The Mom Whose Husband Died in a Car Wreck When She Was 9 Months Pregnant

Because no two paths to parenthood look the same, “How I Got This Baby” is a series that invites parents to share their stories.

Rebecca’s first marriage ended in a domestic violence incident. She lived in Essex, England, at the time, and the police there sent her and her four children — Lily, 7, and three boys, Jason, 5, Aaron, 3, and Billy, 1 — to a secret location where domestic violence victims could hide from their partners and try to make a new life. The family lived in this women’s refuge for six months, sharing one room with five beds. “The kids thought it was a big adventure.” Rebecca says. Then they moved into social housing — affordable homes subsidized by the U.K. government — until Rebecca could save enough for her own place. She cleaned houses and then worked in a clothing shop. Single motherhood was overwhelming at times, but Rebecca approached it matter-of-factly. “I just did what needed to be done and didn’t think about it much,” she says. As her kids grew up, she told them that their father wasn’t a nice man. “They had a good life, so they didn’t feel the need to ask much about him,” she explains. After a few years, Rebecca started her own floral company creating arrangements for weddings, funerals, and other events. She loved the work and decided that between flowers and her kids, she was content and could happily stay single for the rest of her life.

Rebecca shares the story of her unexpected romance with a man from the other side of the world who also happened to be a single parent of four kids, and the bittersweet birth of their youngest daughter.

On meeting a widower online

My sons were 8, 10, and 12 and had started playing a lot of Army Men Strike, an online game with toy soldiers — like the little green men. The game requires you to join a team and message other team members, who are strangers, so I decided to play with them. My kids soon lost interest, but I wasn’t sleeping much, so I carried on playing and found that most of the other players were adults too. Soon, I’d formed quite a circle of friends with the other people I’d met in the game. We all seemed to be going through something. One was a man named James who lived in Cocoa, Florida, who had just lost his wife. Sometimes, the two of us would break off from the group and have private conversations. James and I spoke a lot about life. He also had four kids — Samantha, Jacob, Nathan, and Leah — and though he was ten years older than me, our kids were pretty much the same age.

He was working from home as a software engineer, homeschooling his kids and struggling with managing it all. His wife had been a teacher, and she was the one who had mainly homeschooled the kids. When she got cancer and passed away the year prior, he took over. He was a very impressive man.

On their relationship blossoming

James and I began regularly texting each other messages that were completely unrelated to the game, which led to phone calls and FaceTimes. The calls got longer and longer. We started writing to each other through email and even regular mail. He sent me little gifts, and I sent him things back.

Soon we were arranging to eat at the same time on FaceTime — so it’d be dinner for me and my kids in England, and it’d be lunch for him and his kids in Florida — and we’d chat and play games. That’s how the kids got introduced. The children became pen pals, sending letters through the mail.

I thought we were just friends. I mean, it got a bit flirtatious, but we just hung out. The kids didn’t find it weird, which I find weird.

After three months, he told me and my friend who also played Army Men Strike: “I’m going to come to England, and I want to meet you.” But later, he said secretly to me: “I’m really coming to see you.” I was happy and nervous, but I didn’t have long to think about it. He would arrive the following week.

On meeting James in person

My friend and I picked him up from the airport. I trusted that James was who he claimed to be, but to be on the safe side, we had my friend’s husband speak to James on the phone before he came, and he knew where we were going to be when we picked him up.

Meeting James at the airport was the most magical moment of my life. He scooped me up in his big arms and whispered how he didn’t think he could ever let me go.

We dropped him off at his hotel, and the next morning, I met him for breakfast. That’s when he told me, “I think I may have fallen in love with you. I had to come here to find out if that was true.” I replied, “I feel the same.”

Then he said, “When we get married …” I cut him off and was like, “I’m not getting married.” Then I paused and thought about it. And I said, “Okay. Yeah.”

He was supposed to stay for a week, but he stayed ten days, and we spent most of them together. We had picnics and walks on the beach and things like that, but I didn’t introduce him to my kids.

Toward the end of his trip, I said to him, “What are we going to do now?” He answered, “I don’t know. We’ll take it slow.” It was July, and he said he would come back early next year and we would figure it out. I was okay with that.

On changing their plan

When James arrived back in Florida, he called me. “I don’t want to wait until next year. Can I get you and the kids tickets to fly here in a couple of weeks?” he asked. We flew to Florida three weeks later, in August 2019.

