Write lyrics like spreadsheets with number crunching
Calculate the isotopes
numerical accuracy in the vein of vain attempts to overcome
the show off tendencies of artist who exhibit flow to illicit
concern about existence beyond what they can see of pedagogical poetry
more concerned with numbers and patterns
who gives a **** what the stress is on the vowel in the third stanza  
lyrically despondent personal correspondents for a publication that says
more about what you know than what you feel
and who you are
computer says no, statistically impossible, synaptic haiku
five seven five
musical ronin
go go gadget of talent
extend-o-pole and flying nimbus as you train like son-goku
hyperbolic chamber where time is an illusion only to collapse
true Saiyans are warriors from the womb until death and after
over nine thousand and the scanner short circuits
write on the clouds with light so hot that it burns on thought
not contact
no constants, just variables, electron microscopes to try and hear the angels sing.
Large Hadrons small dreams, no love, just roman numerals
XIV, ***, Blood transfusions in the realm of “O Positive” and you're just a pessimist, negative Nancy at the end of evolution
Flesh and bone as a tent in your double helix of a genome,
flesh like clay in the hands of some master
but you know no master
no nations, under no gods but Darwin
all 23 chromosome pairs making 46 parts of your brain
screaming neurons fire
WRITE
WHAT
YOU
ARE
If you should so choose as to end not with a bang but a whimper
then your memory is forfeit
contribute in some meaningful semblance of sarcasm and sinsethesia with anesthetic medications of pop remedies and voided memories
of sinthesisia
Smell the colours and taste the sounds of pen on paper
when you never own a pen or a pad
just a bright white rectangle you stare at for hours on end
No thoughts just Digg and Reddit
your only contributions a thumbs up or a red thumbs down
like buttons
but no dislike, because if you've got nothing nice to say
then say nothing
unless you're outrage and full of spite
and morose
at the state of human nature
beauty and song thrown out in an effort to leave nobody behind
and so we have a generation coming in
at the age of 5, who are told new math
new science
wrote memorization of equations
no thought process, no argument about relation
theory of relativity, the genious mind just numbers and letters on a page with squiggles and lines that don't have to mean anything more than they mean on the book
we have a generation with no lust, no hope
Do they dream in black and white?
do they dream at all?
is the consequence of IQ tests and graded paper intelligence
the thirst for knowledge and creativity?
WE HAVE TO SCREAM
at the injustice
Burn it to the bricks and ashes
we hurl through the windows
in the streets and in the parks
car radios and clock towers sold
for cheap homemade *****
dance around the fire like the wild things are
LET THE WILD RUMPUS BEGIN
but then we're still hollow
no happy medium, just excess
in the pursuit of Dionysus, trepination,
demon possession is illegal in the eyes of the police and federal law
spread your legs and lean against the car
as they frisk you and plant the seed
of doubt
in the cuffs of your jeans
You have the right to remain silent
but I hope you don't
refuse
question
resist

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.
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The reason there aren't so many vampyres
around these days is they don't like TV hype
and the intrusions of TV news crews. It transpires
that vampyres prefer late hours and like low light levels
because they're egregarious and don't like to be seen inebrious
in the middle of their heinous, intravenous revels.
Also, unfavorable reviews about transfusions
and the confusion caused by AIDS, at this juncture,
has definitely reduced the appeal of being seduced
by some crazed and gurgling Transylvanian
bloodsucker lusting to puncture the jugular,
or any other available vein again,
especially when you don't know if they've disinfected their fangs
or only licked them after draining their last victim.

After all, vampyres were brought up in castles
when there weren't antiseptics for gargles
and they haven't been taught prophylactic criteria
against such apocalyptic viral bacteria.
And if you've ever seen vampyres with condoms
on their teeth, you'll know what I mean.  
It's a scream. Everyone finds them hilarious. It'd be easier
to die laughing than to go down with anemia.
Also, like everyone else, vampyres hate ridicule.
No-one likes being seen as the fool.
  
