I have a disability
Because it is lack of memory
Others refuse to accept it is
The way my mind shall be
After testing my memory
The PhD of Neuropsychology
Agreed that I suffer with
Cognitive impairment, MCI
My forgetfulness is here to stay
With me until I die
Yes, I can exercise my brain
It may help a bit, still I will forget
So just accept it!! PLEASE QUIT
Telling me to exercise my brain
I know my limitations best, oh Yes!
Everyone telling me to try to remember is really what
Drives me insane!!!
I have tried my hardest everyday
For years I have been fooling You
All in so many ways!
Now the truth has escaped
It is a relief, I must say
I am so tired of  playing
The main role on the stage
Every single day!!
Please, all of you quit telling me
To exercise my memory
If this was happening to you,
God forbid, then perhaps you
Would understand me when I say
I am tired, oh so tired, of striving
for just an ounce of memory
Day after day!!!!
So again I say
Please, just let me be Me!
The Ole' lady with memory disability
THIS IS ME, ₩€ND¥°•°°•°•°°•°•°°•°•°°•°•°

The Avro Vulcan, a majestic big old iron bird, sublime,
was to do a flyby for just one memorable last time.
Maybe with a jet fighter or a Spitfire on each wing, who knew?…
Unthinkable to miss it… almost a crime.
Thousands turned up every year, always a great day out -
but this year would be special, there'd be no doubt.
The last flight of such a legendary plane made it essential…
So, after the flyers’ break for lunch, the crowd filled out.

The entry fee to occupy the field was heinous. 25 quid!
That was for adults - and a fiver for each kid.
So, many more than those that paid, sat happily outside pubs.
Others found shelter in the perimeter’s trees and... kinda hid.
Now, to see a Vulcan fly anytime, anywhere, was magic…
She was a Leviathan of the Cold War,
that held players in the planet’s power games in awe.
And this would be her last time doing the rounds on the air show circuit -
Seeing this locally was hard to ignore.

Mark (a nephew) was a window cleaner by trade.
A regular, down to earth, happy go lucky guy.
…Saturday comes and the kids all voted "McDonalds"…
“A Happy Meal!” they’d cry.
He said that was fine - they’d all go after he’d nipped over
to the airshow to watch the Vulcan fly.
No idea whatsoever, of course, that just by going to Shoreham
just 5 miles away, for half an hour or so… that he might die.

He told his fiancé he’d only be an hour or so…
be back in time to take the kids for a burger and, "NO!"...
He wouldn’t stay. He was the only one in the family
who was bothered anyway…so he wouldn’t ****** up their day.
So, in haste, because apparently Chicken Nuggets & Fries
was much better for the kids than a load of old planes,
he cranked the best out of his bike along the 27 and,
once at the lights by the Sussex Pad,
he pulled over to the kerb to watch from the bushes.
Good view? Well not bad!

Andy Hill was a flyer of many years. His weekday job,
flying for BA.Taking holiday makers, business folk, transatlantic in Seven Four Sevens...
A flight deck maestro, soaring up, just under the heavens.
He’d done Shoreham loads of times… it was exciting, exhilarating... almost sport, his game!
He was off the hook,  became an ace. It gave him that 15 minutes of fame!
Free to thrill - a hero! Standing out from the crowd with every daring step. His aim!

He wasn’t just a petrol head… this bloke had aviation fuel in his blood.
Adrenalin on tick-over. Nought to 60 in 2.7 seconds with 22,000 Horsepower under the hood.
He left Epping full of fuel, just 90 miles away, so in two ticks he was with us, fully loaded and, the weather? It was good.
First up after lunch at half past one… he streaked across the crowded field.
Over and out and up, up, up… Little did the spectators know that Andy had forgotten he was flying a Hunter…
He thought it was last year’s aborted routine in a Jet Provost… The one they'd stopped part way through being, too risky.

"He’s not gonna make it… I can’t look!" There was a hush… a nanosecond’s silence and then the rush,
the whoomph that said it all… that hush! The ground shook!
And the eleven - plus others injured - went up in Andy Hill’s very own fireball!
No, of course, Mark wasn’t the only one to die that day.
Ten other ‘innocents’ left us in pretty much the same way…
Maurice, Dylan, Tony, Matthew, Matt, Graham, Mark R, Daniele, Richard & Jacob.
Mark T, our Mark, had the distinction of having two funerals, not just the one…
More remains were discovered, analysed and found to be his!
Even after he’d…already well... ‘gone’.

The injustice that eleven spectators or just passers by should die
when the survivor, the off target driver, who sped too low from the sky, should, after a suitable pause in this ghoulish game, be exonerated and not take any blame.
Well it’s all sort of things… It's ridiculous, pathetic, obtuse, a joke… who do they think we are?

But the great and the good deliberated, scratched their heads and worked hard to make everything look ’right’…
Tolerance for the bereaved to grieve, platitudes, condescending attitudes, a memorial service.
Thanks - genuinely - to the emergency services… Not just a little buck-passing… But the public often judged them. Arsing about - to cover their corporate backside.
They can’t insult me (or us)… intelligent people have tried…

Andy Hill was judged to be not guilty of 11 counts of manslaughter by gross negligence.
But he claimed he blacked out in the air, having experienced ‘cognitive impairment’ brought on by hypoxia … possibly due to the effects of G-force…. Of course!
The 11 were either hit by the plane or roasted in a fireball caused when the jet flew too low and too slow. But if it wasn’t Andy’s fault then whose was it?

Surely this can’t be the end of this travesty of justice!!

BUT, there IS a new memorial to the dead. And, trust this...it’s a good one too…  The best that money can buy - and that anyone can do.

But there's is also a very bitter taste, still today…
that somehow... just won’t go away!

Somebody call Ben Affleck
We got phantoms in this *****
This endless haunted mansion
Their presence pervades
No company
In this lonely labyrinth
Only phantoms
The only figures resembling humanity
Are the corpses of those before
Who couldn't navigate this torturous structure
And of course, the masquerading phantoms
My soul they aim to puncture

I tried closing my eyes
But I just kept running into walls
I tried sleeping through it
But I just sank deeper into the basement
When I attempted to join the phantoms
You were there
You waited until I was hanging there
On the rope
And eviscerated everything
Lycanthrope
The rope in shreds
Your heart then fled
Leaving me alone again
Lying in my exhausted blood
The phantoms sensed my desperation
And took advantage of my disorientation
So I ran to the darkest recesses of the basement
To retrieve my blindfold and sledgehammer
But is my hammer powerful enough?
Will visual impairment abstain the trickery of ghosts?

I put Sisyphus to shame
With the determination I utilize to demolish these walls
But the phantoms are devious
They ***** new facades
Thicker, sturdier, with odder textures
I destroy them all the same
It just takes a bit more time
And time means nothing
To a man who's sole purpose is knocking down walls
And cowering from apparitions
Yet a man means nothing
To a time ruled by phantoms

The clock struck midnight
With an informative pang
I couldn't face it's music
So I turned counterclockwise
But time kept moving forward
As my wisdom dissipated
Bad times I anticipated

As I wandered through life
Burdens grew
Weight added with each step
My feet started to sink into the ground
So I got in my car
And drove
And kept driving
The more I traveled
The more I witnessed
The less I talked
As I grappled with the futility and necessity of communication

The clock warned of night's approach
I decided to continue driving
Luminous fireflies pelted my vessel
Their lamps exploding upon impact against my vehicle
The ability to destroy light
Exhilarated me
And I became addicted
To extinguishing that which shines
Until darkness flooded my engine
And an abysmal order was made by my abyssal odor

I had to exit my vehicle
And consult a mechanic
He explained my engine wouldn't work
Unless my windows were down
Which solved my darkness problem
But those ****** pests pervaded my car
Their locust glow disoriented me
The slight variations of their unique displays
Manufactured chaos within the light

My eyes grew accustomed to entropy
My brain grew accustomed to impairment
Commuters noticed my erratic driving
And offered to assist me
By attempting to ram me off the road
But the impenetrable light created a force field
Impalas couldn't run through
For my light bugs too much
Buffering me from others
And driving others from me
Leaving me alone
As a giant pulsating light that never stops moving
Is this how a star is born?