The night we landed, James took me to the beach, got down on one knee, and proposed. I said, “Yes.”

I was surprised, honestly. Yes, we’d discussed marriage briefly, but I didn’t think we were going to move that quickly. After he proposed, we talked about getting married the following year in England.

The next day, James’s eldest daughter, Samantha, watched the kids, while James, my daughter Lily, and I went to an immigration lawyer to see what steps we would need to take to live together in Florida. “Basically, you need to get married,” the lawyer told us. “Until you’re married, there’s not anything you can do.” James turned to me and asked, “Should we get married now?”

On planning a quickie wedding

I still wanted a proper wedding, but we both agreed that getting married now was a way to get the legal stuff out of the way.

So James found a husband-and-wife team who did seaside weddings. He contacted them and said, “This is crazy, but we are trying to get married within the next two weeks.” They said, “All we have available is today.” We said yes.

I found a florist and grabbed some flowers. I hadn’t packed anything that was suitable for a wedding, but I had a long pink dress, so I put that on. As we drove to the beach, I made a flower crown and did my makeup.

Since Lily had been with us, she came to our wedding, but we didn’t want to tell the other kids yet. It was a bit mad. We needed time to figure out what we were going to do. We asked Lily to keep it a secret for now.

On getting married on the beach

We somehow managed to write our vows right before the ceremony and had a beautiful, private wedding on the beach, 12 hours after our engagement.

It was so hot that after it was done, I said, “Come on, let’s go for a swim.” We dove in the surf, wedding clothes and all. Then we got ice cream, still soaked.

We picked up the other kids and went to a Chinese buffet. The night ended with my 13-year-old son getting stuck in a baby swing at the park. We had to call the fire brigade to cut him out of it.

Two days later, we found out there was a hurricane headed for Florida and we were in the line of it. My flight home had been canceled and we couldn’t get another one for a week, so we decided to drive down to Tampa with the kids and call it our secret honeymoon. We knew we would have to go physically separate ways in a few days, but we got an extra week together, which was a blessing.

On finally moving in together

James and I spent the next few months traveling back and forth to see one another. Even though we were on the other side of the world from each other, we had become close as a family. Both sets of kids said they would be happy with wherever we decided to live.

By October, we had decided that James and his kids would move to England because his kids were homeschooled and his remote job allowed him to transfer offices. James’s daughter Samantha and her new husband were going to stay in the U.S. and move to South Carolina.

James and his family moved overseas in December 2019. We found a house to rent until we figured out where we were going to settle permanently. It was a former senior-living home that was due to be demolished, so we got cheap rent. It wasn’t ideal, but it had enough rooms for all the kids. They still didn’t know each other well enough to share rooms, and we wanted life to be as easy as possible.

Still, the first week of January 2020 was rough. The novelty of the situation had worn off, and the kids started bickering. Thankfully, that phase was short-lived. By March, if you came into the house — and you didn’t listen to the accents — you wouldn’t have known which children were biological siblings.

On getting good news

About a year later, on Mother’s Day of 2021, I didn’t feel well. James said, “Why don’t you take a pregnancy test?” My period wasn’t late, but we stopped and got a test.

At 36, I was pregnant with my fifth child. We had discussed that we’d like one baby between us, but we were relaxed about it and weren’t really trying, so we were really pleased.

I became ill with extreme morning sickness and had to go on an IV drip a few times. The children were starting to worry since James’s kids had seen their mom become sick with cancer. So we booked an early scan to make sure the baby was okay, and then we told the kids I was pregnant at seven weeks. That August, two years after we got married, we finally had the wedding we wanted with family and friends, with a church service and a little party. The rest of the pregnancy went smoothly, and our daughter Daisy was born around Christmas.

On thinking about moving to the United States

Pretty soon after Daisy’s birth, we started talking about moving to America. James had taken a pay cut to move to England. Even though he worked for the same company, he got paid a U.K. wage. Plus, the rent and food costs are lower in the U.S. Financially, it made sense. The kids were up for moving. Lily, who was 19, decided to stay in England because she had a boyfriend and a job. We had no restrictions on where we could live, but I liked the idea of New York in case I needed to get back to England quickly.

