A lively debate
that inside I create
A seemingly
simple state
But this state
of affairs
Is like a ****** affair
The details
I wish not to share
Please,
don’t stare
For inside
I’m scared
Am I prepared?
Do I have
the ***** to do
what I really care?
Or am I going
to stay on this ship
of self-despair
Where
I can scream
my lungs ******
into the air
But does anyone care?
Do I even f@cking care??

Maybe a life spared
but spare me the
retched bullsh@t
of self-pity
I’m self-giving
It wreaks up the air
It’s noxious scent
is not one I care
to ever encounter
or fair

Let’s “clear the air”
and take on
what I want
from now on
No longer a pawn
who is living the tired
joke
of some pathetic
love song

No, THIS
is my “Swan Song”
Where I belong
This sh@t is ON!

Climbing the mountain strong
Bellowing a chant
a song
That’s been so deep within
for so long
It can only come out
Right
Because “wrong”
does not belong
This virus
is airborne

No longer forlorn
All the darkness
is gone
You have been
forewarned
Are you ready?
Because it’s coming
Sounding the horn
Sacrificed
the firstborn
The “storm”
Once icy and cold
Now simmering warm
Going to bubble into
volcanic ash scorned
This Oath
hath been sworn
Tattered and torn
**** cloth
all that is worn

But forward my path
What’s behind me
My ***
The past
Worn out,
decayed,
and shriveling trash
All that
is gone
as I head
towards the dawn
Through the darkness
I’ve trekked
The Sun rises ahead
And with it
My song

My Swan Song
I am reborn
withered and worn
But still strong
I belong
I am one
with the Universe
The path before me
is brightly lit
with happiness and joy
No more patheticness
All the grit
and the spit
Broken teeth
All that sh@t
It all meant something
It was THIS

Every bruise
Every break
All the “wrongs”
and “mistakes”
Are what it takes
You can call it fate
or simply short of fatal
but since
neonatal
through this day till
Every day
I thankfully say
“Thank you”
for showing me the way
Because now I have
A love that stays
A true love
One that can’t
get away
Because I value Me
One ‘hopes’ or ‘prays’
But like a house
Each brick is laid
Onto the next
Foundation made
A sturdy house
Can’t blow away
Hard work put in
Made it this way
The same for me
The price I paid
But end result
A saving grace

As I looked into her glazed blue eyes
I suddenly became very tired.
Every inch of my body
felt weighted;
heavy.
I had been doing this for
13 years,
hoping, waiting, trying, believing.
Most of the time, I succeeded.
I saved them.
But when I didn't,
when I
failed,
I can't take it.
When I go out with my husband for dinner with friends,
or at parties,
I get asked what I do.
A furrowed eyebrow, a gentle easing voice follows,
"Isn't that hard?"
It's all part of the job, I say.
Taking care of these babies,
making sure they are healthy.
You get used to it, I say.

I wish that were true.
I wish I could say it were that simple.
When my work is dragged, forced in
unannounced like a estranged aunt
in
in
into my personal life,
my husband grabs my hand,
gives me a knowing look.
He thinks he knows how I suffer,
how it pains,
how it rips at my soul --
he has no clue.

Most days, my job is not overwhelming.
Is even rewarding.
Saving lives,
keeping parents' new-born, struggling miracles safe,
trying to make them perfect
like parents always imagined they would be.
On days like this,
when I am forced to look into my responsibility's
eyes
and realize I couldn't save and perfect them,
realize that blank stare will be with
me forever,
I hate my job.

they ask what
    little sisters should
        why the water is blue when deep
        how the stones skip uncaring
    on the surface

    on the surface
  we are tied through bloodline
vein to vein, spine to spine
retched to form through
a single woman in 45 hours
    of neonatal grace
        echoing anything but silence

         they are a quiet pair of scissors.
            mirrors, in perfect function
          balanced from present lifetimes
        of subtle practice
      shimmering in sequence
   one glammer, one smitten
echoes of anything but silence

I am that third thing
the cog on wings
mildly pressed between two
perfectly pounding structures
smiling in the buffer
I am drafting,
a stick on the ripple.