He carries her purse on his arm
without awkwardness;
His comfort shows he must have been caretaker,
for some time.
Yet awkward she does feel.

He carries her purse on his arm
as if it belonged there.
Just another parcel to be handled
with care; yet not a care
to what this stranger thought.

This old woman hobbles
ambling behind;
a footfall - thrusts her forward,
one more step.
Doesn’t he understand she wants to go forward -
no more? One step closer
to the grave,
she can sense.

The cane catching
and holding her steady;
The pain, catching
and holding her firm.
She follows his lead; always hitting the mark
with her blue veined hand
wrapped around that staff
in her grasp.

Her gait, unsteady,
wobbly at best
As he carries her purse on his arm,
She follows his lead
one step at a time

A crooked cane
her only assist for the
ambulatory impairment she bears;
as he carries her purse
on his arm.

© 2010 Marlene Dunham

I.
Still thriving beyond immaculate walls.
Tincturing the water that solemnly streams in the river,
I await the corner of grassy marshes, and
Gather your secret spells.

In days when the land is prey to rhythmic beats;
The water dances with disturbance.
I run through the meadow barefoot, and
Cast the sun-dried bricks beyond me.

The red Moon drowns in woeful bliss, while
Its jealous relative illuminates the dew on Morning petals.
I glare through my destruction;
And see your silhouette.

Torn bridges of yesterdays misfortune send
Violent waves forth, undying they proceed.
Bravely-- they despondently conquer me;
No longer a trace of you I see.

II.
Unable to grasp reality, bitter
Tears of a Bright knowledge no longer in possession.
Red yonder, cognizant of former tribulations
Appear among the contour of wilted trees

Desperately searching for extraneous disposal,
Only melted clay reflects the ruins of an icy marsh.
Spring is obscure; but inevitable.
Soon harvest shall return to the field,
And barren no more will the land be.

No longer riddles, or secret spells;
Greet the stream of lost memories.
Impairment heals itself; it weaves
Filaments of seconds- to create a
Labyrinth of Time.

it drips
down the strands of hair
that populate my scalp
seeping in the pores
penetrating the folds and fissures of my brain
it lodges itself in my cerebral cortex
impairing my thinking, judgement and reasoning

it reigns
it never ceases
continuously present

daddy fractured our world,
titled it off it’s axis, sent it
careening out of control.
that was before the day
his own impairment
made him overcorrect,
****
the mercedes onto unpaved
shoulder, then back
across two lanes of traffic,
and over the double yellow
lines, head-on into traffic.
that was before the one-ton
truck sliced the passenger
side wide open. that was
before premature death, battered
bodies, and scars no plastic
surgeon could ever repair.
yes, that was before

The firmest handshake
I've ever felt
Was that of a woman with

Only three fingers left
On her
Hand.

The biggest person I know
Is about the same hight as
His wheelchair.

His life is a richer one
Than mine will ever be.
Because he makes it so.

What worries do I have?
Yet some days are heavy.
I suppose being born

Unimpaired and staying so
Is an impairment at times
In itself.

I walk alone contemplating the scenery of an abandoned castle
Beside the Forest of Whispers an amazing view am baffled
I contemplate the thought if I should walk inside or not
All the sudden I hear a voice in my head inviting me to come in
I gather all my courage and enter the castle
I stop briefly to look at the entrance of the castle itself
It has Two Giant Stone Cyclops statutes and a huge metal door
The scenery is captivating yet am a bit nervous to press on
I look everywhere but there is no one there and I get closer to the entrance...

Without warning I see the huge metal doors begin to slowly open
Lots of dust and smoke emanate from the ground as they slowly sway open
I think to myself (What's going on this is just weird) I hear the voice again...
"Come inside adventurer I have something for you" I carefully step inside the Abandoned Castle
Inside the Majestic Palace it's beautiful...I carefully examine everything insight
A Old Painting with a Young Man dressed in an 1800's Draco Tunic (Black & Red Colors)
A Gorgeous Staircase that looks like it has been recently cleaned and polished
Many pieces of Marble Art all over the Main Hall Room -The part of the Castle am in- and many doors up the staircase and where I recently occupy
I ask the voice "Who are you?" and it replies (The voice itself sounds a little rusty and hoarse a bit old in fact) "I am Aziel Count Of the Darkness the 3rd Prince of the Night, I have lived here in my Castle for 750 years" As I survey the Main Hall Room in the middle of the room above the stairs that lead to the second part of the Castle itself there hangs the painting I briefly looked at. It's a huge painting a beautiful masterpiece carefully detailed and crafted with a young man dressed in a handsome Draco Tunic. His long dark hair deep black eyes and the black and red garments his wearing truly make him stand out and make him look like a Count of the Night...I think to myself (Could this be him...Aziel?) and just as soon as that thought came to mind I heard the voice again..."Yes that is me Adventurer the one portrayed in that painting is me, now tell me may I have the pleasure of knowing your name?" then I swiftly reply "My name is Frank Deltoro" As I get closer to the painting ...
All at once five scarecrows come out of no where ...from various parts of the Castle I assume and they all get together and commence to form a shape...about 10 ft from me.

Then I realize the form it's human and there I stand in awe it's an Old brittle man shirtless with silver eyes his skin pale as chalk and his pants wore out and thorn down. I get closer and closer to him then am about 3 ft from him and he says "Stop right there...I want to request something from you my mortal friend." Then he proceeds to speak again "Hello Frank my name is Aziel Governale. I am one of the 3 princes of the Night. My 2 brothers Vladimir my Elder Brother and Uriel my younger in fact the youngest sibling of us 3 reside in different abandoned sites long forgotten by mankind. It's 1933 in England in the remote sites of the burned down village of Qwutzentok. It was 13 years ago that the Order Of the Silver Knights burned down the village due to their iniquity and blasphemy against the one true God Almighty. The village conducted dark rituals to try to revive the Lord of the Night my Father...Dracula, but their attempts where in vain and futile. I still command to some extent the power of the night but my powers have been weakened by the Order of the Silver Knights and their Holy Crusade to conquer and extinguish the Night forever. I have hid here for 700 years after a Silver Knight known as Joshua Villamont defeated me and I was cast into hell periodically until I was revived with a blood ritual from a woman known as Elizabetha a young mortal woman who had fell in love with me when I was a mortal man. (He pauses for a second) (I analyze him head to toe as he speaks but I am in bewilderment and tremendous fear.) -He begins to speak again-

"I want to extract revenge on the Order regain all my power and might as one of the princes of the Night and revive my dear Elizabetha. She was killed by a Silver Knight back in the year 1225. I had just become a Prince of the Night and shortly after the Order raided our family and killed me or so they thought in the process...my Father had about 12 years of being dead and my 2 other brothers where no where to be found. We had all been scattered by the Order. I had been a Vampire only for about 3 years and then I was defeated by the Order and cast into hell and she rescued me and saved me. We stayed together for a while but I was too weak to make her a vampire and then the Order raided me once more and killed her. Now I want her back and I want revenge...you understand?"