And the other reason vampyres are scarce now
is that there are so many genuine muggers, hoods, crims,
druggies, financial leeches, homicidal maniacs,
psychopathic liars and genocidal tendencies to conjure up real fears
out there, that there's not much room left for quaint old-fashioned vampyres, poor dears.  

But do you know something? Even though they were naughty,
I miss their occasional ****. I know it was gory,
but those kisses, oh boy. We got into the femoral artery inside the thigh. It was *****. But when AIDs came along,
that was it.  Definitely bye-bye. Nobody wanted to die.  
These are the facts.  
So these vampyres were starving and they reverted to bats.  
Did a midnight flit,
and that's the end of my story.

Insanity lies there, in corners,
Along with spiders of my mind
Their web it's made of irises
Of my memories left behind.

Memories, dreams and feelings.
They all passed over my beliefs,
On a floor of spinning ceilings,
A sky of autumnal leaves,
Withered bits of a decrepit soul.

Time is fierce...
My skin is rusted, hard as stone
Maimed and parched to the bone -
I need a pill, just one more.

Dawns won't pierce
My thoughts falling high
In a sea of toxicity -
There's a pill which might
Bring me closer to the light,
Far from its velocity
And its painful shards
Dissipated in pitched, soften clouds.

There's always a pill
And another pill -
To strengthen up my will.
Though, I will never feel
My emotions crystal clear.
These fake illusions
Will never cheer
Heavy whispers in my ear.
Diseased blood transfusions
Of my dreams becoming real,
The world has stood still
While I tremble, poisoned with fear.

*So I'll take another pill
Because I fear...

had a picture of dad on my nightstand
it fell not too long ago
but landed upright
atop his shoe shine box that I kept
its new position not precarious
I let it stay there
thought it was kinda fitting
a picture from his older years
taken in the kitchen
looking up into the camera
from the task at hand
peeling boiled potatoes
for potato salad
my potato peelin' pop
morning sun shine spot lights that picture
warm, smiling, reassuring

mom's back in ICU now
transferred to rehab with high hopes
bleeding, unresponsive
cardiac arrest en route back to ER
x-rays, CT scans
transfusions, blood draws, ventilator
endoscopy?
colonoscopy?
dialysis?
quality of life questions
the more I watch her
the more I wonder

How I wish pop could tell us what to do

My momma always warned me
She’d say
“Baby doll liquor runs through our veins”
I was making a family tree for health class last week and a third of the people hanging from the branches had beer bottles clinking next to them.
My grandfather’s favorite hobby was downing a bottle of jack and carrying out the cliché tradition of beating his wife and kids
Just like his father did.
My dad learned from this vowing never to forget what alcohol did too his family
My uncle he drinks just trying to forget.
My mother has a similar background
She remembers riding into town with my grandma to buy her granddaddy’s medicine
It was only until she was older she realized the pharmacy was an ABC
The “medicine” cheap whiskey
As the elixir slid down my great grandfathers throat it trickled into the workings of our tree
Infecting its core
Yeah my parents would always warn me
Against the dangers of alcohol
Don’t drink the punch at parties
Don’t be like your uncles
Don’t end up like your aunts
But what they failed to tell me was depression runs through our veins too
They taught me how to ward off being a drunkard
But never told me to stay away from the dark spaces in my mind
They never taught me what to do about the numbness
And in my house people are more ashamed
Of going to therapy than alcoholics anonymous.
How do you protect yourself from something already inside you?
You see those relatives of mine
They were doctors
Preforming at home blood transfusions
Replacing the bad blood with good beer
The dark thoughts with white wine
Until the depression swimming through them was too drunk to see straight
We nurture our family tree with PBR and Prozac
Helping the roots twist and grow so they can grasp for the younger generation dangling from the lower limbs and I mean
Hey we all need something to make the feelings go away
And they say alcohol’s not the answer
But it sure as hell makes you forget the question
We all need something to forget the questions
And Like my kin I picked my poison
Because I felt it
The liquor in my veins I felt it
getting warmer
Hotter
Hot
This liquid in my veins it gets too hot.
I’m slitting my wrist to poor myself another shot
It’s not what it looks like momma
I just wanna feel that buzz and my blood is all I got
I picked my poison
I’m like my uncles
A crude copy of my aunts
I’m an addict
Just not an alcoholic