Another starlit Hemetucky night,
Finds me listening to one of my many,
Many Bonnie Raitt CDs.
Metaphorically speaking,
We must lick her ****.
Give her the recognition
She indubitably deserves.
10 GRAMMYs?
Listed as number 50 in
Rolling Stone Magazine's
100 Greatest Singers of All Time;
Number 89 on their list of the
100 Greatest Guitarists of All Time!
Lists? We humans love lists.
The HUAC loved lists also.
And while we’re on the subject of lists,
What list has your name been added to?
A statistical anomaly worthy of further
Investigation by our Big Brother in Bluff, UT,
Those guys tracking anyone goo-goo,
Googling my name, my poetry,
The poetry of Giuseppi Martino Buonaiuto,
My UNpublished poetry, i.e.,
By definition, nothing in print,
Nothing between book covers,
Nothing you can get your hands on.
Merely cyber-effervescence,
An Off World ether,
An ether although vaporous,
A digital fingerprint, nonetheless:
Quickly identifiable,
Easily reducible,
An entirely redacted,
Boiled down, cooked down roux.
A roux you’ll rue? Perhaps.
Not to mention the kanga roo,
ROO as in secret, offshore
Kangaroo courtrooms.

So know, know you’re on a list.
One of numerous Watch Lists
Watched by the Watchers who
Watch people like us.
So, if you’re reading this online,
Don’t say I didn’t frickin warn you.

BONNIE RAITT:
Of particular interest is her brilliant cover of –
Her complete musical reupholstering of--
Del Shannon’s neonatal 60s-era classic:
“Runaway.”
That twang slide-bass intro.
That harmonica squeal hovering above;
Those long, pulsing instrumentals
Punctuating her grit.  Her heart.
Her dark & lonely childhood
That drew her to true roots music.
Like me, born in 1949--
Unlike me: in Burbank, California.
Daughter of Broadway Musical Star
John Raitt: a true Roadie,
If ever there was one
Bonnie sent to private Quaker schools,
Banished to pricey summer camps.
Routine experience for any child of
Successful entertainers on the road,
Again. (Sing it, Willie!)
Bonnie: denied nothing but
Parental time invested.
Consumed by a drive to
Get the man’s attention,
Daddy’s little girl,
Addicted to ******. Fade out:
“I wah-wah-wah-wah wonder.
If you will stay, my run, run, run
My little runaway,
Come back baby,
My runaway.”

7/1/2015

"you will remember, for we in our youth did these things:
yes many  beautiful things" - Sappho's fragments

Greenwich Village, NYC

Only the 24th of June and
Simpson and i already
tire of the summer weather.

I always seem a little thinner these months
i note, i bite a strawberry candy and show her
how to light her lighter

just hand me the fork
no more callousness
both on palmflesh and human dealings

the building facades on Charles street
as in the southern Chawellsss....
she explains alcoholism runs in my family, you know?

i nod. no other problems i presume?
the community garden nods and
people who will always be richer,

prettier, strut past with tuesday briefcases
and their children's wheelcradles with ethiopian
and guatemalan hands on the handlebars

follow a block behind.
But we're from Joisey, and **** proud of it!
Lobster rolls and jimmies and johnnies and

boardwalk planks Erin dreams of
broadway instead and neonatal nursing,
who doesn't?

the only youth on the street that day we
teetertotter past all the cafes and pubs and
laundrymats

*you know, if this was the school year we'd
get picked up for skipping school

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.
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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.
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The age of men has morning seen,
A blessed hour, pure and new,
When all was fresh and bright and green,
And clad with sparkling drops of dew,
That caught the neonatal light,
Proceeding from the infant star,
That gave to men the gift of sight
And bathed the darkling isles afar.

The age of men has midday known,
And man has seen his golden years,
But monuments of carven stone
And kingdoms forged with swords and spears,
Cannot endure, but pass away.
The years of men are but a breath,
The evening swallows up the day,
And all is swallowed up in death.