Deltoro: "Yes I understand. But why should I help you?"
Aziel: "Due to the fact you have some distrust and hatred in your heart towards the Order. You was denied to become one of them due to your visual impairment in your left eye you can only see blurs and part of your right hand it's movement is restricted due to your born defect you can't move 2 fingers from your right hand. To be exact those fingers are your index and your pinky finger."
Deltoro: -Stands there in complete awe and shock- "How how...ummm...how did you...know?"
Aziel: "Am a Count of Darkness I can read man's hearts. I control to some extent telepathy. I can read 97.5% of individuals. It's a perk you get for being a Count."
Deltoro: "Fine...you have swayed me I will help you. But wait why can't your brothers help you if you can telepathically talk to them both?"
Aziel: "Oh mere human. Vladimir is dead...he was extinguished by the Order. Uriel I do not know his whereabouts I know he isn't in England. Therefore am here alone practically...it just I finally got an opportunity to extract revenge so that's it's exactly what I plan to do."
Deltoro: "OK so what must I do?"
Aziel: -Thinks to himself for a minute- "Have you heard of the so called Goddess Of The Forest?"
Deltoro: "Oh yes I heard that myth before Nabyah The Goddess Of the Forest Of Whispers."
Aziel: "It's not a fairy tale you know she exists and she is in the heart of the forest itself. All you must do is convince her to give you some of her blood willingly and if she isn't cooperative you must take the blood from her anyway and bring it to me."
Deltoro: "But she must be a powerful deity am sure she is going to fight back if I try to do such a thing."
Aziel: "Well ...those are the risks you must take in order for me to grant you my reward."
Deltoro: "Very well challenge accepted. I'll depart now."

(And so Frank Deltoro departs swiftly towards the Forest)

KEY

Draco Tunic= A Robe worn by Counts back in the 1800's. It displays Dragon scales in them. Only the true Counts of the Night had real Dragon scales placed on them however.

The Order Of the Silver Knights= Founded in 1000 the first millennium by King Nathan Bulderaux III. It fights the powers of Darkness ever since it's formation. It became famous after defeating the High Lord Dracula King of Darkness and vanishing his soul into hell.



                                                                                                      ->TO BE CONTINUED...

Were there no stalkers or high school shooters in the 50s?
Or are social web sites just more influential than our parents think?
Did texts and tweets raise the *** drives and black out drinking?
Or is the thinning atmosphere contributing to mass judgement impairment?
It's strange
that we have a cure for small pox, can remove cancerous cells
but can't convince some to drive home sober.
It's fitting, in a way,
that Mother Nature has figured out a system to keep the human population relatively in check:
we have the technology to survive diabetes and malaria
but  access to delicious saturated fats is slowing down and stopping hearts from properly earning a living.
Progress has ended many terrible ailments and has expanded understanding and brains
but has also given more creative ways to be lazy and irresponsible.
A double edged sword, with most likely more benefits than setbacks,
we have all become hypocrites under advancement.
We learn of the monstrocities in far away places we will never see,
yet still do the very things that contribute to its existence.
Sweatshops?
I'll buy an anti-slavery t-shirt!
(made my children. in sweatshops.)
Pesticides?! I'll go organic!
(and perpetuate pollution with the fuel used to import the goods. and continue terrible working conditions)
It's impossible to resist the inevitables, like death and setbacks and corruption
so sometimes it's best not to fight
but to just do what you want, even if it's stupid or lethal or involves making an *** of yourself.
We're all stupid at sometime and susceptible to faulty thinking,
and sometimes advanced thinking leads to inventions that create crutches for living or coping,
but  the fields  level out
and global common sense always balances individuals who lack the ability to be actively responsible.

Norwegian summer night.
She opens her guest room window and
Balcony door to

Give the scent of warm pine and
Sunstroked willow a free tour of her
Apartment on a welcome breeze.

I mute the TV, as she enters her bedroom  
Leaving me shirtless in shorts on her
Sofa, headphones nearly plugged into

My laptop when she requests a tuck-in,
Knowing that granting me the remains of
Her Saturday night sixpack means

She's going to bed alone.
I kiss her forehead goodnight. She steals
A bonus hug, wanting it to

Last until morning though it's
Futile. I bury my face in warm, soft
Neck. She

Releases hesitantly. Smiles.
She has bed. I have Johnny Cash and Chet
Baker, Alan Watts and Allen Ginsberg,

Beer, time, and a window of solitude.
"Silent" and "listen" are spelled with
The same letters.

My impairment is that I am a man.
I love her. And the aloneness that
A man can only obtain when

Even the loneliness has left him.
I can't feel my feet, unless she does what
She has learned to do;

Give me space. Space with the texture,
Colour and pattern of the
Blanket one tucks

Around
The legs of someone
In a wheelchair, gesturing by it:

*I love your
Every single
Circle.

From Lepanto, the Armis Christi appeared exhausted, with fiery eyes volatilized in stratospheres that Belligerent received them. As if they were extraterrestrial castes seated in inflexible breath, floating from their chin in fuss and idiosyncrasy. They arrived cracking the pristine sections from Tel Gomel…, when they arrived a military strategist attacks him, asking for clemency to extend.

Falangist: “With the crest in my hands and the Dorus on my chin from the ground, I said; every arrangement I tried on the double edge of my sword bruised it. The upper sheet Sansevieria nominated me towards a Hebraic past and a medieval future ..., it was the Sword of Saint George, notifying that my family in Kalidona was under a paradoxical state, given to my two older children who were summoned to the service of the military. "The second lower edge of my Xiphos, the Sansevieria, betrayed me vile before the prosopopeia when I entered with discouragement to support them ..., the sclerosis of my soul continues to explode ..., surpassing and driving my wife into easily disposable splinters. I know that my descendants were buried under the effect of a mortal reunion in the catharsis of Pompeii; the becoming of Saint George made it clear! All will emigrate and flee after being devastated, and the inopportune comrades manage to return when they reintegrate in the festival of Holy Mary in Athens, the Holy Patroness consoled me and prepared my resistance of such bad money, so that one day I would drop my seeds in cultures of peasant archangels with sacred devotional fruits. I sighed and moaned rubbing myself in my animals! My empty eyes day and night were mesmerized as they became ethereally magnetized. They did it together with me, with the singularity of not affecting me ..., they went through nearby streams to sob so as not to see them demagnetized by certain fatalistic and consummatory effects”

Etrestles moved by the tribulations of the Infant of the Phalanx, he bowed imposing nonexistence, after her words implied the exhortation to Hera for her benevolence, prohibiting and parasitizing him to be able to reside with her. Thus they would be immune to progressive lives under the influence of sharp primary and secondary stews in the arms of the Falange. Hera's eyes shone when the Falangist's soul entered her, they were not vanities, but the advent of the vanistory in her pretense towards the Acropolis, taking him to her.

