A few simple words in an appropriate situation can have inordinate influence. A while back, I received a note from a father who just lost his prematurely born twin daughter to a condition called twin- to- twin transfusion Syndrome. One twin died in utero and the remaining twin was born at twenty-five weeks, gravely ill and on life support systems in the newborn intensive care unit. After a brave but futile struggle, she too died. Her father contacted me from England asking if I could suggest some words to read at the memorial service for his children. I sent these few lines to these bereaved parents: Let us not succumb to winter's portent, the solstice of our darkest hour... In their reply I learned they will be placing these words upon the headstone of their twin's grave and will be reading another poem of mine at their memorial service. Needless to say, I was quite humbled by this use of my poetry. I intend my words to be available to comfort and it may take several if not hundreds of contacts with my work before they serve such purpose, but when they do, I know that by benefiting just one family, their purpose has been served. I write each poem to reach one family at a time. By not expecting a multitude of recipients and acknowledgments, each individual acknowledgment becomes that much more special. The Virgin Winter Let us not succumb to this portent, The solstice of our darkest hour. For it is but a finite point Upon an infinite journey Which began with all creation and Upon whose path walk The souls of our children; Pure as the silence of the virgin winter, Alive with winds of indomitable hope

Now after 55+ years in the Profession of Medicine, working with and relying on nurses every day, I am affronted by the recent reports to denigrate and disparage the nursing Profession. Nurses are Professionals in every way. Nurses are the consummate professional. Nurses are a vital and essential part of the professional team. Nurses are indispensable! Every patient and physician who has been touched by a nurse’s care should voice their concerns. Here is my tribute to all nurses, written with the greatest respect, admiration and love: Affirmations You are the dedicated and the dear; Who bravely face the abyss With courage that bespeaks Your truths To the unfaltering oaths Upon which you swore; A grace of caring Which comes from your Outstretched hands and noble souls and more… Your calling: A strength, To strike and penetrate As coulters (1) to shear each morsel Of disease and despair Into infinite shards; To awaken the safely guarded Hopes of humankind’s promise As life’s order is at last restored, Returning to us the dreams To freely breathe the air, To walk hand in hand Upon the byways and the beaches, And travel distant shores, And speak of todays and tomorrows Once again with smiles And even drops of tears; Gleams of gratitude and affirmations, For you, the dedicated and the dear. © 2025 Michael R. Berman, MD All rights reserved (1) From the Latin: culter meaning ‘knife’ or ‘plowshare’

I am honored to be able to participate in this service tonight as my heart reaches out to all here tonight who have experienced the loss of a child. While the death of a baby is a catastrophe and a tragedy which shatters good, secure and confident lives in a matter of moments, the sharing of feelings of such profound loss with one another at a service such as this and beyond can actually beget a healing experience. One bereaved mother has put this in another way: : “Strangers we may be, but we are all connected by the loss of a child, and that makes us all soul mates.” Like yourselves, countless mothers and fathers and those close to them silently grieve with little resolution over the loss of their pregnancies, newborns and children. Seeking reprieve from their sorrow, they cry and yearn for solace and hope, many times for years following their loss; cries that are but a muted weeping of despair as a child so longed for is not born, or is not born alive, or cannot be conceived. Pained by these losses, their lives seem devoid of hope. Yet they-you- prevail, for within each of us is a timeless, enduring spark of divine hope, a uniquely human greatness that permits us to challenge adversity and courageously face the unexplainable suffering of our souls and bodies. To realize the existence of this divine hope is a most cherished purpose, for with it our lives have promise and reason. Infertility, pregnancy loss, neonatal illness and subsequent death are among the most painful losses we can experience, for they deny us a family and leave sightless our vision for immortality through generations of the future. Moreover, a child not born is likewise denied the delight to revel in the simple beauty and endless wonder of this divine hope. Memorial services such as this, ceremonies and tangible items of remembrance are vital for healing after the untimely death of the child, born or yet to be born. They give us permission to remember and cry publicly as well as privately. Memories are what remain of our lost children, invisible bonds between mother father and child, everlasting. Remembering and praising our lost children can make darkness, visible. Perinatal loss entails a "unique bereavement" and is an "exceptional" type of loss, for a child is not expected to die before his or her parents. Across all cultures, the parent-child relationship is and has been the most enduring and significant. The natural processes of birth, life and death should follow in an orderly and rational sequence and through one’s lifetime. Any death but death from "old-age" after a "rich" and fulfilling life is premature. Yet when parents like yourself see their child die, or carry the burden of an unborn demise, they live with this disruption of said natural order forever. There has not been nor is there now one common and standard way to manage the recovery from such grief, for it’s shadow has been and will be indelibly imprinted in the minds and souls of these parents. Bonding between mother and father and child or expectant child occurs and must be recognized. Death tears this apart. The issues of mourning, of lost promises, of sadness and above all, of maintaining faith must be addressed. The impact of these losses must not only be recognized but must also be "main-streamed" into our society. We are at the threshold of an era when solace and compassion for the deaths of these our smallest and most vulnerable of patients are being recognized more than ever before. I believe the days when perinatal loss is considered an unspeakable loss are waning.

