Grief: Day 731

On the second anniversary of my father’s death I am ten weeks pregnant. Last night I dreamt that the baby was born, not in the hospital we have planned but rather a bougie one two hours north by the sea, with a window looking out at the water and a chic gray and midnight-blue color scheme. I labored quickly and easily, feeling soreness but barely any pain. I didn’t need any stitches, and our baby latched right away. She was beautiful with clear bright eyes and she met my gaze without hesitation.

Three months ago, on the other hand, I sat at the edge of the water outside the hospital on a cold sunny day thinking of my father together with a new baby in the wings of the stage of life. I cried a lot of tears then, thinking that this comfort – this idea that my father would meet our child after all – was grasped for desperately; but also asking that he not to wait too long in sending us our child. I cried harder knowing that we’d have to wait, feeling strongly that the universe could do all sorts of things to you, and that making us wait for this child was exactly the kind of thing it would. It felt inevitable.

Since two years ago, it’s felt so sure to me that the universe – having been so unbalanced – would only have tragedy in store for us now. Because my father, a man of great magnitude and importance, was gone, the cosmos was essentially and irreparably misshaped, its axis tilted suddenly.

Three months ago, I wept for a long time on a bench at the water and imagined my father’s amorphous soul-person leaning down to whisper wisdom into the ear of our child’s inchoate soul-person. I thought of the time that had passed since I’d seen my father, and the time that would pass still until I’d meet our child, and the former was growing ever longer into the past and while the latter felt like it must be an eternity into the future – years, probably. Maybe never. I was feeling pretty pessimistic, and convinced.

When I texted my mother about my thoughts she agreed this meeting of soul-people must be happening in some part of the cosmos – “Of course he’d be there. He loves babies.” I asked her what she thought Dad must be saying to our baby, and we agreed: “That it’s all about love. And donuts.”

It is all about love. It’s something that I think was important to my dad as his life went on, that he learned in a multitude of ways and tried to teach us.

And it all being about love is the whole essence of grief. Love of my father belies the swollen bitterness that took me over for so long, that darkened my gaze and convinced me I’d be barren and shielded my eyes from joy and optimism for all this time. It’s also behind the feelings that are coming after.

Because today, I am pregnant with a child that I imagine will enter this world with my father’s words in its ears, conceived only weeks after that sunny day crying on the bench. I woke up today with the image of a beautiful baby gazing up at me, and feeling strongly that this was a message sent from my father, that he wanted to say we’d be alright, that she was a gift from him and so he’ll see that things go smoothly.

These things, of course, require quite a bit of cosmic imagination, and imagination is maybe the label we should apply. Ultimately what they reflect, though, is a shift in perspective in myself. A burgeoning belief that maybe things aren’t determined to be so bad – that, perhaps, the universe is righting itself.

 me and my father, c.1992

me and my father, c.1992

Here's What Happened To Me This Year

In February something very bad happened in the world, which is that my father died.
It broke my rib, the sudden force of my sadness shattering and then settling into that sharp pain which lasted for weeks. I was numb to everything else in that period. I barely breathed, the pain stretching long fingers to my throat and chest wall and tethering them still. Even my anxiety went away, washed out by that heat at my side. My carefully cultivated optimism cracked with that rib and in seeped the idea that there was no being okay after all, that there were things that you don’t recover from in the end. My father was a great, great man, one of true magnitude. You don’t get over that.

Eventually my rib started to heal itself. By April I could move again without wincing. Instead I became bathed in fear like an electric current. By the time anxiety returned it had sensitized all my nerve endings so that anytime anyone I loved got in a car I felt the sting of panic.

When the world around you feels as if it’s made up of knives, the stuff of the atmosphere itself sharp and cutting like razors, then a person tends to contract. That’s what happened to me. Sadness was a big, growing, sopping mess at my center and it was heavier every day.

When I started my intern year in July I knew I would have to find some way to survive. Sadness was that mess at my center and fear was an electric rash that was opening up new raw places every minute. It’s so hard to walk around like that. I put my head down and braced myself for the year ahead with the wounds I had. I worried I was getting smaller.

New people I met saw me as permeated by rage, I think they characterized me by it – frothed up into flaming rants at the least provocation. But even then I felt broken, like a skipping record, like a wrung-out rag trying not to mildew. Rage was a reflex that spewed forth from something more difficult to characterize but that surely saw its origins in that deep well of mourning in me. October turned over. I sunk deep below the surface of hard times.