On learning she was pregnant again

In June 2023, I walked past the pregnancy-test aisle in the pharmacy in Essex and thought, I’m just going to buy one. I didn’t think anything of it — I didn’t feel sick, and my period wasn’t late. But a couple of days later, on Sunday morning, I realized I actually was late. I took the test and it was positive. The funny thing was, it was Father’s Day.

I told James I was pregnant, followed by “Happy Father’s Day!” Because we had found out I was pregnant with Daisy on Mother’s Day, he thought I was joking. He was so happy when he realized it was real.

I remember him saying, “I hope it’s a girl. I kind of like all the tea parties.” Both of us had really enjoyed raising Daisy — we were more present now that we were older, whereas with our other children, parenting had felt rushed. We both liked having time to enjoy the little moments. James was a brilliant dad, and I’d never had that kind of support before.

This time, we didn’t tell anyone, not even the kids. We kept it a secret because we were in the final stages of planning our move to America and didn’t want to add to their stress. We planned to move in September and thought we’d tell the kids after that. But in the end, our visas were delayed, so we decided to put our Christmas tree up in November and announce it to our family via an ornament on the tree. I was six months along at that point.

On moving to the United States

We moved to New York on a Wednesday — December 13, 2023, to be exact. We checked into a hotel and planned to move into our New Paltz rental two days later. All of our stuff had been shipped over separately and was set to be delivered to our new home. But the next day, we got a call from the landlord, who said he had decided to sell the house and it was no longer available to rent.

It was a very bad time to find a new place. We were in chaos again, which was a running theme of our lives. But we found an Airbnb in the Catskills to rent for a month. We didn’t have any of our Christmas decorations or presents, so we bought a Christmas tree display from Walmart and got the kids board games as presents so that we could play them on Christmas Day. It was a complete mismatch of decorations, but fun. All of the kids were with us except Samantha and her husband. It wasn’t quite the Christmas we wanted, but we were okay with it. I remember thinking, “We’ll make up for it next year.” 

After the holidays, we found a different Airbnb in Richfield Springs. It was a small town in the middle of nowhere, but we needed some semi-permanency since the baby was due soon. The rental was available for five months.

We moved in just after the New Year; the older kids started at their new school the same week.

On the drive that changed everything

The day after we moved, I had an appointment at the hospital an hour and a half drive away. I was almost nine months pregnant at that point and I had developed gestational diabetes, so I was having three appointments a week. There was confusion about my due date. Apparently, how they calculate it in the U.K. is different than in the U.S., so the doctors wanted to keep an eye on me.

The appointment went smoothly, and afterwards, I assumed that James and I would walk to Panera Bread for breakfast like we normally did. But on this day, he walked straight to the car. I thought it was weird, but I didn’t say anything. I just assumed he was tired. I got in the passenger seat and we chatted like usual. We always talked and laughed a lot in the car. It was one of the only places where we didn’t have our kids listening to us. Daisy was with us, but she was 2 years old.

We had been driving for over an hour when I started texting with Lily. I was in the midst of writing a long message when I looked up from my phone and saw that we were crossing the double yellow lines of the two-way highway.

I shouted at James. He didn’t respond. We were heading straight for a tree on the opposite side of the road. I shouted again, and he didn’t respond. Then we hit the tree.

On the moments after the crash

I remember thinking, Okay, I’m not dead yet. I wasn’t getting any response from James or Daisy in the back. I couldn’t move because the car was crushed on top of me. I didn’t think James was dead, but I could see that he wasn’t good.

I grabbed my phone and tried to call 999. Then I remembered, Wait, that’s not the number. I can’t remember the number. Oh my God.

All of a sudden, my phone went black. I couldn’t call anyone. Two tractor trailers drove past. I screamed for help. No one stopped.

I don’t know how much time passed, but eventually someone came to help. They managed to get my door open. I didn’t realize the seat belt was tight around my neck. A man cut it from around my neck and I was bleeding. But I didn’t feel anything.

I was trying to figure out what was happening with Daisy and then I heard her and knew she was okay. Someone was trying to get to her, but the car had locked from the outside, so none of the doors could open other than my door. They couldn’t get to the back seat because of where James was. The tree had hit near the middle of the car, but more on his side, and that had moved James over to my side.

Daisy was calling for her dad. She’s a daddy’s girl. Then she started crying for me. I was trying to talk to her, but I was dragged out of the car. At that point, I knew there was something wrong with me, but I didn’t know what. I didn’t really care either.

