to appear and become falling leaves. We mark time with the changing seasons. In an unpredictable world, some things still cycle around with unbroken clarity. The pumpkins, apples, crisp air and fat turkeys signal a time for celebration.
Automatically, the world begins to prepare to give thanks for this season of the world’s unbroken cycle. But when you are having difficulty forming a family, it can feel like the cycle is broken in what a friend who is struggling with reproductive difficulties described as “a world already broken”. We live in a time where our world is in crisis and many of us do not feel safe in so many different ways.
It is unbelievable that I am not talking about some far off nation, but our own back yards. In this time, the threat of terrorism is high, our bank accounts are unstable and the weather can feel unpredictable. People are still fighting over land and religion. Right now, the world does feel broken.
This year, as we sit with our own troubles and pain, we may think that our neighbors begin this dance of celebration with ease, but they too dance in “a world already broken”.
Sometimes, the change of seasons reminds us of our dreams and disappointments. Our goals yet unfilled. It can seem impossible to look up and feel joy, when all we are able to see is our broken world. Harvest time, when we don’t feel fruitful. Family gatherings when we fear tears welling up at the mere mention of anything.
Yet I know, that you will feel the brisk air, and it will feel good. You will notice a scarlet tree and admire its flamboyance. You will see little children running and allow yourself a minute of sweet longing. I know that you might look at your life through your struggles and think about daring to feel hope once again. You might even dare to be grateful for the things you have that you know are good and sweet. Find within yourself, that spot of celebration, of gratitude, of blessings. Dwell there. Your struggles will wait for you…they always do…right now…let them go.
Gather around the table and give thanks in this world that is filled with imperfections and disappointments.
Together we will gather up your dreams. Don’t let them fall like the leaves under your feet. Gather them up and cherish them. It is time to give thanks. I urge you to dare to dream and hope in a broken world that you didn’t break. I know that you will find your happiness, unique and pure. Allow yourself the hope of the harvest. You are entitled to the pie and a smile. Gather around the table and let’s give thanks for our dreams and our hope.
Posted under Coping with the holidays, Fertility, Fertility Support, Infertility, Thanksgiving
This post was written by pmadsen on November 26, 2008
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When Death Comes…
I have always been a person that lives fully. But I have gotten better at it as I have gotten older.
I have always had a sheer determination of spirit. It was born to me…it was how I landed out of my Mother’s womb.
But it still needed cultivation. I still had to work at facing my own fears..my own broken places…and the places where the fear of failure..the fear of that particular pain…held the danger of me not trying at all.
It took a sheer determination of spirit to have my kids. They did not just come to me. I had to believe them into existence…and open my heart to the possibilities….I had to face fears in order to conceive them…IVF was new when I was trying to have children. There was a lot of trust involved…and a willingness to go when I had never gone before…and I also had to face my own shame over not being able to conceive my children on my own.
And I had to find the money to pay for it all…but I didn’t want to miss having children for anything in the world…so I did what seemed impossible at the time…and it took huge amounts of courage…and I had to drag my husband Kai along with me every step of the way…
He would say to me…”Why do you want this so much?” “I would never put my body through what you are putting your body through”…and I remember my husband, Kai…holding Tyler…born premature…at four pounds five ounces in the delivery room…tears streaming down his face…sheer joy and amazement in his eyes…and I remember him thanking me for leading him to his son…because he would never had done it..all the steps involved with creating his son…because he didn’t know…couldn’t know…the joy he was feeling in his heart in that moment of holding that child. In that moment, Kai knew that missing this child would have been like not living at all…it would have been worlds missed.
There are so many parts of our lives like that…so many challenges that we all have to face everyday…illness…relationship and job issues…parenting issues…there are so many opportunities to decide whether we are going to live fully. Even this time of being warned every day about a recession – do we stop our lives? Or do we continue on and reach for that brass ring! It becomes a decision about whether or not we are simply going to be spectators in our own lives…or whether or not we are going to live our lives fully.
I challenge you to look at those places…perhaps you are in one right now…perhaps for you it is whether or not to take the risk and fly to China and adopt a child…and the entire process feels incredibly overwhelming…
I don’t know what it is for you…perhaps it is working to raise the money for an IVF cycles that feels out of reach…perhaps it has nothing to do with reproduction or fertility at all!
But what I want to say to you is… go for it…deep dig…go where you never thought you could ever go…because this is not a dress rehearsal…this is it..your life. You have arrived…and in Holiday Season….I find myself looking deeply at my own life…and the joys and dangers of playing full out…full court….and yes…it can be complicated…and difficult…but oh yes…it can be filled with incredible joy…
My youngest Spencer is rolling out of bed…my CryoPreserved IVF Embryo…we played full court to have that kid…he won’t get a hair cut right now…his hair is in his eyes…I try not to notice…not to say anything…Spencer is playing his own full court as a fifteen year old right now…a part of that is not cutting his hair…I find myself grabbing him…holding him….I breathe him in…so much joy. I would not have missed him for the world.
I am feeling sentimental…can you tell? Perhaps it is all of the infertility haikus that I have been reading!! I agreed to be a judge in the First International Infertility Haiku Contest – and I spent so much time reading about longing, and struggle. I am full of wanting for everyone…for all of you to find that place in yourself to take you to live your life fully…to face things that scare you…that may be preventing you from getting all that you want in this life…and to move through that to a place of having what you want.
A good friend just sent me this poem..it sums it up beautifully..it is by the poet Mary Oliver..
When Death Comes
When death comes
like the hungry bear in autumn;
when death comes and takes all the bright coins from his purse
to buy me, and snaps the purse shut;
when death comes
like the measle-pox
when death comes
like an iceberg between the shoulder blades,
I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?
And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,
and I think of each life as a flower, as common
as a field daisy, and as singular,
and each name a comfortable music in the mouth,
tending, as all music does, toward silence,
and each body a lion of courage, and something
precious to the earth.
When it’s over, I want to say all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.
When it’s over, I don’t want to wo…