Bitterness is a hardening and a contraction. The dense, buzzing cloud comprising my father’s death, medicine, the pressures of being a new doctor, my own hard unforgiving nature, all the darkness I have to face, my isolation – I realized this month that it’s getting to me. I am not cloudstuff tossing out my limbs for human contact but the bitter pit of a bruised peach with its flesh torn away – hard, the only touch that can mark it a scratch.

Halfway through December, on the plane back to Seattle from a visit home to Chicago I think that bitter pit broke open and I found myself left drenched in the evidence of my own desperation. It took me a while to get to sleep with sob-swollen eyelids. I resolved to face the world with better optimism, but the next morning I was met with the greatest hits of medicine's litany of horrors as we rushed an otherwise well patient to emergency surgery, and optimism flitted away.

Here’s what happened to me this year: Bitterness was all around me, gushing, and so I painted my sore skin with it. Layers and layers of that tar. I’m trying now to peel it back to walk around abraded. I’ll have to find some other balm. But sometimes you show the universe your cracked-open self and someone fails to catch the debris and you have another opportunity to get worse again. Tacking that rising tide of bitterness on raw skin is a reflex that’s hard to suppress.


Starting intern year in the same year someone important to you dies is hard. You are faced with the world's most awe-inspiring tragedies while you're grappling with the idea that the universe sometimes takes vital things away and then goes on barreling forward anyway. And I’m a stubborn, heartbroken dreamer that assigns greater cosmic significance to myself and everything – which I see as a prerequisite to my vocation and one of my greatest strengths, but which is also hurting me. I’m a narcissistic mystic who can’t cope with a universe that goes on okay in my father’s absence and so this one must not be.

I need to let go of my broken thought processes, but I don’t want to – it’s too compromising, it’s odious to me. Truly moving forward feels like a latch blowing open on sadness, allowing it to disperse all through me. Isn’t it poison? But I see that I have to try now. My stubbornness is turning me into a worse person, a worse doctor. I can’t shield myself with bitterness anymore, and so I’ll have to find some other balm. (The balm is joy. Joy and hope.)

But the world hasn’t seemed such a hopeful place anymore. I’ve wanted to find a way back. And then I haven’t, because sometimes mourning feels like having the truth scraped across your eyes. It’s hard to remember that that is an act of obfuscation, not revelation. The biggest strength is in finding hope despite hardship.

At a NYE party I regretted committing to I found joy and laughter in an imperfect place with imperfect people in a formulation of the universe I would never design. I thought hard on the fact that you have to take people as they are and try to inspire the best in each other. Nothing is gonna be what you would have chosen. But you have to be able to feel the joy with the sadness. See that they exist because of each other. Grief comes from love and there is no love without the glinting threat of grief on the horizon.

I invited people to bring their baggage, their grief, their dashed hopes and wild losses of 2016 to the party. We got the fireplace running and each of us threw the lot of it in to burn as the night went on, so it all could meet some form of cosmic reconstitution.

So in our little gas fire I burned bitterness. I wrote it down on an index card with a hand made furious by desperation and champagne, and I tossed it in the fire. And then again. And again, with fear. And I burned them all again the next day, and the next, and the next, and today. And I think I’ll have to continue, every day for the rest of my life. Burning them away.

Grief: Day 269 -- Fear Laps At Me

Today was my first day back after another precious vacation week. I went home to Austin, the first time since February, and it was the center of that bitter buzzing in my ear.

I think everyone in my family is melted into their elemental pieces and trying to put themselves back together – but of course in the meantime some of us are held hostage as everyone else’s container lest they leak away, dripping through loose floorboards.

I visited my father’s grave, the tombstone now in place and reading “Ubi caritas et amor, Deus ibi est”, and I felt that all I could taste was bitterness, all I could see over my father’s grave was bitter dirt, all I could remember from those weeks in February was a great mountain of bitterness given that life had done to us what it had. In reality there was bittersweet, there was grief as rooted in a foundation of love (as an inevitable part of it); but I didn’t remember that, only bitterness.

Lumberjack and I flew back to Seattle on Thursday. Saturday we were meant to go out and explore a park or something. But early in the morning I turned to see the window assaulted with rain and it struck a flame of fear into me. I slept for several more hours. I can sleep and sleep and sleep this year. I get so little good sleep when I’m working but even when I’m not I sleep for 11 hours at a time, which I’ve never consistently been able to do before.