There is a silence now that you have gone
Somewhere - who knows where?
A silence of your suffering, your laughter,
Your excitement, your enjoyment of food.
A silence of your telephone calls, our lunches,
Your family get togethers, the Christmas puddings.
A silence of birthday cards, Sunday roasts,
Shopping trips, seaside walks and ice cream.
A silence filled with my children's laughter,
Summer picnic days and your flower garden.
A silence of your dementia voice, muddled
And forgetful in your inhabited, twilight world.
A silence of your tears and requests to go home
To safety and your memories of a past busy life.
A silence now that you are gone which I fill with
The voice you gave us to fight on your behalf,
That speaks with truth and grief and sadness
Screaming for your help, care and support.
There is a silence now that you have gone
It fills the deaf ears of those who won't hear
Your sorrow and our pain, who dismiss your
Diagnosis and replace it with a list of lesser
Tick boxes, low scores and minor symptoms.
A silence that is full of blood transfusions,
Infections, falls and fainting and fevers,
A silence that gave you leukaemia and took
Away your life, your heart and soul and being.
A silence that I promise to break very soon
For your silent voice needs to be loudly heard
So we can all rest in quiet,  everlasting peace
Knowing you're protected by God's 'Continuing Care'

God Bless Auntie Joan x

I'm sick of these transfusions
I always have to give
You're always the one dying
And you need my blood to live

Universally you recieve
But very picky how you donate
As a universal giver
This I don't appreciate

Not everybody can love me
Not everyone has what it takes
Only my kind,
I find,
Can love me, and love me straight

No matter the circumstances,
My love never be returned
Because our transfusion doesn't work that way
You leave me dry,
To die
And burn

Still Thin Canvas Walls
What good thing could come from such humble surroundings it’s nothing like the original tabernacle
Made from badger skins but the battle rages in modern life the wounded lie in great tragic sprawls just
Add your city’s name that will suffice wounds of alcohol, ***, drugs, bitter was the fight but the
Conclusion was already cast men and women are highly susceptible to these diseases there isn’t a
Natural antidote quickly wariness robs all strength the fallen lie strewn in the most pitiful scenes to even
Raise their head takes great effort what about the great mortared churches that stand in grandness on
So many blocks in America the already saved and righteous go there effortlessly but a war takes mobility
You have to go to the front lines be abreast of the battle line conditions one day the battle rages fiercely
Then the next clear across town the enemy strikes if transfusions are the single most necessary act in
Natural battles then so is it in the spiritual battles only the blood can clean and doctor the wounds and
Bring complete healing prayerful condemnation of that life and refusing to participate any more then
Going down in pure cleansing baptismal waters will usher you to the birthing place of the final solution
As a creation born of the spirit you will never again be over run you can feel and know temptation but
Always a way of escape arrives in the nick of time you now are the spiritual medical team assigned to
Walk among the wounded comfort and show them the way out of the most extreme circumstances
Tell them from knowing personal experience defeat no longer will rule them with a most cruel tyranny
Now they stand at the portal of freedom where richest life ever flows outward until the bright eternal
Day is revealed. Talk if you will at times and speak with a tinge of pride that causes you to practice a
Little Disdain for brush arbors tents and those humbler days but out of them mighty revival flames
Consumed entrenched strong holds of sin that resisted all other efforts to eradicate them Look upon the
Empty field a lone tent stands seemingly so thin and fragile if you could see what the devils see. They
See those they have enslaved walking bent and bowed all that registers on their faces is bitter
Disappointment they had such dreams the highest ideals they walked with their heads in the cloud but
During these tremendous high times something very base was setting traps to remove you far from
Those Cherished dreams lust for drink lust of *** that has nothing to do with love and tenderness that is
To be shared between a man and women or lust for things can bring people to spiritual wastelands
And when your power ebbs away you hear what you hope is the sound of a helping hand but the lowest
And cruelest enemies use this time and place a their choice hunting grounds these bonds are secured
By human default they have no escape fighting is the same as quick sand the harder you fight the
Deeper and quicker you sink but as in natural war the artillery has spotters with powerful glass they
Pinpoint weakness and the targets that best will serve your side it is so in the spirit but here it is the
Searcher that goes forth he looks deeply and with the most knowing sight he sees those that truly want
And will change he calls to those who are free and they rush in with the weapons that are credited with
Tearing down strongholds of the enemy there is no greater joy found than they who have been set free
To walk without guilt and shame and the dread of future judgment is gone you now eagerly await your
Change that will bring to your eternal home and all longing will be forever satisfied.