Carapace We summon ancestral voices. And peel our skins of daily toil, Moments of banal routine, And stare beyond reflection To cherish living’s wondrous elements; Fusing generation to generation, Parent to progeny, young to old, Passions to deeds, To all...bequeathed today. Our carapace, now shed To unfurl life\'s grandeur Of simply love and caring, Of giving and sharing, And gifted time…beyond dismay.

I read and referenced here a powerful review of the "Trust Crisis" in healthcare by Linda Kazar (The Trust Crisis - Proto Magazine). This is subject I have always been interested in-now 56+ years since entering medical school. I will be writing more about this in future posts but as I just read this article for the first time, I wanted to share my thoughts on how I have tried to engender trust, confidence and better caring for my patients. The embryo of trust begins at the first meeting between doctor and patient. When meeting a new patient, be humble and appreciative that that patient has chosen you to care for them. Always remember the privilege that is ours as physicians. Show confidence but not arrogance. Look at the patient as did Maimonides: “…never see in the patient anything but a fellow creature in pain“. Whenever possible, meet the patient dressed a non-clinical consultation room / office. Listen to the patient’s ‘story’ without interruption. Try to learn as much as you can about his / her life. Discuss their concerns, their fears and needs for this visit. If this is an office visit, after the exam, return to the consultation room / office to discuss visit. This is time consuming but important to cementing the initial encounter. Allocate more time for a new patient. Explain to the patient what they can expect from you. The patient should leave your office feeling that they have found not only a doctor but an advocate. You should leave the office feeling uplifted that you have ‘helped’ and contributed to the well-being of another patient. Sometimes, we meet a patient for the first time in an emergency situation like the Emergency Room or Labor and Delivery Floor. The challenge to gain trust is more difficult here as there are almost always time constraints. Here is where words, body language, eye contact and overt demonstration of ‘professionalism’ takes over. We must engage with every patient and engender confidence. Remembering and practicing our privilege to care and treat these “new” and mostly vulnerable patients that we meet in acute situations as we would for any other patient is paramount. Always promote and practice one standard of care for all and teach the same. Immersion. One concept I have always tried to practice is immersing myself in my patient’s care. If complications develop, if outcomes become unexpected, if patients die; do not abandon them or their families. These situations require attention, compassion and indeed test our abilities as physicians. The easier path might be detachment and avoidance, but I believe this is not the best one. Transparency and honestly, apology and continuity of care can be healing for our patients, their families and for us.Trust can and must be attained but it takes effort and attention. When patients come to us for care, they are vulnerable, needy and many times frightened. They are seeking professional, high quality and ‘human caring’. Making them feel comfortable, safe, hopeful and confident with our care, in our care, will begin the trust required for healing.