I remember this man saying, “The driver’s dead.” And I thought, No, he is not. He’s not dead. He kept saying it over and over. Nothing was coming out of my mouth.

Other people and an ambulance had turned up, and someone started smashing the car window to get Daisy out. I was taken to an ambulance and someone asked me, “Are you pregnant?” I said, “Almost nine months.” They lifted my top up and then they all just looked at each other. One of them said, “There’s no way that baby’s going to live.”

I looked down. My belly was bruised black all the way across and bleeding. My seat belt had been exactly where the baby had been positioned just an hour earlier during my scan.

I remember lying there as they cut my clothes off, and feeling completely numb. All I could hear was, “The driver’s dead.” It was said like it was the most normal thing in the world. But I kept thinking to myself, No.

Someone asked, “What’s your address?” I didn’t know. We’d just moved in. I had also just switched to a U.S. SIM card for my phone, so I didn’t know my phone number. They asked, “Who can we call?” I replied, “I don’t know anyone.” The other children were at school. I remember thinking, I am on my own now. I literally don’t know what to do.

They had taken Daisy into another ambulance. I could hear her crying. That was hard to hear, but at least I knew she was physically okay. They told me that an air ambulance was coming. I kept asking for Daisy. They told me, “You can’t help her. She’s going to a different hospital.”

Two air ambulances arrived. I went in one, and she went in the other.

On arriving at the hospital

In the air ambulance, a medic looked for the baby’s heartbeat and couldn’t find one. It’s a horrible thought, but I was thinking, If James is dead, then at least they’ve got each other. I truly thought the baby was dead. That’s not what I wanted, but that’s what was going on in my head. I didn’t quite believe James was dead, but I also did. It’s hard to explain. I had so many different thoughts. I didn’t even say good-bye to him. I was just dragged away.

At the hospital, I was brought into a room where all these doctors and nurses were waiting. They each focused on a different part of my body and were shouting things at each other. Eventually, someone came in with an ultrasound machine, and it became the quietest room in the world. Everyone just stood there. After two minutes, one of them said, “Oh, the baby’s up here. The baby’s fine!”

The baby had managed to move up to miss the impact of the seat belt. If the baby had been where it was on the scan an hour before, it would’ve been strangled or crushed. But the baby was fine.

Next, they put me onto a contraction monitor and asked, “Are you having contractions?” I told them, “No, I can’t feel anything.” That was because my pelvis was shattered. There was also something wrong with my leg. Basically, most of my left side was in a pretty bad way.

I kept asking where Daisy was, but no one would tell me anything.

A policeman came in while I was being examined and lying there naked. He was almost shouting at me: “Did your husband do this on purpose? Did he try to kill you? Did he kill himself?” That caught me by surprise. I said, “What are you even saying? That’s the most ridiculous thing I’ve ever heard.” He was a horrible, horrible man.

Then he said, “Do you know the status of your husband?” I said, “You don’t need to tell me.” I think I realized I didn’t want to hear it.

Later, a nurse came in in a wheelchair with Daisy on her lap. It was the loveliest thing. She’d been taken to a different hospital, but it was just across the road from my hospital. Daisy was quiet and withdrawn, but they couldn’t find anything wrong with her physically. They were going to keep her overnight to make sure.

Meanwhile, our other children were being looked after by the staff at their school. They’d only been at that school for a couple of days, and yet a few members of the staff were staying overnight at our house to watch them until some of our family could arrive. They were amazing.

On having a C-section

The doctor told me, “We can’t let you deliver the baby naturally. We’re going to give you a C-section.” Then he added, “We can monitor you and have someone in the room at all times if you want to hold off until the date changes so the baby will be born on the 7th rather than the 6th.” “Yes, please,” I said. I didn’t want our child’s birthday to be shared with the anniversary of James’s death.

For the remainder of the night, I watched the minutes click by on a digital clock on my bedside. When it became a new day, a labor and delivery nurse came into my room. She said, “I’m off my shift, but would you like me to be your birthing partner?” I was so thankful. She stayed with me the entire time.

I was awake when the baby was born, but I don’t remember much. It was a girl, and she was perfect. I couldn’t quite believe how she wasn’t hurt. She didn’t even need to go to the NICU. The nurses looked after her since I couldn’t move.