The Sibyl Tiburtina supports him, gathering him in her arms, saying: “you will receive the heat that will imprison you in the house of the high priest, a scene that will be represented in Procoro on the corresponding neutral folio. Events and expletives were from the past; they no longer targeted or abused him. The Armas Christi again swirled with the Souls of Trouvere in the last irascible recesses of the Eolonimi winds in the holistic of all the winds that named Vernarth. "Your children did not live again, the military Macedonian heard", the physical resurrection of the unconverted takes place after the tree of Mars, when they liberate the innocent fallen in the versicular belief that segments the ray with its half, where no minute will be able to get it right. The passages of the wind tunnel are the wasteland that dies revived by the almocaffre, cutting fibrils overflowing with vitality from on high, to overflow it downwards for those who still await astonishing miracles, walking alongside the living with hypocoristic trifles reborn in the same blood that it was spilled. Every famous person walks with pennants that rise from his own grave, cutting smaller capillaries in the impetuous rise of his pale cheeks, where the Greco-Western scepter will be the self-control of whoever escapes free and resolute from the tree of Mars. Now you will lie next to your children and you will be between the hazelnuts and Eolonimis doing the revival of Tagmati or order of succession of the Polis as an elite unit, tribulating the final sections of the Ultramundis straight, by tightening the glorified 103 meters”

Etréstles during the millennial of Satagenesis and Deidagenesis, together with the Heosphoros and the Uomo di Valplacci, prostrated Lucifer before Etréstles (Koumeterium Messolonghi, Ch. 45 - Palibrio USA), ebbing and emulating the Peloponnesian wars, this being a stronghold of the general of the Athenian fleet in western Greece. The Mentor Fleet was led by Admiral Phormio, who defeated all the Lacedaemonians on Naupacto. When they approached the province of Nafpaktia, of the Nome of Aitoloakarnania, confined they followed the undivided and weightless musks scattered, disintegrating immortal souls with the impairment of the exhaled breath that was extinguished in their offering. This is how he could provoke some aversion so as not to be condemned to the Hadic underworld. The castes of gods and demi-gods, with Sansevierias in green leaves and clover, were chained towards freedom from the raging gases of Xenon and Lithium. Sneaking through drains and spaces where no sword or spear crossed the atmosphere of Gaugamela Macedonian. Only Vernarth there hadic, will have to be channeled through the unscathed pavilions of the immaculate back room with heroic lineage. No undulating or flagrant blade will slice sanctified flesh acquired in said sessions in the handcuffs of the Bumodos with the drugs and the potions of Medea.

You went on your fishing trip
Caught a big one this time,
You said.
This one's a bit heavy,
Weighed down.
With a sharp tug on the pole,
You finally retrieved your catch.
Well, what is it?,
You asked.
You held something in your hand
Pulsing and black.
Whatever it is,
It's not worth it.
You threw it back into the water,
Back into the dark depths.
Let's keep on fishing.
I wanna catch a big bass.

They say there's plenty of fish in the sea
But you didn't even notice,
When you caught my heart.
Sure,
It was beaten
Almost unrecognizable.
But it only took you a second,
To judge my darkness
As impairment,
And toss me back to a personal hell
You reeled in my heart,
And you didn't even know.

I'm sorry I can't be
**The catch of the day.

I dream about her and see
a metamorphosis beneath
the ****** woad

I dream about her after falling
into a bed that has held the shape
of my irregular body

I dreamed about her

She is the only morning star and too
the black caterpillar in dye
below the leaves

Does her repose animate me?

I think and think I do
the thought extending to my limbs
somatic skin and the receptors in
my eyes appraising the world

In every moment of sleep and dream
where I could be awoken
from the impairment of unconsciousness
there were moments of sleep
where I did not dream and
the butterfly was not me

Doll eyes, he says
You have doll eyes

Of course.

Glassy, blind doll eyes
waiting for any random child to squeeze me to life

Bring me reaction.

My pupils hold tiny negatives of him.
He checks them for impairment.

Sitting side-by-side on a damp porch step
he tells me the story of the spiders

plunging mouth fangs into live, bound captives
melting and digesting their insides
leaving an empty shell
Brittle, used and dead.

Intact from the outside

Sketching surveys of desolate dreams,
purveyors of private property plots,
their impatient greed,
ignoring purple spray paint warnings.

Six feet under, resting next to Grandpa's coffin,
live valuable minerals, their rights forgotten,
a farmer of soy beans, wheat and corn,
oil & gas law to Grandpa was foreign,
but he knew why our creek's current flowed north,
upwards, defying gravity or reason, why these men had come.

One time executive cowboy hats descended on the farm,
in pickup trucks, just purchased from an oil lot in Odessa,
Grandpa took aim and raised his Beretta,
their unfit hats lost to the blast, the only harm.

I was only five, when I saw his lengths of protection,
he took me on hunts for deer, boar, quail, dove,
would always aim his rifle, fire and miss,
blamed it on his eye sight, yet hit bullseyes on paper targets.

It took me 20 years to understand why, with swallowed pride,
he purposely missed killing these animals,
cursing his eyesight instead, winning an Oscar for his humble acts,
was he blinding me from death?

There was no vision impairment, I found out in hindsight,
probably the trauma witnessed, as he died with 20/20 eyesight.

Impatience is the impairment of patience
Where it is imperative, should be noted
That the implication of impatience
Is the lack of it thereof,
That is, patience
And not having the time to
Improve upon waiting

It's not necessarily a bad thing
Sometimes it's best to rip the bandaid quickly

Permeating - Begins with a simple dispute, argument, disagreement, and conflict with the individual. Second, temperate levels arise, violence emerges, resulting in uncontrollable actions, creating a brutal response. Third, very difficult to describe, but I will do my best, here it goes, limits have exceeded beyond recognition, logic is no longer liable, quickly disappearing, reasoning malfunctions, love is no longer there, hate has taken full control, picture this experience, the demonic manifestation.

Torturing - The body increases heavily in strenght, meanwhile pain flows throughout the blood stream, invincibility neurotransmitters take over, eyes dialect largely covering the entire layer, screams become very unfamiliar, roughly deep raging voices infuse, bloods exposed, numbness arose, receptors react, nothings inevitable its too late, shark bate, regenerate don't anticipate or hesitate, meditate composure and control the setting, pain is in motion.

Suffocating - Powerless embodiments, crucial destruction, ineffective signals, petrified terrified horrified symptoms, death is near if the hody turns weak, vulnerable absorption, manipulating cells propelled, evil casting spell, damaged speech impairment, strange feelings corrupt breathe intakes, prone to cardiovascular shutdown, heart attack, seizures, lose conscious, maybe faint, watching this occurrence is far much more traumatic, I'd say an experience unforgettable, marking scars forever, taken to my grave, remember Jesus saves...

HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to us e
M-M-R II safely and effectively. See full prescribing information
for M-M-R II.
M-M-R® II (Measles, Mumps, and Rubella Virus Vaccine Live)
Suspension for subcutaneous injection
Initial U.S. Approv al: 1978
-------------------------------INDICATIONS AND USAGE-------------------------------
M-M-R II is a vaccine indicated for active immunization for the
prevention of measles, mumps, and rubella in individuals 12 months of
age and older. (1)
-------------------------- DOSAGE AND ADMINISTRATION--------------------------
Administer a 0.5-mL dose of M-M-R II subcutaneously. (2.1)
• The first dose is administered at 12 to 15 months of age. (2.1)
• The second dose is administered at 4 to 6 years of age. (2.1)
------------------------DOSAGE FORMS AND STRENGTHS -----------------------
Suspension for injection (0.5-mL dose) supplied as a lyophilized
vaccine to be reconstituted using accompanying sterile diluent. (3)
---------------------------------- CONTRAINDICATIONS ----------------------------------
• Hypersensitivity to any componentof the vaccine. (4.1)
• Immunosuppression. (4.2)
• Moderate or severe febrile illness. (4.3)
• Active untreated tuberculosis. (4.4)
• Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
• Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
• Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
• Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
• Immune Globulins (IG) and other blood products should not be
given concurrently with M-M-R II. (5.4, 7.2)
----------------------------------ADVERSE REACTIONS----------------------------------
See full prescribing information for adverse reactions occurring duri ng
clinical trialsor the post-marketing period. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Merck
Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-8 7 7 -
888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
-----------------------------------DRUG INTERACTIONS----------------------------------
• Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
• M-M-R II vaccination may result in a temporary depression of
purified protein derivative (PPD) tuberculin skin sensitivity. (7.3)
-------------------------- USE IN SPECIFIC POPULATIONS--------------------------
• Pregnancy: Do not administer M-M-R II to females who are
pregnant. Pregnancy should be avoided for 1 month following
vaccination with M-M-R II. (4.5, 8.1, 17)
See 17 for PATIENT COUNSELING INFORMATION and FDA
approv ed patient labeling.
Rev ised: 06/2020
FULL PRESCRIBING INFORMATION: CONTENTS
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Dose and Schedule
2.2 Preparation andAdministration
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
4.1 Hypersensitivity
4.2 Immunosuppression
4.3 Moderate or Severe Febrile Illness
4.4 Active Untreated Tuberculosis
4.5 Pregnancy
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
5.2 Hypersensitivity to Eggs
5.3 Thrombocytopenia
5.4 Immune Globulins and Transfusions
6 ADVERSE REACTIONS
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
7.2 Immune Globulinsand Transfusions
7.3 Tuberculin Skin Testing
7.4 Use with Other Live Viral Vaccines
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.6 Persistence of Antibody Responses After Vaccination
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Clinical Efficacy
14.2 Immunogenicity
15 REFERENCES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
Sections or subsections omitted from the full prescribing info rma tion
are not listed.
2
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
M-M-R® II is a vaccine indicated for active immunization for the prevention of measles, mumps, and
rubella in individuals 12 months of age and older.
2 DOSAGE AND ADMINISTRATION
For subcutaneous use only.
2.1 Dose and Schedule
Each 0.5 mL dose is administered subcutaneously.
The first dose is administered at 12 to 15 months of age. A second dose is administered at 4 to 6
years of age.
The second dose may be administered prior to 4 years of age, provided that there is a minimum
interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}.
Children who received an initial dose of measles, mumps and rubella vaccine prior to their first
birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to
complete the vaccination series [see Clinical Studies (14.2)].
For post-exposure prophylaxis for measles, administer a dose of M-M-R II vaccine within 72 hours
after exposure.
2.2 Preparation and Administration
Use a sterile syringe free of preservatives, antiseptics, and detergents for each injection and/or
reconstitution of the vaccine because these substances may inactivate the live virus vaccine. To
reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other
antiviral substances which might inactivate the vaccine.
Withdraw the entire volume of the supplied diluent from its vial and inject into lyophilized vaccine vial.
Agitate to dissolve completely. Discard if the lyophilized vaccine cannot be dissolved.
Withdraw the entire volume of the reconstituted vaccine and inject subcutaneously into the outer
aspect of the upper arm (deltoid region) or into the higher anterolateral area of the thigh.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration, whenever solution and container permit. Visually inspect the vaccine before and after
reconstitution prior to administration. Before reconstitution, the lyophilized vaccine is a light yellow
compact crystalline plug, when reconstituted, is a clear yellow liquid. Discard if particulate matter or
discoloration are observed in the reconstituted vaccine.
To minimize loss of potency, administer M-M-R II as soon as possible after reconstitution. If not used
immediately, the reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from
light, for up to 8 hours. Discard reconstituted vaccine if it is not used within 8 hours.
3 DOSAGE FORMS AND STRENGTHS
M-M-R II vaccine is a suspension for injection supplied as a single dose vial of lyophilized vaccine to
be reconstituted using the accompanying sterile diluent [see Dosage and Administration (2.2) and How
Supplied/Storage and Handling (16)]. A single dose after reconstitution is 0.5 mL.
4 CONTRAINDICATIONS
4.1 Hypersensitivity
Do not administer M-M-R II vaccine to individuals with a history of hypersensitivity to any component
of the vaccine (including gelatin) {3} or who have experienced a hypersensitivity reaction following
administration of a previous dose of M-M-R II vaccine or any other measles, mumps and rubellacontaining vaccine. Do not administer M-M-R II vaccine to individuals with a history of anaphylaxis to
neomycin [see Description (11)].
4.2 Immunosuppression
Do not administer M-M-R II vaccine to individuals who are immunodeficient or immunosuppressed due
to disease or medical therapy. Measles inclusion body encephalitis {4} (MIBE), pneumonitis {5} and death
as a direct consequence of disseminated measles vaccine virus infection have been reported in
3
immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. In this
population, disseminated mumps and rubella vaccine virus infection have also been reported.
Do not administer M-M-R II to individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.
4.3 Moderate or Severe Febrile Illness
Do not administer M-M-R II vaccine to individuals with an active febrile illness with fever >101.3F
(>38.5C).
4.4 Active Untreated Tuberculosis
Do not administer M-M-R II vaccine to individuals with active untreated tuberculosis (TB).
4.5 Pregnancy
Do not administer M-M-R II to individuals who are pregnant or who are planning on becoming
pregnant within the next month [see Use in Specific Populations (8.1) and Patient Counseling Information
(17)].
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
There is a risk of fever and associated febrile seizure in the first 2 weeks following immunization with
M-M-R II vaccine. For children who have experienced a previous febrile seizure (from any cause) and
those with a family history of febrile seizures there is a small increase in risk of febrile seizure following
receipt of M-M-R II vaccine [see Adverse Reactions (6)].
5.2 Hypersensitivity to Eggs
Individuals with a history of anaphylactic, anaphylactoid, or other immediate reactions (e.g., hives,
swelling of the mouth and throat, difficulty breathing, hypotension, or shock) subsequent to egg ingestion
may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving M-M-R II vaccine
.The potential risks and known benefits should be evaluated before considering vaccination in these
individuals.
5.3 Thrombocytopenia
Transient thrombocytopenia has been reported within 4-6 weeks following vaccination with measles,
mumps and rubella vaccine. Carefully evaluate the potential risk and benefit of vaccination in children
with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous
dose of measles, mumps, and rubella vaccine {6-8} [see Adverse Reactions (6)].
5.4 Immune Globulins and Transfusions
Immune Globulins (IG) and other blood products should not be given concurrently with M-M-R II [see
Drug Interactions (7.2)]. These products may contain antibodies that interfere with vaccine virus
replication and decrease the expected immune response.
The ACIP has specific recommendations for intervals between administration of antibody containing
products and live virus vaccines.
6 ADVERSE REACTIONS
The following adverse reactions include those identified during clinical trials or reported during postapproval use of M-M-R II vaccine or its individual components.
Body as a Whole
Panniculitis; atypical measles; fever; syncope; headache; dizziness; malaise; irritability.
Cardiovascular System
Vasculitis.
Digestive System
Pancreatitis; diarrhea; vomiting; parotitis; nausea.
Hematologic and Lymphatic Systems
Thrombocytopenia; purpura; regional lymphadenopathy; leukocytosis.
Immune System
Anaphylaxis, anaphylactoid reactions, angioedema (including peripheral or ****** edema) and
bronchial spasm.
Musculoskeletal System
Arthritis; arthralgia; myalgia.
4
Nervous System
Encephalitis; encephalopathy; measles inclusion body encephalitis (MIBE) subacute sclerosing
panencephalitis (SSPE); Guillain-Barré Syndrome (GBS); acute disseminated encephalomyelitis (ADEM);
transverse myelitis; febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis;
polyneuropathy; ocular palsies; paresthesia.
Respiratory System
Pneumonia; pneumonitis; sore throat; cough; rhinitis.
Skin
Stevens-Johnson syndrome; acute hemorrhagic edema of infancy; Henoch-Schönlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses — Ear
Nerve deafness; otitis media.
Special Senses — Eye
Retinitis; optic neuritis; papillitis; conjunctivitis.
Urogenital System
Epididymitis; orchitis.
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
M-M-R II vaccine should not be administered to individuals receiving immunosuppressive therapy,
including high dose corticosteroids. Vaccination with M-M-R II vaccine can result in disseminated disease
due to measles vaccine in individuals on immunosuppressive drugs [see Contraindications (4.2)].
7.2 Immune Globulinsand Transfusions
Administration of immune globulins and other blood products concurrently with M-M-R II vaccine may
interfere with the expected immune response {9-11} [see Warnings and Precautions (5.4)]. The ACIP has
specific recommendations for intervals between administration of antibody containing products and live
virus vaccines.
7.3 Tuberculin Skin Testing
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually
may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin skin test with
tuberculin purified protein derivative (PPD) is to be done, it should be administered before, simultaneously
with, or at least 4 to 6 weeks after vaccination with M-M-R II vaccine.
7.4 Use with Other Live Viral Vaccines
M-M-R II vaccine can be administered concurrently with other live viral vaccines. If not given
concurrently, M-M-R II vaccine should be given one month before or one month after administration of
other live viral vaccines to avoid potential for immune interference.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
M-M-R II vaccine is contraindicated for use in pregnant women because infection during pregnancy
with the wild-type viruses has been associated with maternal and fetal adverse outcomes.
Increased rates of spontaneous abortion, stillbirth, premature delivery and congenital defects have
been observed following infection with wild-type measles during pregnancy. {12,13} Wild-type mumps
infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Infection with wild-type rubella during pregnancy can lead to miscarriage or stillbirth. If rubella infection
occurs during the first trimester of pregnancy, it can result in severe congenital defects, Congenital
Rubella Syndrome (CRS). Congenital rubella syndrome in the infant includes but is not limited to eye
manifestations (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and
intellectual disabilities. M-M-R II vaccine contains live attenuated measles, mumps and rubella viruses. It
is not known whether M-M-R II vaccine can cause fetal harm when administered to pregnant woman.
There are no adequate and well-controlled studies of M-M-R II vaccine administration to pregnant
women.
5
All pregnancies have a risk of birth defect, loss or other adverse outcomes. In the US general
population, the estimated background risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2% to 4% and 15% to 20%, respectively.
Available data suggest the rates of major birth defects and miscarriage in women who received
M-M-R II vaccine within 30 days prior to pregnancy or during pregnancy are consistent with estimated
background rates (see Data).
Data
Human Data
A cumulative assessment of post-marketing reports for M-M-R II vaccine from licensure 01 April 1978
through 31 December 2018, identified 796 reports of inadvertent administration of M-M-R II vaccine
occurring 30 days before or at any time during pregnancy with known pregnancy outcomes. Of the
prospectively followed pregnancies for whom the timing of M-M-R II vaccination was known, 425 women
