It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look.

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered and his jeans have patches. The lunch box is empty, but no one around him knows that. His is quiet and withdrawn. He doesn’t play with the other children. He is much too thin. He will grow up to be a successful businessman, and buy his mother a house. His children will not have to live like he has.

The girls sitting across the aisle from William are Suzette and Lisa. They like to sit in the front so they can rush off the bus when they get to school. Suzette is known as the school gossip. If something is going on, she already knows about it. She will grow up to be an advice columnist for a local newspaper. Lisa’s path is a little bit different. She will succumb to the allure of drugs and get pregnant at an early age. After the birth of her child, she will change her life. She will never go to college or see herself as a success. But she will bring up a confident young daughter.

Behind the two girls are Terence and his best friend, Paul. Terence will grow up the class bully. He eventually will be arrested for armed robbery and during prison will find religion. After serving his sentence, he will work to help released inmates reintegrate into society. He will change many lives. Paul will be known as the boy who never took any chances or risks, afraid of his own shadow. Until the day, at the age of thirty-five, he rushes into a burning building and saves three children before he collapses and dies.

Sarah screams across the aisle at Terence, and tells him to stop bullying Paul. She knows in her heart that one day she will find Mr. Right, and settle down and have five children. Seems a bit premature for an eight-year-old, but that is exactly what she does.

So many faces you could see if you were riding on that bus. Each with a unique story and future. But the point here is not the children, but to take a closer look at the man sitting up front driving. He is a beautiful and courageous man, and he is dead.

***

The call from the cardiologist surprised me. She was in the ICU visiting a mutual patient after a routine bypass surgery. The surgery had gone well without complications. I could hear the concern in her voice as she asked me what to do. She had been talking to our patient when he suddenly had a seizure. I told her to give him five milligrams of diazepam, start a Dilantin drip, and get a stat head CT. After calling neurology, we both waited with trepidation.

“By the way, is his wife there?”

I remembered that he had come to my office at the urging of his spouse. Like so many males in their fifties, he started the visit by telling me he didn’t like doctors. Being healthy, he didn’t feel the need. But he recently started having twinges of chest pain while on the school bus. After a month of suffering he finally was persuaded to be evaluated.

His testing showed coronary artery disease and he was sent to a cardiologist. She recommended the cardiac catheterization that showed extensive blockages in multiple coronary arteries. He was scheduled for a bypass surgery.

***

The call from the radiologist confirmed our fears. There was a large tumor in the anterior portion of his brain that had bled during bypass surgery. It was a benign tumor and could be removed. None of us had known it was there. The telltale symptoms were absent: no headache, no visual problems, no signs on physical exam. It was just bad luck.

The neurosurgeons were antsy about taking him to surgery right away. It was Saturday morning and the blood thinner used in the bypass was still present. Furthermore, this would be a complex procedure and they felt it would be better to schedule for Monday. So he rested in the ICU and waited.

On Sunday night he started to feel mildly nauseous. He sat up to call the nurse and said quietly,

”Something is wrong.”

He then collapsed back on the bed and died. Likely the bleeding in his brain had restarted. The increased pressure and swelling then caused the brain to herniate. CPR was performed for thirty minutes to no avail. His wife and daughter were called at home and notified.

***

The next two years were a blur. There had been multiple visits with his wife. We had met with the cardiac surgeon to discuss what had happened. There were tears and more tears. I felt a pang in my chest with every visit. I watched as depression took hold. We discussed medications which she decided against. We discussed therapy which she attended. The birth of her daughter’s baby, her first grandchild, was bittersweet.

When she strolled into my office today, however, I knew immediately that something had changed. I could see it in the way she walked, her facial expressions, the way she talked. She had stepped away from the sadness and started to live again. We exchanged polite conversation for a few minutes and then I gently asked her what had changed.

Since her husband’s death she had been focusing on loss, focusing on tragedy. She was mourning a life that was taken away far too early. After the birth of her daughter’s child her perspective changed. Her husband, she explained, was a bus driver for a local school district. Everyday he drove countless young children. He loved his job and he loved the kids.

She figured that he had two ticking time bombs: One in his brain and one in his heart. Each of them could have instantly caused death while he was driving the bus, not only taking his life, but the lives of all those children.

She told me that now instead of morning his death, she celebrates all the beautiful lives that were saved the day he died quietly in the ICU. When she feels sad, she calls her daughter and they make up stories of what would become of those precious children.

You see …

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered and his jeans have patches on them. The lunch box is empty but no one around him knows that.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.