Instead of going out we sat on the couch and read and watched TV all day. I think the cats were pleased. We skyped with Lumberjack’s parents and they told us about a car accident his father was in – he’s fine but the car was totaled.

When we finally left for dinner my fear gained remarkable substance in the ballooning quiet of this city the non-city, in the sirens that landed across the street, in the terrible lighting on the bus, in the scrubbed silent streets in the neighborhood of the restaurant. It’s still so weird to me that I can feel so uncomfortable, so creeped out, outside in a city, on a bus, etc. How different it is from the city I know. What a warm blanket familiarity makes.

Yesterday morning I drove Lumberjack to the airport again and I am realizing that fear laps at me. When Lumberjack’s parents told us of that harmless car accident I see it as a lucky near-miss, further evidence the universe waits around the corner to hurl further damage and destruction and despair at us. I worry that every time I let Lumberjack leave my side I am tempting fate to make it the last time I get to see him (even writing that I have to knock on wood). And so the current life, in which nothing I live is really real because I’m away from my partner, which brings a whole new level both of exhaustion and responsibility, which took so much from me and expects such an unprecedented amount, which precludes joy and fullness – in this life, I also must spend precious energy quashing interminable sparks of neon fear. And the cycle keeps on turning at an increasing rate, a steady acceleration. A year ago today I posted an instagram a photo of the Christmas lights on a tree downtown (I spend so many moments going back through my instagram pictures, gazing greedily on that Before Time), which filled me with so much joy. Here I ride past a small lake on my bike and realize that at that speed the water reminds me of water I know, frames-per-minute slowed, a suspended animation. It makes something flicker alive in me that I recognize when I look at that picture of the lights a year ago. Everything here is almost entirely too insipid. Perhaps I will adapt.

Grief: Day 183

I've just passed the six month mark since my dad died. Six months since getting that phone call. Six months since the cosmos was acutely destabilized by his leaving.

And I say that as if I mean it figuratively but in reality the way a vice tightens around my chest even still makes me believe some thread connects my dad to the rest of the universe’s pace tromping forward, a knot tied on that day six months ago whose frayed threads tug at various places along these new present moments causing them to hunch forward with the weight of his vacancy. What I mean is that it still hurts. What I mean is that it’s not right. Everything I encounter seems like further evidence that all is off-kilter.

The vice has been tightening around my chest for six months and each time I bleed and bleed until I turn myself to something desiccated and brittle, my dad’s favorite shortbread crumbling. When Lumberjack visited we poured our hearts into a common vessel where I felt safe to bleed again and he said words that filled me back up just to leak.

Alone again yesterday, I went to work desiccated and brittle. I had an experience with a patient with spinal trauma, which is a particular challenge for me given my dad's injury. After that day I brought my desiccated and brittle self home, where I could reflect on the way the universe’s axis has been tilted since my dad left, leaving all of us stumbling around off balance because some other version of earth’s magnets pull us the wrong way. I thought of the lake we visited this weekend and wondered if my dad had been there, years ago. I strained my ears to hear his voice through these threads that tighten around my chest and fray off that knot tied six months ago.

Grief: Dark Shadows

Every day, at least once, it comes back to this: I’m tired of this being the worst year of my life.

It’s just that all in this world seems so marred by the dark to me lately. Everything so heavy, dark and brooding, thick and bitterly saccharine like molasses. All seems to be pressed on on all sides by something very monstrous and diffuse. I can’t seem to think about anything except my patients, whose lives have trailed themselves through such tragedy. The spectre of my father’s death hangs always. I can’t escape sirens, always right outside my window, ambulances in front of me any time I step out the door representing either the weight of expectation on me as a doctor or the burden on this world of new tragedy or both. I always seem to be walking up a hill in this city and even when I’m walking down it’s not buoyant or good – characterized by nothing more than being not-uphill. And negative in its own way, a tumbling. Even when I try to look for the good in this world it feels weak and without power – brought down by the mud its feet are stuck in. And I am unsurprised by each new piece of horror brought to my attention, though still dejected. It seems there are shadows in every corner.

I miss my lake. I miss my husband. I miss soaring on runs and feeling at home. I am so, so tired.

After my first call shift, which was terrible and similarly filled with horrors and harbingers, I slept for the most restful four hours in weeks. When I woke I felt fugued, feeling briefly like I had pulled myself up through the dark clouds by a great force of will and obstinance, a gasp of fresh sunshine on my face, a muscle-up through the muck. I looked around at the bright and beautiful restaurant I had chosen for brunch by myself, where I had been a few weeks earlier with Lumberjack. It was soaked through with sunshine.