The age of men rolls on and on,
The land grows darker year by year,
The chariot of Phaeton and Helios shall disappear,
Then darkness shall o’erspread the land,
A spectral, phantom moon shall rise,
Until a black and withered hand
Shall cover heaven’s watching eyes.
Then blackest night shall cover all,
And darkness will the ruler be,
And in his blindness man will fall
And wish that he had turned to me.

The Volume of Her Tones

The volume of
Her tones
Create a creakiest
Voice at the night...

Ocean of her smile
Wakes a slumber
Of her absences.
Ringing tones spread
amidst choruses
and crowded rim:
The conflagration of rhymes.

The melody in her voice
Like a heavenly voice
In a hushed cathedral
The rain drops one by one;
And some people flies outside
To see the flowing of her dulcet
Counting a cracks by the said rain.

The grave that changes trajectory
Lives in the grey!
The state is neonatal and aged
In an empty growth!

Adam garko


Dedicated to her surpass ******* earth❤

Cautious where my heart's placed,
careful where I show face,
when we reach the final lap,
start to see the true pace.
Tired of being surprised need to be harmless yet wise.

Jew wish to share the good fortunes,
the gossip makes the muzzle tight,
First you hear a lot of bark,
waiting till you bear the bite.
Tired of being surprised need to be harmless yet wise.

Can't always be right or liked,
the pallbearer to one who digs their own grave,
can't liberate one who sees freedom in chains,
Let me disclaim that I'm often the same,
I'll pause the refrain.

Starting to see a pattern feeling like an omnibus,
getting harder to know who to trust,
fool me twice shame on both of us,
I needed real ones to get me out my slum,
better wounds from friends than enemy hisses,
the certainty of a brides than volatile mistresses.
Tired of being surprised need to be harmless yet wise.

Bottom line is teeth are bones,
many playing an act like clones,
standing in glass yet throwing stones,
friends are few but fear is fatal,
thread between child-like and childish,
faith is so neonatal.
Tired of being surprised need to be harmless yet wise.

Learning where to seek applause,
not trying to make enemies without a cause,
best to make amigos but never know who i might offset when i take off,
need discernment to see the cain while I'm still able,
cause even if my blood cries,
I know it's been paid for.
Tired of being surprised need to be harmless yet wise.

"When Christ calls a man he bids him to die."
Though it doesn't sound like the most bonne offer it takes away the fear of the grave,
grace would have a hollow cost if no price was paid,
the hand of ****** would still leave a thirst for retribution,
Dietrich knew the true ruler of the people,
the one who holds the keys,
which is why he confidently said before he was sent to be hung for protecting the young,
"this is the end – for me the beginning of life."

chapter three


June 4th. 1980;