Raised in the midst of war
You stubborn, tenacious, little girl
You saved your friends
and lost your family
You rode on the top of trains
to make room for the sick
and the elderly

You met an American Soldier
Who had a big mustache and
a long face
You didn't know English, but
you fell in love with him

The odds were against you
but still you moved across
the ocean
To a place that didn't
understand you or
the way you spoke, or the way
you looked.

You had a little girl who died
and your racist Mother-in-law
crudely said,
"Wake up, your baby is dead."

You had four more daughters
Your husband was always away
And yet you had time to make
Hot breakfast every morning
sew 17 dresses in one summer
and never complain

Your daughters grew up
and gave you 8 grandchildren
we were your light
and you made us laugh
and taught us how to be strong
in the face of adversity

For 7 years you fought this illness
and in all those 7 years
of over 60 blood transfusions
and practically living
from hospital to hospital
you were patient and you never
once lost your spirit.

Even in our last day together
You held my hand with so much strength
though your body was weak and failing you
In your hand I felt all the love you had for me
All the love you had for our family
and I know you did everything for us

I miss the way you swear
your tenacious strength
your incredible tenderness
holding your hand
feeling comfort in your quiet presence

Even though you're gone
and I will never see you again,
I feel you. I feel you in my heart
I feel you in my hands, I feel you
in my soul. I feel you every time
I stand up to some one and tell them
No.

You always said, "I'm a rich woman"
because you had us. You told me,
"If I asked for anything more,
I would be greedy."
The reality is, we were all rich because
we had you.
I am so grateful for you. I miss you.
I love you.

Blood pumping through our veins,
Involuntary.
Two
Three
Four
Five
Cities
Countries
Nations.

Hearts beat simultaneously.
Beat for our countries,
For our people,
For ourselves.

The lips that form a greeting smile.
The flush of an embarrassed,
nervous,
excited face.

Old,
New,
Transfusions.
One pint will save three lives.
You and three others.

An accident that connects two people for an eternity,
Or longer.

Panting tongue,
Best friend.
Rough tongue,
Old friend.

The end button.
But they’ll call back,
Or you will.

No new parts for you,
Mother,
Father,
Sister,
Brother,
Friend,
Neighbor,
War hero,
Civilian,
Believer,
Human.
Say your good-byes.
We’ll miss you.

Look...look-e here pause for a second before the seconds get near

the clock is dishonest and it cuts like shears.

I stare into the sky yet I do not fear

even if the end was near, I would be in the clear

Like visions that are translucent, let's mix it up like blood transfusions

don't think too hard just say you can do it!

what are drugs to a man using?

I call it addicted, my logic is gifted I'm on it, you're just with it

let me call a witness...to this lyrical massacre

my letters strangle the pilot, co-pilot, and passengers.

There belittled by small riddles am the verbal ambassador

My minds pickled so sick hospice...not hospital

my rhymes ripple as I watch the clock trickle.