Even strangers from afar know of you and the aura of your birth, the darkened hope and hue of stormy clouds that shadow streaming light, and know the flawless shards of love disguised in tear drops crying day and night one by one, gleaned tears from loving faces reach towards pinnacles of immortality and makes us all believe that as the paces of heart beats breach life itself, love too ascends, cast heavenly upon rainbows and shooting stars, our gifts to comfort for eternity. And in the longer nights of winters liar, your beauty can be seen by all and in the frozen air where bellowed breaths of hope inspire. Though today it lives, a chrysalis, laced in grief and pain, one day it will awaken when winters\' snows spur springtime rain, and fuse sadder thoughts with memories And distant smiles will bind eternal love with hope and promise, even strangers from afar can find.

Amare Forlorn, with tears And cries, am I. To lose you to your death Without but even gasp or sigh, Save a wisp of Angels breath; The darkest sorrow I have known. Yet, your image burnt in my Soul is my gift, my grace, And always will I see your face Upon the simmer of Placid ponds And in the clouds where Sunbeams hide And raindrops form, And I will speak kind words And write of you And sing in sweet demure, In early morning's dew And in the crown of daffodils Which bloom amidst the storms Swept cross my brow, In every dream In which it seems You come to me. My love forever Do I avow.

Reflections "The body, impotent to maladies; thirsts for harmonies of cure by gentle ways and artful skills to dignify countless souls' infirmed and helpless wills..." (From Nadiyb, 2014. Berman). We seek answers for questions which cannot be answered. We grieve at a time when we should be smiling. A moment in a century of years which has come too soon. Among us, there was no better person. Among us, no better Physician. We cry aloud not just to sound our sadness But to trumpet our love. His missions are now our memories. Indelible in our eternal thoughts. We will always hear His gentle tones of gentle words And feel the caring others knew when they, Frightened and ‘sometimes frail, In desperate need, Alighted from their illness, free Of morbid pain and agony. And if we feel richer today, Amidst a drear of funeral and eulogy, It is because we revere A person we strive to emulate. And thus, through death and legacy We will magnify our goals, To unravel every morsel of our souls, And strive to live as Larry lived. הִרְהוּר The Hebrew word for "Reflection".

Aoide The first song on earth was a child's cry, ageless music of heart-sounds and first breath sighs to immortalize the promise of humankind, and insist our hope… for promised dreams and sanguine visions, for May-time baskets, of floral scents and sights, and smiles upon our faces in the springtime morning’s light, for children when they dream again and cry out golden notes for joys of breaths and heartbeats, to float in silent nights, singing on winds diaphanous, simple passions and delights. for a love that never hides its wonder every day, for frosted tears of winter's cry, succumb to the countenance of promised dreams to be of each child everywhere whose first-breath sigh has sung. Shirah in Hebrew is a song or poem

Martyr for Desire for all children, lost You are my quiet darling. Your eyes, like morning burn The minutes of futility To contrite hours, turn Eastward where begins the dance Of ocean tides, and slumbers still The famine of our grief, to hide So deep within my wounded will. A promise, poisoned from the start So brief without reply or song Did graze your spirit in my field. "Return to me" I cry, I long. As chaos prods my anguish, yet Neglecting fortunes in my soul, Tinted hues of destiny Are tender thoughts which sorrow stole From me when first I heard your voice; Each murmur on your breath that sang Like harps converging as a choir, And chimes afar, with passion, rang. You are my quiet darling Within a cold and flame-less fire, And I, a prism in the shadows; A silent martyr for desire.

When we are ill, vulnerable and in need of care, although our spirits may fade and our viscera may bleed, we are enabled by the agents of our humanity empowered by ancestral song and promise. I intend this program to be a pathway towards healing even when we cannot cure. There remains inexorable suffering which accompanies tribulations not only from inevitable limits of new medical technologies but from pervasive disparities which exist to deny all to have access to and to be recipient of one standard of care; disparities defined by the social determinants of health, limited or no access to care, unconscious bias, lack of advocacy and "avoidance and dismissal rather than involvement and immersion". The works here reflect my career as a physician, an obstetrician, and shares my personal work: my projects, thoughts and poetry which above all enables me to ask why even when we already understand how. Poetry permits me as a Doctor of Medicine, witness to the frailties of our humanity, to abet healing through the very core of what makes us human, our language and our personal emotions. It has been my platform to tell my stories to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man".