But soon the coffee and mimosa started to dig their sharp edges into my belly.

I am mincemeat. I am the raw bloody face of someone punched then pushed across the gravel. I am shaken to broken pieces in my fragile glass innards then set back down with my vessel intact.

I ordered something spiced and biting but wished for that warm melting I had had with my husband sitting across from me, weeks ago. At the restaurant’s store I browsed the cards section with tears coming to my eyes at the casual relevance of sympathy cards. I wonder if there will ever be a time that those don’t feel like they apply to me. I meticulously sniffed $12 soaps and picked the thing softer and warmer. I carefully chose five stems for a bouquet, pouring myself into the bright and tangy ones, hoping to bring forth again the joy I used to feel from being made of passion and fury. A dahlia, a dark daisy. Two peppered support stems and a single pure white tapering one to make me feel like I could bear holding onto this vision of myself – intensity – which lately feels dark and frightening and unstable.

I feel rattled like I’ve been other times I’ve been on inpatient psych but I don’t remember how I put myself back together before. Then I had Lumberjack by my side, listening with an open face as I got home every day, holding me on our couch. Then I had runs on the lake. Then I had a father.

Everything feels so different now.

I don’t know that I see the way out now. But I will try to paint myself with sunshine. I think the way out now will be a different way.

Grief: The Universe Takes

My last name has started to feel swollen in my mouth. It’s one of the most important gifts given to me by my father and now it makes my tongue feel like cotton. I’m choking myself on it. I’m worried it, too, will be taken away from me. Is that what this is, this swelling of the second syllable behind my teeth? Is that this malicious universe’s doing, turning something precious rotten inside me?

Grief: Triggers

Cervical trauma is triggering and the Cubs are triggering.

Cervical trauma, of course, comes up often on this radiology rotation. More than one lecture, lots of films that look like my dad’s did, classmates saying things like “cervical trauma is so fun!” – etc. When it happens my brainstem reacts first. Somewhere behind my xiphoid process a knotting, gnawing discomfort starts. Then the chills: every 20-30 seconds, my hair stands on end, all up and down my arms and legs the sensations prickle. Of course I know I will be triggered whenever the subject comes up, but it’s not until a minute or two later that the cerebral sensations kick in: something recognizable as sad, as vulnerable. I look around hoping nobody can tell I’m upset, and also looking for someone to fight.

Ultimately, I feel breached. Grief is an egg cracked over my head and running down my spine.

The Cubs are predicted to have a shot at winning this year. My family is a Cubs family, and my dad was especially a fan. Last year they did really well and we thought maybe the curse was broken, but I really can’t muster any interest in sports, and I kept up my jokes about how I couldn’t care less. This year for the first time I’d like to have a Cubs hat or shirt to wear. They’re predicted to have a shot at winning, and that’s the saddest thing in the world to me, but I also hope they do. If they do, though, I’ll fall apart. My mom sees it as evidence of the afterlife – “There’s no way your father would miss this.”

Ultimately, I feel betrayed. Grief is a water balloon popping in my chest and widening my mediastinum.

Grief: A Case Study

Day 1: After I get off the phone, two parts of me diverge in some way. One part sees clearly, even identifies the things it predicts will cause me regret and anguish, remembers to pack an extra skirt in black in case my little sister doesn’t have one, starts planning for how best to take care of my family. The path seems laid out before me: “These are the steps to grief,” this version of me says. “They will be hard but once you take them you will be okay.” I buy tickets to Austin, and make a to-do list: Email your rotation coordinator. Arrange for someone to take care of the cats. Pack the shirt Dad gave you for Christmas, the last time you saw him (will ever see him).

But the other part of me slips herself in, always unexpectedly, at least every half an hour, and cries until my eyes are sore. (Samuel Beckett's words enter my thoughts: I can’t go on, I’ll go on.)

Day 2: On the way to picking up my little brother at the airport I talk to my husband about platitudes in grief. I had always wondered whether my metaphysical agnosticism would collapse in the face of irrevocable loss, but here it is staunch, and chafing at statements that plaster meaning over tragedy, that try to say that this thing that happened wasn’t entirely, completely, wholly wrong. Anger prickles at the back of my throat.

Every time I sob it launches me into a coughing fit. Lumberjack starts to store cough drops in his pocket.