Time is the enemy never stare at it...and if you look for too long...you will become an addict.

An addiction to numbers...one two three...along with others

Countless counts of time equal a waste of time so pause it, take your time.

A debate will rise ...to take equates to loss..we run,drive, and fly at any cost.

But there is only one currency...time is the coin of all eternity.

When the hands turn they move clockwise with certainty.

the counter clock is unwise certainly.

because it moves in contrast with urgency...

Father Time what is thee emergency? Mother Nature's calling she waiting for the earth to speak.

Look..look here, pause for a second before the seconds get near

the clock is dishonest and it cuts like shears.

I stare into the sky yet I do not fear

even if the end was near, I would be in the clear

Like visions that are translucent, let's mix it up like blood transfusions

don't think too hard just say you can do it!

what are drugs to a man using?

I call it addicted, my logic is gifted I'm on it your just with it

let me call a witness to this lyrical massacre

my letters strangle the pilot, co-pilot, and passengers.

There belittled by small riddles am the verbal ambassador

My minds pickled so sick hospice, not hospital

my rhymes ripple as I watch the clock trickle

Time is the enemy never stare at it, and if you look for too long...you will become an addict

An addiction to numbers...one two three...along with others

Countless counts of time equal to a waste of time so pause it, take your time...

A debate will rise ...to take equates to loss..we run,drive, and fly at any cost

But there is only one currency...time is the coin of all eternity.

When the hands turn they move clockwise with certainty.

the counter clock is unwise certainly...

because it moves in contrast with urgency...

Father Time what is thee emergency?
Mother Nature's calling she waiting for the earth to speak.

Around 8 there was much confusion
testing and needles and transfusions
the chemo made him so sick
hard to breathe, the air is thick
he lost all his hair when he turned nine
his parents wishing they could turn back time
to when he was healthy, when he was whole
but there is much that we can't control
so they'd say prayers by his hospital bed
kiss his face and stroke his head
sing him songs and read him books
they didn't bother to notice the looks
people felt pity beneath whispering voices
gave advice and questioned their choices
when he turned 10 he was ready to go
their little boy who would never grow
he'd never become a man, never know life
robbed of a future family, children and a wife
he wouldn't get his license or reach graduation
never feel the sun from summer vacations
so they took him out of the hospital at his request
and he said that was the part that he liked best
because he knew it was time to go home
but they should never feel alone
because he saw angels, everywhere
so not to feel lonely because he'd be there
a whisper in the wind, stars that shine at night
they had to let him go, he was too tired to fight
it wasn't about giving up, or giving in
it was the promise of seeing them again
in a place where flowers always bloom
and little boys can catch the moon
they'll see him, they'll know he's free
no more pain and misery
so in silence they will weep
for their little boy who went to sleep
and woke up in a better place
healthy, whole, his smiling face

Why are all my flowers dead?
I gave them water to help them live

I hooked them up to IV bags
& performed blood transfusions
with my own liquids

Its as if they were in a head on collision,
in a 12 car pile up on a highway in August.

As if they laid upon the asphalt in the sun,
withering to the bone, they pass.

Why are all my flowers dead?

You never once asked me to save you
I guess I just took that upon myself
The first time I put my fingertips under your shirt you trembled
There were bandages and scars underneath

Things you’ve never let anyone else see
Things you were scared to show me

All I saw was milky white beauty
Muscles and bone
Strength of the more memorable kind

No, you never asked me to save you
I don’t regret trying
But during all of the 2 am phone calls
I spoke with my face buried in my pillow

I told you my secrets one night
Not all of them
But enough to make you run away into the sunrise
They’ve been caught in my teeth ever since
I threw them up and didn’t wash my mouth out
I don’t feel ***** when I really talk to you
You didn’t wash your hands after you touched me
He always did