My mentor, teacher, colleague and friend, Dr. Nathan Kase, died on July 12, 2025. He was a leader among leaders in Obstetrics and Gynecology. He was honored at the Yale Ob-Gyn Society in 2013, and I wrote a short poem for him which I am sharing today. Sinan The compass or "south-governor" Dedicated to Dr. Nathan Kase, Mentor, Colleague and Friend To find our way when night shines black, And life's work struggles to raise the bar; To create a difference for all on earth, At times, you know, we need a star.
The bar of truths that science lends, To souls and thoughts of certain minds; To genius rare -yet here today, A man whose equal none will find.
A granite pillar holding strong, His vision un-roofs mysteries. And heavens to reach with inquiry, To learn what makes us live and be.
An artist etching intaglio, On canvases of academe. Sustaining us his proteges And our collective, purposed dreams.
A Magnet he for his own ilk, Humanists, ethicists, scientists, scholars; Venerable, formidable, leaders and friends, Who trust, revere, respect and honor.
Yes, when our night shines black with doubt, When all seems hazy, uncertain and grey. Nate remains our enduring compass, With prescient wisdom, illuming our way.

My work with families who experienced the tragic loss of a pregnancy or newborn is founded on a model of care I have practiced throughout my career; the use of language to help the grieving and healing process: words we write, words we read, and words we say and hear to serve as an invaluable source of solace and hope. I believe our words are songs from our hearts: "songs of hope and songs for hope." I have written and continue to write words and thoughts in letters of condolence when my patients, family, friends and colleagues have experienced a pregnancy, newborn or infant loss- or a childhood / adult death-and includes a personalized, original poem which I either send to them and / or read at their memorial services / funerals. I have many years of experience doing this and the responses have been universally positive and "healing". This has enabled me to foster deep and lasting relationships with them. I have been fortunate to have presented this work at local, national, and international meetings and symposiums and it is currently a core element in my lecture series to third-year medical students at the Icahn School of Medicine at Mount Sinai and prior, to the students and house staff at the Yale School of Medicine. A signature feature of this program offers the opportunity: - for families who have experienced these tragic losses to individually request a personalized poem dedicated to their child or their friend's or family member's child. - for Physicians, Nurse-midwives, Nurse Practitioners and / or other Health Professionals to download an appropriate poem and to send to their patients as a personal, empathetic thought when their patients endure these losses. I believe the impact of words and thoughts at these difficult times of loss are powerful and of universal need. I have written scores of poems but only include at this time first-lines of five poems each written for a particular but universally common reason for loss. Each poem addresses the universality of loss and the promise of hope. When a poem is selected, it is dedicated to and personalized with the child or parent's name and signed by me as the author. It will be suitable for framing or to place in a "memory box" that many families have after their loss. It will be sent to you in PDF format and can be printed or forwarded electronically. It is my hope that by sharing these poems at this very difficult time along with a brief personal note, a healing process can begin even when there is no "cure". This program is available pro bono.

"What grows never grows old." Noah benShea
I am greeted by a softness Of this another day, As my heart collects the Perfumed scents of all my years And at well reveals life"s passions I have dreamed and dream and dream.
Though not alone But with soul astride These years within my flesh and frame Sharing every beat my heart can throw, While gentle breaths unfold Their whispered secrets never told; The scents of youth now freed To call the fervor of the muse, To warm the rains that bathe Some days in sheer delight. Not yet travelling to the mark To where withered petals fall In a dark and ageless night.
To the mark This journey goes alas With my heart besides my soul, And only when what I've loved lies cold, When rains no longer warm And thunders' whine becomes a distant moan Will I like petals in decay Fall to the shadow of the ageless dark And rest, forever, blinded to the pallor Of my then to be vanquished heart.