James and I had picked out a boy’s name and a girl’s name. The girl’s name we decided on was Poppy Annabella. I wanted to keep the name that we chose, but with a bit of James, so I named her Poppy Jamie Annabella.

On having pelvic surgery

Because of everything wrong with me, I had to lie flat on my back after the birth. I had to recover from the Cesarean before they could operate on the rest of me. The accident was on Tuesday. Poppy was born on Wednesday, and I laid in the same spot until the following Monday, when I went in for a seven-hour surgery to fix my pelvis.

In the meantime, my friend flew in from England and took over the care of Poppy in the hospital. James’s aunt and uncle had driven up from Pennsylvania, and his mom flew up from Florida. My dad and my stepmom flew from England.

After the surgery, I was finally able to sit up. It was the first time I was able to hold Poppy properly.

My dad came to visit and said, “So many of your friends had been around with food and presents for the kids. I can’t believe you know so many people already.” I said, “I haven’t got any friends. I’ve not met anyone since I’ve been here.”

Then the pastor and another man from the church in Richfield Springs came to visit me in the hospital. James and I had gone to the church one Sunday and stayed after the service for a few minutes to talk to the pastor and a few other people. They’d heard about the accident and made the almost two-hour drive to the hospital and visited me twice a week for the three weeks I was in the hospital.

I’d gone to the library once too. So based on one Sunday at church and one Wednesday at the library, this little village of Richfield Springs banded together to help us. They looked after the kids at home. They brought food, nappies, paper plates, and detergent. They were fantastic people.

On returning to the rental home

When I got home, the Airbnb was filled with stuff that I hadn’t even thought about: a walker, a shower chair, a wheelchair, a commode. I said, “Where did this come from?” My dad told me the pastor had brought them.

I couldn’t believe it. My family was completely amazed. And the people of Richfield Springs continued to look after us pretty much every day.

There was one woman, Mary, who had ten children. She would bring food and send her kids around to clean, fix things, and take Daisy to play in the snow. She was a homeschooler and they lived on a farm, and yet gave me so much of their time.

There was another young woman with seven children under the age of 8. I think she was Mennonite. She would come around with jars of peaches and homemade applesauce, and she filled our freezer with meat. Her husband had died the year before. She would say, “Can I just sit with you?” Sometimes we’d talk; sometimes we didn’t.

I’d never seen anything like it — the kindness of these people. You wouldn’t get that in England. In fact, if the accident had happened in England, people would’ve crossed the road to not talk to me. There were some really special people in that area.

On uncovering why the accident happened and how James died

James was 49 when he passed away. I’ve not read the coroner’s report or anything, because I am not ready. All of that was done while I was in hospital, so I was never told anything. Some days, I want to know; other days, I don’t. I started reading the accident report and his death certificate. I know the cause of death was blunt force injury. The place of death is “side of the street.” To me, that sounds like a cat that’s been hit by a car.

The paperwork is just too much. Eventually, I will read it, but as far as I know, he just passed out. It wasn’t a heart attack. I think if he’d passed out standing up, he would’ve been fine. But he passed out in the car, so he died.

I found out later that we were about 400 meters from our road when we hit the tree, which I didn’t realize because I didn’t know the area. We were close to home, which makes it so much worse.

On her long recovery

After a couple of weeks, my dad left, and then my mom and Lily came. They were a big help, along with all the children. It was hard to move. I would sit on a chair in the living room with an ottoman next to me, and we put a basket on top to put the baby in so I could reach her. But I couldn’t lift her up. That was difficult. I did a lot of sitting in one spot.

Now, if I’m downstairs, I can push her around in a small stroller from room to room. But if Poppy is crying in the night, I have to call one of the children to get her out of the crib. My injuries have made parenting difficult.

I remember giving Poppy her first bath at 10 weeks old. It wasn’t technically her first bath, but it was the first bath I’d managed to give her. That was really special, but it was sad. Because it shouldn’t be like this.

On how the kids are dealing with the loss of James

Watching your kids suffer and not being able to do anything about it is indescribable.