You whispered my name
Moved my hair around in your hands
Said my name aloud while your toes curled
Knees on hardwood floors
I never felt it
Too preoccupied with pleasing you
Nothing more beautiful than your half closed eyes;
The way your lips part to let out a low sigh

Counting the days with you like stars in the sky
I hope they are limitless and shining
I hope our love will be a galaxy

You stood in front of me
Naked in soul and body
I kissed the freckles on your chest and lower
I kissed the scars on your stomach where they cut you open
Where they pulled parts of you out when you got sick
You may not be whole
But I plan on making you feel as if you are missing nothing

You say you are ashamed of the marks
9 years of pain
The blood transfusions
The multitude of pills waiting on the counter
9 years and 2 months of pain
Months in the hospital
IV’s in your arms dripping what you couldn’t make
And all that lost weight
You still aren’t fixed
I tell you that you are perfection
I will love you through everything

With my face twisting I tell you about my pain
The scars curling like ivy on my forearms
Wrist to elbow
Elbow to shoulder to thigh to calf
The days I spent crying instead of living
And how the hospital makes you want to die
About all the pounds I shed into thin air by not eating
We both dehydrated when we lost 40 pounds
We’ve both been so close to death we tasted it
Felt cold fingers wipe the sweat from our brows

I ask myself how I ever breathed without you
Without the help of your lungs
Please don’t pull the plug

We had *** the first time we met in person
I bit your bottom lip so hard it was still raw a week later
I told you I was sorry
You said you felt no pain
It only showed how I thoroughly enjoyed you
That was the first time I felt that I was making love

I want to ride my skateboard down the contours of your legs
Make your body a half pipe
A park only for me

You lit my cigarette when we stood in the snow
“pretty girls never light their own”

I love the way your eyes look when you are trying to be worth something
When you are excited;
Happy
When you are looking into my eyes while you are inside of me

You opened my car door for me
You watched me leave as the snow fell harder
And then you stopped me and pulled me out of my seat

Kissed me hard because I had to go

Kissed me hard in the snow

It felt like a summer night in July and all I wanted was you
Snow turned into fireworks in a field at night
Fireflies dancing

You go to church sometimes on Sundays
A lot of times you sleep instead of going with your father
I still don’t think I'm getting into heaven
I used to drink blood and eat flesh too
Never felt any better after kneeling in that red velvet pew
I would stare at the sunlight coming through the stained glass
And think about ******* Jesus
I’ve heard a lot of voices but I’ve never been haunted by the Holy Ghost

There are freckles on our back
Mine from 3rd degree sunburn two summers ago
I told you they were beautiful
I still don’t know if you believe me

The first time we talked on the phone
You told me you loved someone who didn’t make you happy
All I wanted was to be yours
You told me beauty radiates inside of me
Beyond that of the moon and stars

I don’t believe in heaven or hell
But I think there is something magical waiting for you

i never drank to get drunk
but at times
i got drunk as i drank.

wondering why i drank...
i recall
a friend who never saw 44 at all.

Ft Lauderdale spring break
so pretty and sweet and petite
who could have ever seen
what a few
would eventually do
to you.

at least 3 rehabs
Betty Ford counting among them
you recounted how many
spoke of all the chardonnay
that finally got 'em.

at times i envied your easy life
or so it seemed.
new home,
new sheets and towels
bright white carpet and all.

successful husband
diamond jewelry
art on the wall
mercedes benz
and money too.

no worries about bills
to pay
jobs to get
love to find.

but i liked your VW beetle much better
and your painter's pants on you,
so chic and popular at the time.
your so sweet a nature
honest and true
generous and all.

blonde and adorable
the years took their toll.

i never knew the pain
you were going through,
you never told.

what an education
you did give,
when finally you
revealed
where you had gone,
where you had been.

tales of hidden bottles,
drinking on the sly,
hiding and covering
all of the lies.

the cops couldn't believe,
you could still be alive,
with a blood alcohol level
of 4 point 0.

how we grow strong,
build up the tolerances,
until they amaze and astound
each and even every one of us.

the years and the glasses,
caught up with you,
the first place you begin to bleed,
or so i learned,
when your liver goes  
and starts to harden
and your blood can't flow,
is through your neck and throat.

blood transfusions,
they
helped for awhile,
then one night.........

well one night...
that was all.

a cautionary tale...
for all you college bound...
you never know which one of you will be the one...
who never sees your next sun
the next sun's light.

