A Request

This is a "very special episode" in which things take a turn for the serious. Just so you know.

It seems like this was one of those weekends where the universe got jammed up and too many people got bad news. I'd like to discuss one of these situations in particular and then a few generalities that have been on my mind while I wrestle with how to best support people (of varying degrees of closeness to us) through challenging times.

If you have a moment today, I'd like to request that you send up some good thoughts for friends of ours who found out on Friday that they're having identical twin girls. In the same appointment, the girls were also diagnosed with Twin-to-Twin Transfusion Syndrome (TTTS). Essentially, there is an error in the blood flow between twins: one ends up with too much blood and amniotic fluid, and the other ends up with not enough. This causes serious problems for both babies.

The Specifics:

• TTTS occurs in about 10%-20% of monochorionic pregnancies (those in which multiple babies share one placenta, as in the case of identical twins).
• In the absence of intervention, 90%-100% of babies with TTTS die of heart failure in utero. 
• This couple is currently en route to Miami to consult with one of the nation's experts in TTTS. They will learn whether they are candidates for a relatively new surgical procedure in which an endoscope is used to identify the malfunctioning blood vessels, which are then sealed off with lasers. 
• When this surgery is performed, a few outcomes are possible. Sometimes, both babies die. Often, one twin survives and one does not. It is also possible that both twins survive and the pregnancy continues under higher supervision until delivery. In this case, there is actually a relatively low risk of long-term problems as the babies have a chance to even out developmentally the longer they stay in the womb. 
• The bottom line is that there is a very real possibility that our friends will lose one or both of their baby girls. I don't think I need to explain the difficulty inherent in this for them, their families, and close friends. It also leaves me wondering how they'll want or need to interact with us (or not) in the coming weeks, given that we're at exactly the same point in pregnancy and had been walking the road together. I think that will take sensitivity and awareness on our part. It's also given rise to some more general thoughts...

The General:

• Strong emotions, especially negative ones, are difficult for me. I would prefer to avoid them rather than confront them. I think this is true for a lot of people, but it's something that I try to be aware of when it's a situation that means someone else is in need. So I'm often left wondering what to do or say to people who are facing difficult circumstances. Too often, I think people who do not know what to say end up saying nothing at all. This has the unintended effect of making the bereaved feel neglected or forgotten. So I have come to the conclusion that I believe it is best to say something--the best you can come up with--rather than to say nothing at all. This is particularly true when it is most difficult to do so. I sent an email to the twin mommy, and after I sent it, I panicked that it was clumsy or not the right thing to say. But both she and her husband have thanked me, so I'm glad I said it, even if it wasn't the most eloquent thing I'd ever written. 
• All that being said, I do believe there are some general guidelines for things that are more or less helpful for people to hear. Many of the people I have talked to on this topic report being hurt by things that well-meaning people said to them in challenging times. Most of these comments fall into the category of "it was God's plan" or "at least you have [another child/some "silver lining"]...". As I said, the speaker means well and is trying to comfort. But I think people in the fog of grief are frequently not comforted by the complex idea that their loss is part of some plan. That may come with time, but not while emotions are still raw. I think that a simple, but genuine, "please know that I am thinking about you" covers all the bases. I try to start from there. Also, sending flowers is almost always right.
• One of the most basic human reactions is to help someone in need. Very often, this takes the form of a statement such as "please let me know if there is anything I can do." I have said this often, and I always mean it. However, over time, I have come to realize that, in a way, this places an additional burden on the bereaved. There's probably a lot that they need. But they aren't going to be able to identify it in a lot of cases, and if they do, I bet they won't call to let someone know. I try to identify a specific need and offer that--bringing a meal, watching a pet, getting the mail, picking someone up from the airport, etc. I offered to send someone over to mow the lawn while the aforementioned couple is in Miami this week, because they happened to mention it needed to get done. Yes, that is weird and random, but they can either accept it or not and I've tried to avoid burdening them with the task of letting me know what I can do. 
• These are just my thoughts on the general evolution of trying to become a more decent and thoughtful person. I know that many of you--who have experienced challenges and loss in a different way than I have--might have much to contribute or critique. Feel free to comment. In the meantime, take some time to appreciate the little things just as they are today--because it can all change in an instant.