Desiderium (Latin: an ardent longing)
In this New Year Let us with all our hope For all our days Bare no malice, anger, Prejudice or harm and Promise a wish to extinguish All searing conflagrations Of our fellowman; their plights of war; Their illnesses and their poverty, Their homeless pain and more.
Let us with all our hope Abet others who be sicker or poorer, Ailing from greater oppressions, and Look beyond the facades of hypocrisy And denial and un-roof the truths, For it is here we may find our naked selves; Minds and souls and physical beings of A human birthright: To live above darkened clouds of desolation; To thrive in tranquility absent hatred and denunciation.

For a beloved father Thirsty paths wind about The gravesites in July. Wind gusts arouse the umber earth To clouds of dust. Mourning becomes laborious; Tears spill upon sweat-soaked blouses. A canopy drapes the casket Wedding death to earth to consummate Return. Headstones stand in rows, Grey-granite markers chiseled with Names and numbers: birthdays And death-dates. I hear his voice Amidst the silence That is dreaming, among The voicelessness that is death. I see his image prostrate, his mind, a muted, sightless, labyrinth of thoughts contained within a motionless body ...and me weeping whispered words of love.

The sun staring upon me has stopped for one immeasurable moment, a lone pause in an infinite journey, a slivered chasm in a timeless wandering.
The sun staring upon me has stopped to embrace and welcome me traveler to the borderless boundaries of Eternity.
The sun staring upon me has stopped to comfort; Its light transcends the darkness of despondency, Its warmth melts the icy crust of mourning.
The sun staring upon me has stopped
to deliver
a quarry
of hope out of hopelessness,
tranquility from turmoil...
...and peaceful dreaming
forever.

Let us wish to: retreat from all unjust suffering, banish afflictions, vaporize pain; fashion peaceful harbors and orchards, cultivate gardens, plant trees, harvest grain. dream of lyres' and harps' splendid music, watch beautiful children dance and be gay; never see sadness and crying bear witness, keep illness and sorrow far, far away. abolish the hunger that threatens the fragile, crave for vision and prescient wisdom; nourish each other with love and with kindness, live with bountiful hope and compassion. seek out always life's streaming sunbeams, dissolve each dark cloud in sunlight's way; entwine outstretched hands with one another... ...and turn all tomorrows to halcyon days.

It is now 50 years since I began my residency in Ob-Gyn, a career to which I committed all my energies and emotions, sympathies and empathies. I would do it again the same way and always encourage it as a career choice to my students. I believe it is only the tasks we learn and do that become mundane- as they should. These tasks represent our diagnostic and treatment and / or surgical skills. In my opinion, we must cherish and fulfill the true privilege it is to be a physician and this privilege must never be taken for granted or considered mundane. We must be emotionally and empathetically present for each individual patient that we metaphorically "stand before" (the Latin root of the word obstetrics is Obstare which means to stand before). We must do this to uphold the tenets of trust inherent in the doctor-patient relationship and the aforementioned privilege which we have inherited from our physician-ancestors. In this way, we can best promote caring and healing especially when our patients are incurable, or their children are stillborn or die. No doubt this is not easy, but I believe, imperative.

I believe the care of a patient whose baby has died tests the very core of our "oath" and incorporates all that is vital in the role of a physician. Becoming involved and taking time from our busy day to provide care to a patient in need will self-serve not only our own need to assuage our inherent feelings of what our limitations as physicians are, but moreover, let our patients know they can rely on us for sensitive, compassionate, and humanistic care, and that we will not abandon them at their most vulnerable moment.

Prociedo
Going forward (l)
Today are times of great hope To affirm our oath As unfiltered reason and purpose Rush in our blood Every pulse a wave Approaching distant shores To leave our prejudice behind To fade into vapors As common as fog And guide us to plant Roots to bond our humanhood and Vines to grow our brotherhood As we go forth into tomorrow.

Anuraga
Love insists our hope Hidden in winter's facade. The arduousness of these days Crave creative wonder To seek the shining of Next year's springtime. Longing, when our reverence and friendships, Like the very soul of art, Will enjoin; never to be lost or diminished As seasons themselves Endure in cascading timelessness To unveil wonders and Gifts of tomorrow.