Day 3: The rage is overwhelming, and I don’t know where it’s coming from, shifting in and out from hour to hour. I’m mad at everyone. I’m worried they won’t honor him well enough. I become possessive of my grief, thinking there must be some right way to do it so that I can rectify the anguish I feel for not telling my Dad a million times more often how much I loved him while he was still here to hear it.

I snap at my sister, then Lumberjack, and then I hide away, hating myself. In my Dad’s office I scan in dozens of pictures of him, and tears slip out of my eyes for hours straight. I’m careful not to let them touch the pictures. I suck on cough drops for dinner.

Day 4: In the morning in my Dad’s office I experience a meta-mourning, because the path I thought I saw forward is obliterated, and it hurts that I’ve lost the grief I thought I’d have. I tell Lumberjack I expected to be good at this. I apologize over and over that my grief makes me ugly and mean. He holds me but I can’t see a way out anymore. It hurts to breathe. (I can’t go on.)

Day 5: (I’ll go on.) At the visitation my mother sobs while she says, “It’s not really him. He’s not here anymore.” When I see him the same tears I’ve cried all this week come, but I’m mad at the edema that made his hands not his, at the funeral home that made his face not his, at my medical education that reminds me his ribs and sternum are broken, his heart beaten: not his. It truly isn’t him. I thought seeing him would help me believe he was gone, so that I’d be spared over and over the stab of re-remembering.

I stand in front of everyone and say imperfect words about my father that are wrenching. When I’m almost through I let myself look up and see that everyone is crying. I feel some of the anger leak away. And I let myself hope that my dad really is somewhere where he can hear how much I miss him, how I feel the space of his magnitude.

Day 6: I watch my brothers, my father’s sons, carry his casket. I had dreamt that he was here, for us to tell him all the plans for the service. In the waking life I re-remember again. My brothers all cry. Lumberjack hands me a cough drop. There’s a twinge at my side as I watch two sailors fold a flag meticulously.

All of my father’s beautiful, huge family together makes me feel he’d be proud, but in the evening it starts to peel off again, into cars and planes. The twinge deepens.

Day 7: I step on a scale and realize I’ve lost ten pounds. “Consolation prize,” I think to myself before I realize I’m wasting away with nothing else to think about besides grief. I slip into a familiar place where sadness doesn’t show in my face, and eat enough pizza for dinner.

Day 8: I wake up at 6am to the pain in my side stabbing now, localized and tender to palpation. My medical knowledge says I’ve coughed so hard I fractured a rib. Still I wonder if it’s my grief transmuted.

But I rate the pain at a 7 or 8 out of 10 and I know that’s certainly not enough.

I can’t go on. I’ll go on.

Books I hope you read: When Breath Becomes Air

When Breath Becomes Air, by Paul Kalanithi

Whether we like it or not, and whether we are aware of it or not, when we decide to become doctors we choose to ask the problem of death into our lives more bodily, more substantially, than most people. Paul Kalanithi took that to the extreme when he decided to become a neurosurgeon, and he wrestled with the problem of death – helping to guide patients across the landscape of health and disease which brings us so close to it – just as he wrestled with the problem of human meaning by choosing to become a physician after studying literature. His openness and vulnerability in discussing these problems in his book reflects not just a remarkable wisdom but also a rare and clear-eyed bravery, especially as the problem of death became personal for him.

Dr. Kalanithi talks in several places about the struggle at humanity’s very basis, and then he reinforces this foundational idea throughout the book when he talks about his own struggle. This constant striving really is essential to being human, and it reflects the conflict between life and death that we are all perpetually trapped within, and which he himself must face more readily than most of us ever will.

Living life means a constant balance between grasping and acceptance. We all must find our values – find the right way to spend our lives reaching while facing the knowledge that eventually, at some unknown time, everything we’ve reached will be taken away. Accepting death but knowing that the answer isn’t to stop the struggle – that’s life’s great challenge.

And Dr. Kalanithi faced it, and demonstrated it, beautifully. He takes the reader on our own, heartbreaking version of it. We get to know him, we grow to admire and appreciate him and his life, and this all the time knowing that his days are limited. I think knowing that Dr. Kalanithi died before he could see his book finished, but also having this version in my hands here in front of me, played out that never-ending challenge like Sesame Street teaches you how to tie your shoes.

This book was, ultimately and fundamentally, enough. I wish that Paul Kalanithi could have lived years and years longer to have written many more words for us, and I also accept that he didn’t. I am so grateful to him for baring himself open, for helping me figure out what it means to be a doctor, and for teaching me this really important lesson.