One loss may hide another.

At a railroad crossing at the edge of a Masai village in the heart of Kenya, the late poet Kenneth Koch saw a puzzling sign: "One train may hide another." It turned out to be a warning: Before you cross the tracks, make sure the first train did not block your view of another train coming straight at you. The sign led Koch to ponder its deeper meaning. In his poem "One Train May Hide Another," he describes the many ways in which one event, one emotion, one experience, may hide another, even more profound meaning. I thought of this poem recently after my mother died. This was a sad though not tragic event in my life. But in opening my heart to grief, I found that I was really mourning the loss of my husband's companionship, support, and love. I have lost my life partner, and not to death, which is final, but to a continuous series of reminders of what was and what might have been. It is by any measure a terrible story, and the telling does not get easier with time. In January 1990, we were both in a terrible automobile accident on an icy road about one hundred miles north of New York City. My husband was driving; we were both wearing seatbelts. The car skidded, hit a guard rail, and flipped over and slid down an embankment. Amazingly, I was unhurt. My husband suffered a severe traumatic brain injury. A testament to one of American medicine's major successes, saving the lives of trauma patients, he survived, but with permanent severe disabilities. For the four long months he was in a coma, I read to him, played his favorite music, and showed him family pictures. When he gradually emerged from the coma, his thinking was chaotic. He had to relearn basic words and concepts. His moods alternated between rage and suicidal withdrawal. In the anxious weeks he was in intensive care, I was still a wife. Doctors and nurses informed me of each day's progress or setback and treated me with kindness and concern. When he was no longer in immediate danger of dying, however, I became invisible, only to become visible again when I was expected to be the manager and hands-on provider of his total care. In retrospect I date my rite of passage to the first day of my husband's stay in a rehabilitation facility. A nurse stuck my husband's soiled sweat pants under my nose and said, "Take these away. Laundry is your job." Without knowing it, or understanding the consequences, I had become a family caregiver, a role I continue to play to the best of my ability while longing desperately to be just a wife. My husband's rehabilitation and my anguish were worsened after a medical error caused the eventual amputation of his right forearm. When my husband came out of the coma, he repeatedly asked me to put his wheelchair in front of a mirror. He believed that his lost arm had been placed somewhere else on his body and that I was not showing him where it was. The psychologist at the rehab facility was kind, but the physical therapists wrote off any possibility" of his using a prosthesis or learning to use his left hand. My calls to the doctors who had promised me he would have a full recovery went unanswered. I was on my own, and I Felt, and continue to feel, abandoned by the very system that saved his life. Today Fourteen and a half years later, my husband is essentially quadriplegic, has significant cognitive deficits, and is totally dependent For all his basic needs. Eventually I brought him home from rehab to a new and more accessible apartment and began the daily regimen of managing his care and supervising the home care aides who were essential to move, bathe, dress, and Feed him. Providing him with the best quality of life possible under the circumstances requires an enormous managerial effort, the assistance of strong and patient home care aides, and a lot of money. While the medical side of the health care system sees me as a family caregiver, the financial side sees me as a wife and therefore the bill payer. …