We will build Rome in a matter of hours,
Prop the sky up on steel and glass towers,
Stain the seas black with our need for oil,
Burn the earth and watch the oceans boil.
Inject the earth with chemical solutions,
Draw its blood for economic transfusions.
These walls will reach such an astounding height;
They’ll block out the sky and all the sunlight.
And how we justify setting the world on fire?
“All this was done for the good of the Empire.”
But eventually it will crumble; only ashes will remain.
And the Rome that we’ve built will have been built in vain.

change

beautiful child in a bubble, so touched by life
won’t you please come home?

a heartbeat  holy in the method of conformity, of broken rules
                  raindrops pelt their cleansing transfusions onto your hide
how you survived the barrage of all your terms in there
                  the spitting on you and kicking your liver
they gave you everything not intended for your path, penalty unsought
                  but you were so terribly bent on making change
you wanted to run free
                  no reins on your breathing and untethered to ropes
you wrought freedom for the couch sitters from the toil of your blood
                  forgiveness never late
justice runs blind into the night and a bus catches flame
                  a knock at the door, two uniformed soldiers with a flag
you're at the wrong house, my friend
                  please go away




bail

a signpost showed direction and you cantered off, away from there
the only friends you made were the shadows on the bridge at midnight
when your *** got bailed out by even more hopeless sods
you have quite a story to tell, when you get to land again (if you do)
on the goodness of soil
a wooden chair on a stage, lit by candles on the edge
                   you will speak your words
the ones you never could
                   it’s been so hard when they always flitted out of grip
yet you are the one who will bring it round



hunger**

the knight knows well to aid the sufferer
                   but in the dark woods one never knows
hunger comes in all forms and deeds are cloaked by trees
                    moving truth into obscurity
a matchbook sends intermittent sparks of redemption to level the fields
I struggle to see how this is kept together
bring me closer


child of the rains, step out that puddle
there’s warmth in a heart your senses have yet to fully appreciate
please come home

A consequence of merriment and early summer
Warmth, conspired to put him on that midnight lawn.
Lying there supine, his innocent thoughts drift
Amidst the sweet pungent scent of honeysuckle and mingle
With the stale wine on his breath. There is beauty in decay
He thinks, and only death and beauty can flower in creation.
The supreme bounty of all is death and the life there in.

In the dark garden he dreams a little of paradise
Not the mistake of paradise, but a consummate paradise
Unsubstantiated, and free from the vestige of interpretation.
It is here where all else is shadowed and dark,
That he sees clearly a myriad of blossoming colours,
Sharp transfusions of light that glow from leaf to blade.
And he thinks to himself, as he dreams a little now,
Amidst this broad wash of sunshine all around
It cannot yet be midnight in the garden

It's been 14 days since we last kissed
I turned into ashes, my body is missed
The poisons inside we fought for years
Transfusions of blood while holding back tears

In my last hour, no memories evade
I remembered with you laying hot in the shade
A mid-summer's night as the sun starts to fade
We're falling asleep, our eyes a cascade

Awakened at two with droplets of dew
Eyelashes in bloom, pale light of the moon
You looked into mine and mine into yours
Two souls intertwined as the rain falls - it pours

Our lips, they collide with the fury of wars
The beaches of Normandy kneel down at our shores
A tear stains my tongue, I've felt this before
Two weeks I've been gone, yet still I want more

I wrote you a letter to last your lifetime
One every day - long as you are still mine
Delivered in essence to prove beyond death
That I'll wait here in Heaven with bated breath