The day, it’s the morning of June 4th.  It’s Wednesday; I go up the block to be with Kelli; her friend Lynne is a sleepover guest, this day. I and Lynne have never got along but if I want to be with Kelli than I’ll have to hang with Lynne for the day. We’re watching “The Price is Right” on television and Lynne went inside for a while. After a time she comes in laughing!?
“I was just on the phone with Barbra B. and she’s off and running…  Let’s go down by her house and see what’s there to watch!?”  Kelli and Lynne get into the front-seats of Kelli’s White Buick Electra 225
I was in the backseat; the two of them were laughing up a storm! Kelli drives up Calamus ave. until she nears 74th. Street; this is where Barbra B. lives. Barbra is frilling a most extremely large kitchen-knife; it must be the biggest knife in her house?! Here she comes with her father chasing up behind her?  He’s trying to catch-up and stop this girl from getting to whatever place she is so hard-pressed to get too???
Lynne slaps onto the side of the door, Kelli slows and Lynne rolls down the window then sticks-out half her body; she waves over to Barbra B. and screams, “Hey Barbra, what’s going on?”
Kelli says, “What are you doing?”
“Where’re you going? You need a lift? Come on there’s plenty of room in the back!”  The door-locks pop open… “Come-on we’ll take you where-ever you’re going!”
Barbra heads towards the car; Kelli, grips the wheel, laughing; I know this laugh… Kelli has no idea what’s going on?! Barbra takes hold of the door as her father reaches her; he grabs her arm and pulls her hand away; Barbra’s father yells to Kelli, “Get out of here; Leave!”
Kelli steps on the gas and drives off!
Heart’s racing… ‘Holy crap, that crazy ***** had her hand on the door? She was about to be inside this car, she had a knife; she, she, she be sitting next to me?! What the hell just happened???’
Kelli drives back towards the house; the two of them seating in the front seat… laughing?! Not the same laugh but…, laughing! Lynne’s, an all too familiar sort; it’s a kind I heard in the silent-times unspoken about; a delight to a well done of what just happened.
Kelli’s, her laugh is also all too familiar, hers, is the kind that reassures. It’s the kind I’d feel deep inside me at three in the morning while swinging, inside Little Bush Park, on those swings beneath moonlight knowing, oddly enough, I’m safer there at that moment than I’d be anywhere-else.
Kelli parks up on the corner, on the side of Tootie’s house; she runs across to store for soda, cigarettes and stuff then we went upstairs.
“What the hell was that…?” Kelli says, laughing, while she slaps the bag onto the table; bag brakes open and as liverwurst, cheese, bottle of soda and the cigarettes flies off to all parts of the kitchen!? “What did you do? That was f----- up!?” Kelli starts to fix us lunch as Lynne tells us about what she was doing in the kitchen while we were watching The Price Is Right.                    
  
Lynne calls up Barbra’s gay-lover and tells her she’s Barbra’s (formerly) ex-girlfriend and that she’s calling to let her know Barbra and she are back together so she’ll no longer be needed or wanted in their lives!  
Afterwards, Lynne calls Barbra’s saying to Barbra, she’s Barbra’s ex-girlfriend’s newest lover and she’s calling to inform her,Barbra, that Barbra’s ex and this girl’s new lover are bopping the sheets with each-other and the two of them are being played as fools; as one could imagine and as we saw for ourselves, Barbra went into a high-speed tailspin. Barbra snaps?!  And now she is out there trying to go end these two women in a pool of their own blood!?  
Unbelievably, Lynne still thinks what she made happen is a big fat hoot???
Kelli, “What the hell were you thinking???”
Lynne looks at Kelli, and with this snide tone and smirk on her face she says,” What… I was bored! Did you see Barb’s father’s face?” laughter erupting from her as she turns to get her stuff out of Kelli’s bedroom; “Hey it was fun!”
Kelli,” Oh brother; you’re…? Hey, get ready and I’ll drive you… home.”
Kelli looks at me and we both put hands up with baffled looks?!          
It’s just around 3 pm. as Kelli rolls up to Lynne’s to drop her off. She asks Kelli to drop her down at the bar she hangs-at so she could find-out what’s been going on there.
Kelli did and on the way back she stops by Julia’s, her mom’s, work; Julia gives us a list and we go over to key-food to shop.
While we’re shopping Kelli keeps, “I can’t get over what we saw???”
I kept thinking how did Lynne know so much of Barbra’s love-life??? She knew names, places and everything she’d need to get that girl Barbra to to such a point and state?’ I think Kelli and I were both shaking from this for the rest of the day.
  Kelli drops me off, goes parks and goes into house.
I remember this date so well because later that night at around 2:30 in the morning I was at my father’s door knocking?!