received M-M-R II vaccine during the 30 days prior to conception through the second trimester. The
outcomes for these 425 prospectively followed pregnancies included 16 infants with major birth defects, 4
cases of fetal death and 50 cases of miscarriage. No abnormalities compatible with congenital rubella
syndrome have been identified in patients who received M-M-R II vaccine. Rubella vaccine viruses can
cross the placenta, leading to asymptomatic infection of the fetus. Mumps vaccine virus has also been
shown to infect the placenta {14}, but there is no evidence that it causes congenital malformations or
disease in the fetus or infant .
The CDC established the Vaccine in Pregnancy registry (1971-1989) of women who had received
rubella vaccines within 3 months before or after conception. Data on 1221 inadvertently vaccinated
pregnant women demonstrated no evidence of an increase in fetal abnormalities or cases of Congenital
Rubella Syndrome (CRS) in the enrolled women {15}.
8.2 Lactation
Risk Summary
It is not known whether measles or mumps vaccine virus is secreted in human milk. Studies have
shown that lactatingpostpartum women vaccinated with live attenuated rubella vaccine may secrete the
virus in breast milk and transmit it to breast-fed infants.{16,17} In the breast-fed infants with serological
evidence of rubella virus vaccine strain antibodies, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.{18,19}
The developmental and health benefits of breastfeeding should be considered along with the mother’s
clinical need for M-M-R II, and any potential adverse effects on the breastfed child from M-M-R II or from
the underlying maternal condition. For preventive vaccines, the underlying maternal condition is
susceptibility to disease prevented by the vaccine.
8.4 Pediatric Use
M-M-R II vaccine is not approved for individuals less than 12 months of age. Safety and effectiveness
of measles vaccine in infants below the age of 6 months have not been established [see Clinical Studies
(14)]. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have
not been established.
8.5 Geriatric Use
Clinical studies of M-M-R II did not include sufficient numbers of seronegative subjects aged 65 and
over to determine whether they respond differently from younger subjects.
11 Description
M-M-R II vaccine is a sterile lyophilized preparation of (1) Measles Virus Vaccine Live, an attenuated
line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo
cell culture; (2) Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in
chick embryo cell culture; and (3) Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated
rubella virus propagated in WI-38 human diploid lung fibroblasts. {20,21} The cells, virus pools,
recombinant human serum albumin and fetal bovine serum used in manufacturing are tested and
determined to be free of adventitious agents.
After reconstitution, each 0.5 mL dose contains not less than 3.0 log10 TCID50 (tissue culture infectious
doses) of measles virus; 4.1 log10 TCID50 of mumps virus; and 3.0 log10 TCID50 of rubella virus.
Each dose is calculated to contain sorbitol (14.5 mg), sucrose(1.9 mg), hydrolyzed gelatin (14.5 mg),
recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin
and other buffer and media ingredients. The product contains no preservative.
6
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
M-M-R II vaccination induces antibodies to measles, mumps, and rubella associated with protection
which can be measured by neutralization assays, hemagglutination-inhibition (HI) assays, or enzyme
linked immunosorbent assay (ELISA) tests. Results from efficacy studies or effectivenes s studies that
were previously conducted for the component vaccines of M-M-R II were used to define levels of serum
antibodies that correlated with protection against measles, mumps, and rubella [see Clinical Studies (14)].
12.6 Persistence of Antibody Responses After Vaccination
Neutralizing and ELISA antibodies to measles, mumps, and rubella viruses are still detectable in 95-
100%, 74-91%, and 90-100% of individuals respectively, 11 to 13 years after primary vaccination. {22-28}
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
M-M-R II vaccine has not been evaluated for carcinogenic or mutagenic potential or impairment of
fertility.
14 CLINICAL STUDIES
14.1 Clinical Efficacy
Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind
controlled trials. {29-34} These studies also established that seroconversion in response to vaccination
against measles, mumps and rubella paralleled protection. {35-38}
14.2 Immunogenicity
Clinical studies enrolling 284 triple seronegative children, 11 months to 7 years of age, demonstrated
that M-M-R II vaccine is immunogenic. In these studies, a single injection of the vaccine induced measles
HI antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of
susceptible individuals.
A study of 6-month-old and 15-month-old infants born to mothers vaccinated with a measles vaccine in
childhood, demonstrated that, following infant and toddler vaccination with Measles Virus Vaccine, Live
(previously US-licensed, manufactured by Merck), 74% of the 6-month-old infants developed detectable
neutralizing antibody titers while 100% of the 15-month-old infants vaccinated with Measles Virus
Vaccine, Live or M-M-R II vaccine developed neutralizing antibodies {39}. When the 6-month-old infants
of immunized mothers were revaccinated at 15 months with M-M-R II vaccine, they developed antibody
titers similar to those of toddlers who were vaccinated previously at 15-months of age.
15 REFERENCES
1. General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices, MMWR
43(RR-1): 1-38, January 28, 1994.
2. Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, a n d Co n g e nita l Ru b e lla
Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practice s (ACIP), M M WR
47(RR-8): May 22, 1998.
3. Kelso, J.M.; Jones, R.T.; Yunginger, J.W.: Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gel atin , J.
Allergy Clin. Immunol. 91: 867-872, 1993.
4. Bitnum, A.; et al: Measles Inclusion Body Encephalitis Caused by the Vaccine Strain of Measles Virus. Cl i n . In fect. Di s. 2 9 :
855-861, 1999.
5. Angel, J.B.; et al: Vaccine Associated Measles Pneumonitis in an Adult with AIDS. Annals of Internal Medicine, 129: 1 0 4 -1 06 ,
1998.
6. Cecinati V, et al. Vaccine administration and the development of immune thrombocyto pe ni c p urp u ra i n ch i ld re n. Hu m an
Vaccines & Immunotherapeutics 9:5, 2013.
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic
Review of the Literature and Guidance for Management. J Ped 156(4): 2010.
8. Andrews N, Stowe J, Miller E, Svanstrom H, Johansen K, Bonhoeffer J, et al. A collaborative approach to investigating th e ri sk
of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark. Vaccine. 2012;30:3042‐6.
9. Rubella Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP), MM WR 3 9 (RR-1 5 ): 1 -1 8 ,
November 23, 1990.
7
10. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatri cs,
344-357, 1997.
11. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP), MMWR 38(S-9): 5-22,
December 29, 1989.
12. Eberhart-Phillips, J.E.; et al: Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and Gynecology, 82(5): 797-801,
November 1993.
13. Jespersen, C.S.; et al: Measles as a cause of fetal defects: A retrospective study of ten measles epidemics in Greenland. Acta
Paediatr Scand. 66: 367-372, May 1977.
14. Yamauchi T, Wilson C, Geme JW Jr. Transmission of live, attenuated mumps virus to the hu m a n p l ace n ta . N En g l J M e d .
1974;290(13):710‐712.
15. Rubella Vaccination during Pregnancy —United States, 1971-1988. JAMA. 1989;261(23):3374–3383.
16. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. II.
Maternal-neonatal interactions, J. Infect. Dis. 145: 661-666,1982.
17. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. I.
Development and characterization of specific immunologic reactivity in breast milk, J. Infect. Dis. 145: 654-660, 1982.
18. Landes, R.D.; Bass, J.W.; Millunchick, E.W.; Oetgen, W.J.: Neonatal rubella following postpartum maternal i mm un izatio n , J.
Pediatr. 97: 465-467, 1980.
19. Lerman, S.J.: Neonatal rubella following postpartum maternal immunization, J. Pediatr. 98: 668, 1981. (Letter)
20. Plotkin, S.A.; Cornfeld, D.; Ingalls, T.H.: Studiesof immunization with living rubella virus: Trialsin children with a strain culture d
from an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965.
21. Plotkin, S.A.; Farquhar, J.; Katz, M.; Ingalls, T.H.: A new attenuated rubella virus grown in human fi bro b la sts: Evi d e n ce fo r
reduced nasopharyngeal excretion, Am. J. Epidemiol. 86: 468-477, 1967.
22. Weibel, R.E.; Carlson, A.J.; Villarejos, V.M.; Buynak, E.B.; McLean, A.A.; Hilleman, M.R.: Clinical and Labo ra tory Stu d ie s o f
Combined Live Measles, Mumps, and Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. So c. Exp . Bi ol. M e d. 1 6 5 :
323-326, 1980.
23. Watson, J.C.; Pearson, J.S.; Erdman, D.D.; et al: An Evaluation of Measles RevaccinationAmong School-Entry Age Ch i ld re n,
31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract #268, 143, 1991.
24. Unpublished data from the files of Merck Research Laboratories.
25. Davidkin, I.; Jokinen, S.; Broman, M. et al.: Persistence of Measles, Mumps, and Rubella Antibodies in a n M M R -Va ccina ted
Cohort: A 20-Year Follow-up, JID 197:950–6, April 2008.
26. LeBaron, W.; Beeler J.; Sullivan, B.; et al.: Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a
Postelimination Environment, Arch Pediatr Adolesc Med. 161:294-301, March 2007.
27. LeBaron, C.; Forghani, B.; Beck, C. et al.: Persistence of Mumps Antibodies after 2 Doses of Measles-Mumps-Rubella Vaccine,
JID 199:552– 60 , February 2009.
28. LeBaron, W.; Forghani, B.; Matter, L. et al.: Persistence of Rubella Antibodies after 2 Doses of Measles-Mumps-Rubella
Vaccine, JID 200:888–99, September 2009.
29. Hilleman, M.R.; Buynak, E.B.; Weibel, R.E.; et al: Development and Evaluation of the Moraten MeaslesVirusVa cci n e , JAM A
206(3): 587-590, 1968.
30. Weibel, R.E.; Stokes, J.; Buynak, E.B.; et al: Live, Attenuated Mumps Virus Vaccine 3. Clinical and Serologic Aspects in a Fiel d
Evaluation,N. Engl. J. Med. 276: 245-251, 1967.
31. Hilleman, M.R.; Weibel, R.E.; Buynak, E.B.; et al:Live, Attenuated Mumps VirusVaccine 4. ProtectiveEfficacy as Measure d i n
a Field Evaluation, N. Engl. J. Med. 276: 252-258, 1967.
32. Cutts, F.T.; Henderson, R.H.; Clements, C.J.; et al: Principles of measles control, Bull WHO 69(1): 1-7, 1991.
33. Weibel, R.E.; Buynak, E.B.; Stokes, J.; et al: Evaluation Of Live Attenuated Mumps Virus Vaccine, Strain Jeryl Lynn, First
International Conference on VaccinesAgainst Viral and Rickettsial Diseases of Man, World Health Organization, No. 147, M a y
1967.
34. Leibhaber, H.; Ingalls, T.H.; LeBouvier, G.L.; et al: Vaccination With RA 27/3 Rubella Vaccine, Am. J. Dis. Child. 123: 133-1 3 6,
February 1972.
35. Rosen, L.: Hemagglutination and Hemagglutination-Inhibition with Measles Virus, Virology 13: 139-141, January 1961.
36. Brown, G.C.; et al: Fluorescent-Antibody Marker for Vaccine-Induced Rubella Antibodies, Infection and Immunity 2(4): 360-363,
1970.
8
37. Buynak, E.B.; et al: Live Attenuated Mumps Virus Vaccine 1. Vaccine Development, Proceedings of the Society for
Experimental Biology and Medicine, 123: 768-775, 1966.
38. Hilleman M.R., Studies of Live Attenuated Measles Virus Vaccine in Man: II. Appraisal of Efficacy. Amer. J. o f Pu b l ic He a lth ,
52(2):44-56, 1962.
39. Johnson, C.E.; et al: Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles
Vaccine Era, Pediatrics, 93(6): 939-943, 1994.
16 HOW SUPPLIED/STORAGE AND HANDLING
No. 4681 ⎯ M-M-R II vaccine is supplied as follows:
(1) a box of 10 single-dose vials of lyophilized vaccine (package A), NDC 0006-4681-00
(2) a box of 10 vials of diluent (package B)
Exposure to light may inactivate the vaccine viruses.
Before reconstitution, refrigerate the lyophilized vaccine at 36°F to 46°F, (2°C to 8°C).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68° to 77°F, 20° to 25°C). Do not freeze the diluent.
Administer M-M-R II vaccine as soon as possible after reconstitution. If not administered immediately,
reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from light, for up to 8
hours. Discard reconstituted vaccine if it is not used within 8 hours.
For information regarding the product or questions regarding storage conditions, call 1-800-
MERCK-90 (1-800-637-2590).
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Package Insert).
Discuss the following with the patient:
• Provide the required vaccine information to the patient, parent, or guardian.
• Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
• Question the patient, parent, or guardian about reactions to a previous dose of M-M-R II vaccine
or other measles-, mumps-, or rubella-containing vaccines.
• Question females of reproductive potential regarding the possibility of pregnancy. Inform female
patients to avoid pregnancy for 1 month following vaccination [see Contraindications (4.5) and
Use in Specific Populations (8.1)].
• Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
• Instruct patients, parents, or guardians to report any adverse reactions to their health-care
provider. The U.S. Department of Health and Human Services has established a Vaccine
Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events
after the administration of any vaccine, including but not limited to the reporting of events required
by the National Childhood Vaccine Injury Act of 1986. For information or a copy of the vaccine
reporting form, call the VAERS toll-free number at 1-800-822-7967, or report online at
https://www.vaers.hhs.gov.
For patent information: www.merck.com/product/patent/home.html
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I need a win
Any small victory
Amidst these losses
Continual letdowns
Consecutive defeats
Constant calamities
When will it end?
I dress in armor,
But it does no good
For every time I attempt
To repair one impairment
A gust of misfortune
Knocks yet another
Piece out of place
Is it too much to ask
To find myself among laurels
Just for a moment?

