On dying, loss, and medical school. A bit of candor

One autumn morning, two men came to take my mother away. A few hours earlier our hospice nurse had come to the house to change her clothes, brush her hair, and put on sandals my sisters picked out. Silently and ceremoniously the men lifted her off a hospital bed in my old bedroom and put her on a stretcher. As they made their way down the front porch steps, in a moment of dark and much-needed humor, we made a joke about her sliding off the stretcher on accident. And she was gone. A few days later, I went back to school, my family back to work, and life continued. In a strange, lopsided world without the person who had been its center, we looked to celebrating her and soaking silently in our grief as best we could.

I learned a lot in my first 18 months of medical school. Like everyone else, I stretched my capacity for knowledge and stress. I made friends, and lost a couple too. I also learned I could go through medical school while losing the most important person in my life. Many people have asked me how I came to class or survived school through that loss. I know I am not the only one to suffer a tragedy this year or in others, nor do I perceive myself to be nearly as composed about it as some may think. I am far from healed and I think I will always be processing her death; it is overwhelming to wake up in a world where my mom is not living. Now I am engaged to a career that will always holds triggers and reminders of personal pain. This is our reality – as medical students, we are taught to draw on our experiences and emotions to relate to patients and show empathy. But how do we draw on the experiences that are so hard to relive?

I do not have any answers. It is not something I have been eager to discuss outwardly, but I am compelled now to relive and to share with you my unique truth of loss and medicine. So, I take you back to the beginning, to the summer before I began medical school.

That was when a rare cancer took its hold of my mother, a lifelong worrier and picture of good health, with sudden and frightening force. She got treatment through the fall, and we looked forward embracing the hope of life cancer-free. I held on to that ignorant bliss, but by June the malignancy made known its rampant recurrence. Despite all of the brains working toward a solution, it was uncontrollable. We spent the summer trying to enjoy simple pleasures, riding the roller coaster of treatments plus illness, and clinging to but often losing faith that she would survive. When things did not seem they could get worse, they did. Then on a hot Thursday in August I got the call solidifying my worst fear. It became clear we were out of options.

Time changed quickly from if we were going to lose, to when. I agonized no longer over how to save her but how to let go. I looked in to taking a leave from school and moving home to Oregon long before we knew the final outcome, but my mom would not hear of it. She wanted to believe we all had hope of bright futures and life beyond cancer. It pained me not to drop everything and go, but I realized it was what was best for us. It did not matter that such a choice would be different for anyone else. So I muddle along through school and life in Utah and planned weekends to be there. She slept while I studied at her bedside, we had meals on our patio, and we made the most of the idea of time. Time gave just two of those weekends.

On a quiet day in early September, my mother left. It was not beautiful, but it was kind, and it allowed us to be there. That was all she wanted in the end. I learned for the first time that day about a person’s long, last breaths, and the sound of silent, un-beating heart. Still, like a petulant child, I clung to her as she left and begged her not to go. Mostly I learned that day what it was like to be a child without her mother. It is still the most terrifying reality for me to face.

I had known loss and death as an acquaintance before this year. Like or unlike many of you, this kind of pain was something I saw as a distant nightmare. I had known suffering and held losses of others’ close, but my darkest adversities were only personal until now. I always imagined myself being a good woman in a storm-calm, graceful, and courageous. I imagined if tragedy struck it would play out like a film: there would be cathartic cries and sad music would ring as I picked up the pieces of my life. I imagined composure. I did not know what to imagine. It did not matter how eloquent I was, how smart, or how strong, I could not escape the incredibly wrong way life feels when loss becomes real.

Losing my mom was the unimaginable. The five stages of grief meant nothing to me, and still don’t, perhaps because I still live them. From the moment she got sick to the day she passed away, I felt frozen. I was a small piece of the puzzle holding my family together, but I remember it all as a chaotic haze. I wanted to be strong for those around me. I knew that no matter how tremendous of a pain I felt, everyone else had pain that was real too – but I struggled to be empathetic to anyone but my family and myself. I wanted to be a supportive friend, but my emotional capacity was stretched too thin. Social interactions became regularly difficult and awkward. Blurting out that you look tired because your mom is dying does not make easy conversation, but sometimes I felt compelled to be honest. People did not know what to say to me, nor did I know what to say back. I was flustered by anyone who that wanted to talk about her, but bothered if I felt they ignored it. I wanted advice, but was bitter when people wanted to tell me how to feel or what to do.  I did not want to participate in class, but I did not want special treatment. I was so angry with classmates for complaining about school being hard, when I wanted to fall apart but I had to study. I could not understand how people were still going about their days so normally, and how the world was still spinning.

“It gets easier with time,” people say. It does in ways, but this was my least favorite platitude. I did not want time to keep moving, nor for it to get easier. I needed my grief to feel fresh to feel like she was with me. It is scary to think about moving further away from the life my mother was in – and making more memories or building a life without her. No words offered, true as they may be, can comfort that reality.  That life, no matter how much I remember her, how much she is with me, or wants me to be happy, goes on without her in it. She is not present in the same way now and she will not ever be, and that makes the idea of time moving forward very scary.

But months later here I am. I slowly find myself less conflicted in balancing all of those emotions. I still reach for the phone to call her, and I get caught up in missing her and reliving the past, or thinking of the future we did not get. I see her in old ladies and I ponder who she would have grown to be. I freeze in moments of a sadness so forceful I cannot comprehend. But, like everyone, I have moments of laughter and feeling light; or I am sad about other things like a bad test score or a patient with a rough, sad story. My times of sadness and happiness have changed, but they are both still there. Keeping the pain of her death with me, even if subtly, keeps her close. Whether the moments that take your breath away become less frequent, or if you become more capable at handling them, I do not know.

Time, inevitably, continues on. You do whatever the hell you are going to do. It is not about a particular way of moving forward or looking backward, and there is no measure of grace. For me, it works to be in school even when my computer keys are soaked with tears or people are staring. I learned I needed to ask for help, and even to rely on it at times. We will all experience our losses with potent differences, and there is no right or wrong. Some tragedies you cannot understand unless you know them yourself, and there is no way to go about them that is “well.” It is okay to feel weak and messy one day and strong the next. It is often ugly, and rarely pretty. It simply is.

I wish the end of this story was not sad, but my story will not end here. None of ours do.  To lose someone so close is awful, but life does not have to always be awful because of it. My hope is that one day I am that calm person in the storm, and that I can relate to patients in ways I could not before. That, no matter how wrong or sad I feel, I continue to work at life in ways that are good.  We take on the challenge of enduring our own losses, drawing on our experiences, and being a part of other people’s suffering, in the challenge of learning to be doctors. I see my own mom in every mother I see, and myself in every kid – and with that I see hope in healing myself, too. Medicine did not save my mom, but it gave me a year, and the chance to say goodbye with peace. I will always be amazed and grateful for that. My mom was my favorite person. There is no lesson in living life without her, except how much I appreciate having had her worries, love and memories. And how much better happiness is when you can share it with someone you love as much as I loved her.