” Dad? Dad? Dad; you need to get… You have to get-up!?”
My water broke??? My due date’s not ‘til September 18th. I first thought, ‘Oh no not again?! This can’t happening; … not again?! But, there was no pain, no blood, and no sense of dread like the other times?
I went into my room and grab onto my bag and what-ever-else I thought to take; I figured, by this time my dad would be ready to bring me up to the Boulevard and we’ll cab it to St. John’s. He wasn’t in the middle-room; he wasn’t in the kitchen I knocked on the bathroom door and… He’s not in there? Maybe he went up to call a cab to pick me up at the door?? I’d think he would… He’d have said something…,  like when you have what you need I’ll be downstairs I’m going up to get a cab??? The hall-door’s closed?!’
“Holy crap?!”
No, no, no, I go back to my Dad’s bedroom door and knock. “Dad…? “
“What?” My eyes nearly pop out of my head!
I try to open the door but as usual the lock is on? “Dad?! My water broke???” As one could imagine my voice is no-longer an indoor voice?!  “Never mind broke it’s like the dam broke here and there’s water everywhere out here! Come on you have to get up… you need to take me to St. John’s?!”  
Pin-drop silence…?
“Dad?”
This low soft moaning whimper comes from behind that locked door, “Can it wait until the morning?”
  ??? Bang! Needless to say dad needs a new door-lock.
“Nelson…; Get up!”
“Ok.” Slowly he gets to his feet. “I don’t know why…, now? Why can’t you wait ‘til morning?”
“No, now.” In my head,’ Maintain: Four six-packs… I’m lucky I’m going alone?!’
“I need coffee? What the hell is all this water on the floor?”  
   “Dad? Dad; … that would be me?! It’s why you’re up?  We need to go… St. John’s?! Let’s go!”
Ever notice how when you need… there’s never one to be found??? Phone-booth! Lindy’s cab come and picks us up; not one yellow-cab? We get there and they check me out.
The doctor, “You have had what’s called a premature rupture of membranes; you’re being admitted so you can continue to be monitored. Your baby’s vitals but…; we want you to understand the baby’s condition is at high-risk it’s holding its own.”
“Doctor…?” My eyes begin to whelm-up…
“Miss Rose…” The doctor places his hand on my arm, “You need to remain claim; I have the nurse come give you something and I’ll come check on you when they put you in a room; for now remember the vitals are good.”
“Thank you.”
“Ok; your father’s outside, I have him brought in to you.”  
I told him I’d have to stay and he should go home.
“You have money for a cab?”
“My bag is under there, Dad.”
You know, it’s strange; he has no problem asking me to give him money so he could get home!? He doesn’t know where I get money… But, he couldn’t care less?! And, I doubt very much even if he knew it would bother him; hem, he’s lived off her all these years…, knowing that I’ve been signing Elaine’s name and cashing her checks from the checkbook I took and packed in my bag the day I left that place in Brooklyn would faze him?! Well maybe if he was aware I only cashing $50. to $100. At a time out of an account which has $33,000. In it would?! I stopped writing checks after I bought everything I needed for a baby until a baby is one month old; after $1700. I didn’t take anymore. Till the day my mother died neither she or I ever said a word about that checkbook. And, I know she knew… every time a check was cashed.  When I cashed them at Manufacture Handovers Bank would confirm with a call before any check cashing; they did it since my brother, Kevin, cashed out a $12,000 check and left town! A signature that was in no way like my mother’s! The bank made a deal to replace half?! I’m sure she could have had ever last penny back but the bank would have had police-case opened and a warrant out for Kevin and she never did turned her back on that boy?! That check wasn’t even, close-to, the worst thing that boy had done. The day he died I smiled, enough said.  Well, I think she thought I would have felt bad and come home and I’d do what she wanted me to do that day.