and why do you think
they shot the serial killer
in the back of the head?
you know, having experienced
a brain haemorrhage aged
21 i'd know... there's nothing
kafkaesque about it...
the slow bleeding out via a hole
in the cranium, you really
are a decapitated cockroach by
this point (living two weeks more
dying from starvation), but in
the serial killer's case also a little
bit fidgety...
oddly enough impairment of the brain
doesn't mean your heart stops
ticking... poor kurt cobain
with that shotgun wound of his...
i mean a stab to the heart is wildly anticipated,
but why would you shoot your brains
out, given that the ***** per se
is not an automaton pump, or a decipherer
of toxins (the liver)?
the brain is a puppeteer of bones.
it's the flow of the haemoglobin
that's kind, kind enough for you to be
conscious and decide your last thoughts
on the matter, auto-suggestive atheism
is what i call it... shoot the thing that's
functioning automatically - your
brain is a paradoxical dual carriage way,
it allows both science and mysticism
to reach the ultimate, reasonable parallel;
basically... don't mess with
the sponge soaking up the porridge;
asked politely, seneca slit his wrists
in a hot bath.

I'd paint you a picture
But my image I may not convert
I'd write you a song
But my words can not be learnt
I'd clasp to your words
But they slide away like sand
I'd fall into your hands
But they move away, just a tad