I’ve been doing a lot of reminiscing with the older children, and there have been sad moments talking about missed opportunities and things they wished they had said to their dad. Teenagers don’t like to show much emotion, though I don’t doubt that they went back to their rooms and cried. But they also wanted to carry on with school and returned quickly. I think they needed the routine. I was always amazed at the kids. I noticed that they became more helpful when they weren’t particularly helpful before. I think they wanted to take on some part of their father. He was a good person, and they each wanted to be a good person too, maybe more so than before.

James’s children don’t like to talk to me about losing both their parents in a relatively short amount of time. They do see counselors, so that could be something they talk about with them.

Daisy was not her usual self after the accident. She was very clingy and dealing with separation anxiety. She was shaken by being taken in an air ambulance to the hospital alone. Who knows what went through her head.

In the beginning, I would watch Daisy stand by the garage door every day,  calling for her dad. She still asks me every day when he’s coming home. Sometimes, she tells me he’s at work, which is funny because he worked from home.

We talk about him, but Daisy doesn’t understand. She gets angry with him. She went through a stage of pushing all his photos over because she just thinks he’s gone.

James had asked my daughter Lily if he could adopt her, and she agreed. But it never happened. Lily struggles with that and with the fact that she wasn’t in America with us. She says things like, “If I was there, maybe it would’ve been different because he wouldn’t have been so tired.”

On living with raw grief

It’s like waiting to wake up from a bad dream. I question everything. How did this happen? Why did it happen? Was there something I could have done? Was he under too much stress? Was he too worried about me because I was stressed? Did I have time to grab the steering wheel? These things go through my head daily.

This is my big one at the moment: Would this have still happened if we had stayed in England? When we lived there, I always drove because he worked or took calls in the car. So if I had been driving, then it would be me that’s dead.

I think about our last Christmas and how we said we’ll make up for it next year. That rings in my ears constantly.

I spent the first six months numb and in shock. Now that’s wearing off, but I actually don’t believe he’s dead. I really struggle with this. But that’s a whole other story. Obviously, I know he’s dead, but I still talk to him.

I’m glad we did it all fast. We got as much time as we possibly could together: married for four and a half years. We could have messed around for ages, trying to decide what to do. But we did it all straightaway, and that gave us the most time.

I look at Poppy and think, How could he have not met her? I like to think that in the between time — before she was born and after he died — that they connected somewhere. I was a very black-and-white person before all this, but now my mind has opened up. I find myself saying things I would’ve rolled my eyes at. I guess when that’s all you’ve got, you hold onto things. There’s no way he would’ve left this world without me and the kids. Well, that’s what I believe. I have all these funny thoughts like that. That’s all I’ve got left.

On her life with the kids today

At first, I wanted to go back to England straightaway. Then I wanted to stay. I left it up to the kids, who felt we needed to be near family in the U.K. We were also in a temporary Airbnb and my visa status was complicated. I was in America as a wife, but I’m no longer a wife.

I waited until the doctors told me I was fit to fly. Then all of us, except for James’s son, who’s in college in the U.S., returned to England. Samantha also stayed in South Carolina with her husband, but said she hoped to eventually come to England.

A couple of months after we moved, a legal complication arose regarding the custody of James’s younger children. And so James’s children had to return to the U.S. They are living with James’s mother in America now. I want them to live with me. They want to live with me, and James’s older children want the younger ones to live with me. We are currently working through the legal issues.

Physically, I’m not the same as I was before the accident. Even now, someone else has to carry Poppy down the stairs. My mobility is not fantastic, but it has improved. The main issue is my leg; it just gives way. Everything’s hard work.

Poppy keeps saying “Dad.” I will say, “Mama,” and she says, “Dad, Dad, Dad,” and then she laughs. Which is exactly what Daisy used to do. Whenever I would say “Mama” to her, James would go, “Say ‘Dad.’” And she would always say “Dad” and laugh.

We are currently staying with my father. I’m having a florist’s studio built in England, so I can carry on with the business next year. We need to decide what we’re going to do next, I guess. We’re starting a new life that we don’t really want. Everyone says you’re not moving on, you’re moving forward. But I don’t feel like I’m moving forward. I feel stuck somewhere. If it weren’t for the kids, I don’t know if I would’ve gotten out of bed after the accident. With the physical pain and the emotional pain, it’s just too much.

But I don’t have the option to not carry on with life. I’ve got lots of kids to look after. They’re missing out on a really good dad. So I need to make up for that.

The names of all subjects have been changed to protect their identities.