The sun’s coming up… They just put me here in this room, room 410; I hear the Doctor down the hall. I hope he has good things to tell me!? I pull the drape to see him when he comes in the door; a circle of people are out there with charts. They’re coming in…,”Miss Rose, these are the team who will be watching over you.” Doctor was saying their names but I wasn’t hearing him; all I want was for him to tell me the baby’s going to be alright. “Miss Rose I spoke to your GYN and he informed me you were already aware of this being a high-risk pregnancy?
“Yes.”
“The chart says you been pregnant before?”
“Yes; never over five months.”
‘Well, you do have that in your favor; although, there’s still no… Miss Rose? What wrong?”
“There’s… No…”
“Listen!” he places his hand on my arm. ”Understand what I’m saying; we’re monitoring the vitals and you and your baby are, for right now, fine. The longer that baby stay in there the better be the chances of survival. Do you understand this?”
“Yeah”
“Good; in order for this to be we will need to keep you in the most sterile environment possible. Do you understand what this means? I can see you’re not; Miss Rose you’re going to have to stay in the hospital until the baby is born. And you’ll need to be on complete bed-rest so we can continue to monitor the baby. This means no wondering the halls this is a private room and you have a bathroom all to yourself no getting out of bed just to walk around, no unnecessary movement you need to stay pregnant for as long as you can. Now, you understand what I’m telling you?”
Crap! I look at this doctor like he just grew three more heads??? “You want me stay here, and to sport this bed? Until, September 18th?”
“No… Miss Rose September 18th Is full-term an ideal time for the baby; we already know that won’t happen that date’s gone and is impossible now. But the idea is to now get you as close as we can to that date. Let’s just take this a day at a time. I come and check in on you later. Remember, no getting up except if you need to use the bathroom. Ok?”
The bathroom only; got it!”  
The doctor leaves my room… Its Thursday morning 7:12 am. June 5th. 1980
Mind this point, it’s still 1980?! You can smoke inside a hospital; and, if you’re in a private room without Oxygen Tanks in use.
The date and time of baby’s birth is...; Friday, morning, on June 6th. 3:54 am.
They took him right away from the delivery room I only saw him from the mirror up in the corner of the room; you know the kind where things are closer than they look type’s… they put me back into my room. It’s 7 am. I know, I have had a baby boy but I haven’t met him? Three hours not one word; not one word to me by anyone here?! Did something happen? Again.
It is 7:10am. Door, to my room, opens… The doctor steps in… “Miss Rose?” he walks to the side of my bed. “Has anyone been in to talk to you?”
“…no.”
“We need to talk to you about what is next for your son…”
“My, son…” I thought sure… he was going to say???
Yes, they are ordering transport for him, now; our hospital isn’t equipped to care for his needs we need to rush him to another hospital that can give him the best chances to survive this early most… we’ll do best we can. They’ll bring him in a moment I know you hadn’t had a chance to hold him.”
As he said this four people enter the room and my baby, my baby.
The nurse walks around to the left of my bed and hands me this itty biddy blanket holding this little face.  I look at him and thought ‘His skin he’s so purple; his face… he looks just as she did. But he’s here. ” Hello Joseph! I’m your mommy. I’m grateful you’re here. “
Big hands; the nurse who handed my baby to me to hold is now on my right-side to take him away from me.
They rush my tiny boy out to the neonatal ambulance He’ll be at Long Island Jewish Hospital when I leave here on Monday.

Zionist father's "lamentation; his sons burial."
The family of an IDF soldier was gathered for his funeral from Rapha rubble. All that was left of him was a small box of his ash remains. Words began to pass over his grave.
"I remember how handsome he looked in uniform," said his mother, "with his matching Helmet  & Pampers." "I remember how brave he was," said his father, "he once neutralized a neonatal intensive care unit without hesitating for a second." "I remember how loving he was," said his daughter, "he once demolished a school for me on my birthday." "I remember how strong he was," said his wife, "every child he faced fell before his might." "I remember him being bigger," said his son, "What happened to him?". "Apparently," stated his mother,

"He triggered a *****-trap while plundering a house in Gaza."

"Well, I guess he died as Israel lives" stated his father.
"And how is that?"

Asked the others?
"By burglarizing someone else's home after proudly murdering all palestinian family members "

Oh! Said his grandmother

"Every muslim Palestinian, any non zionist jewish birth poses an existential threat to his new and future born children, thats why

"this IDF soldier's remains are buried among genocidal war criminal hereos in Izrahell."
~~~~~
Izrael:August 2024.
~~~~

If you’re gonna pass laws that force women to
Birth and raise the babies they get knocked up with
        Make those laws also include a neonatal paternity test,
        After which the father has his income attached
        To the tune of seventy-five dollars a week for 21 years,
        Adjusted for inflation.
Then Enforce that law every bit as rigidly
As you enforce your new abortion bans.
         It takes two to make a baby, after all….. and
         Fair is still fair, isn’t it?    In what Universe?
                           ljm