For you and me
Will never quite see
What it is in each other
What we want to be
We're both in a trap
Like the rest of our friends
We need to break free
But only in the end

It's really not hard to see
Once you look at it simplistically
We're all in a trap
Encaged by this world
A sense of self
The impairment of our sight
Is our real plight
What we call "I"
We should really call "us"
It's the blinder to our lives
The captor of our freedom
The separation of each other
Is what makes society shudder
But fear not, dear
It's not but an outgrown husk
At the end of your life
At the end of our years
When unity reappears

I wish I could explain it to you, but I can’t.
You’d have to walk around with me for a month
or so for it to make sense,
to seem like a real thing.
Sometimes, it’s not even real to me;
but it’s my life and
I’m the one walking around in it,
so there it is.

In the fall and winter,
particularly around the holidays,
it gets worse.  Some days,
especially during the last two weeks
before Christmas,
it gets really bad.

(Why do I think it’s a bad thing?)

(Is it?)

(What is this about?)


They come at me like zombies
when they see the crutches
and yet I refuse to blame my Cerebral Palsy
for what they do.  
Really, I believe that they’d show up anyway.
I think that they, and I to a degree,
feel some sort of cosmic pull
toward one another.

The drunks come to me.

(the developmentally disabled too.)

They tell me stories of how they ended up
in the same place that I am.
They tell me that they know also
that our paths were supposed to cross.
They tell me about their relationship with God
and how Jesus loves them in spite of their drunkenness
(or impairment.)
They tell me how blessed we are to have met.

That one always leaves me flummoxed.

All I wanted to do was eat a tenderloin and some fries.
All I wanted was a cup of coffee or a beer.
All I wanted was to occupy a small bit of
grey space for a couple of hours.

These cohabitates,
these space-stealers
always go straight for The Bible.

They talk of rapture
And the wholeness that I’ll
find in The Kingdom of Heaven
and I want to tell them that they’ve
taken some of that wholeness for
themselves, but I can’t.

I always say: “Thank you.”
And speak to them in
bumper-sticker platitudes;
telling them that we’re all
making our own ways
down our own paths.

And, it’s true, but I don’t want
to have to say it.
I don’t always want to believe it.

(And, I don’t always.)

I wish I could tell them that I want to be more like them,
to work in a factory,
lift the heavy stuff;
to work steadily on the line
or over the road,
inside the grey spaces
with more time to think,
to be quietly oaken
and iron.

*

-JBClaywell
© P&ZPublications

For many years, you were our family's breadwinner.
Your money paid for our breakfasts, lunches and dinners.
Because of my mental impairment, you continued to support me after I turned eighteen.
You could've outworked two twenty year olds, you were the hardest worker I've ever seen.
After twenty months of chemotherapy, you lost your fight.
Your battle with Leukemia ended six years ago tonight.
For the last two days of your life, you couldn't even reply to what people said.
When I received a call from my sister-in-law, she informed me that you were dead.
Your existence on Earth ended at around 10:20 PM.
One day I'll go to Heaven and I will see you again.

A faint white light
and still frames in sight
whispers from walls
blur decor of sorts
impairment of my senses
leads to my loss of innocence
a dark red-gray thought
the impurity and youth..
He, with a lack of understanding
said life is just the beginning,
while She the other friend
says it all starts where it ends,
the indecisive Me always in between..

I've got these hands
bony, scarred, dried and cracked
and they can do great things
or so I'm told
but have you ever tried to
pick yourself up?
I mean really pick yourself up?
when you fall flat on your face
when you're **** out of luck
that requires a strength
I sadly do not possess
couldn't drag myself out of the mud
if I waited for it to freeze over
before I fell in

I've got these eyes
light brown, they're more of an amber
especially in bright light
gifted with sight and minor impairment
or so I'm told
I myself don't care to look at them
I can get lost in them though
for all the wrong reasons
but have you ever tried to
actually see yourself?
I mean really see yourself,
not the image manifested
instead, what you truly are?
I think I have but then again
I have a needed aptitude for deceit

I've got this heart
this heart that that beats
fast when I'm excited,
fast when I'm scared,
faster still when in love
and it's a big lump of muscle
or so I'm told
I guess it must be
I won't argue with that
it's heavy inside, that's a fact
but have you ever tried to
wear it on your sleeve?
the phrase is an idiom
I'll explain what it means;
to be overly sensitive or easily hurt
and have no control over emotions
or show them too readily for people to see
despite my deceit, my heart it still bleeds
that's the only reason to be careful
when you shake my hand

I've got this secret
this secret that eats its way through me
secrets are bad and we shouldn't keep them
yet everyone has secrets and we need them
or so I'm told
and I don't even know what mine is yet
though I suspect that it's that I'm sad
sad when I shouldn't be
lonely when I needn't be
but have you ever tried
to tell a secret and get it off your chest?
feel it come up from inside, make its way through you
and as it's about to come out just suddenly stop
as a gassy lump in your throat so you choke
as you swallow it down?
I have and I can tell you
it's not the taste that gets you
it's the texture