Meandering Musing

Truly.  Damn you.  You wrote a musical I tried to ignore because I never believed anything could be as good as all that hype.  I believed nothing would ever knock Les Miz off its musical pedestal.  I wouldn’t even listen to this thing until three days before our tickets to see the tour production.

And now I cannot listen to anything else!  Damn you.

Les Miz knocked to my number two.

You inspired a notion to fight for freedom – damn the cost to self.

You cause tears to well in my eyes  with quiet blubbering at the thought of something happening to my children.  Every.  Single.  Time.

I smile ear-to-ear as Hamilton yells, “Sit down, John – you fat mother——!”  because my life is full of fat mother——- to whom I would love to do the same.

And then there is Hurricane.  The storm of this life.  Violins, harp and a bell.  Delicate choices for a wrecking ball of a song.  Musical perfection.  Your lyrics have nothing to do with our current circumstances as physicians, but could just as easily be about the chaos permeating the lives of so many of my brothers and sisters in medicine.  Every day feeling like the day we could drown.  Every day, waiting for it.  Whatever it may be.

I already fell to the urge to write my way out, but you have helped turn it into an imperative that I begin catching up on 25 years of words unwritten.   You fill my head with the absurd notion I can do something just by writing.  Damn you for inspiration.  No longer waiting for it.  Can’t just wait for it.  No choice but to try and write our way out.

Despair has been trying to find me again.   That fickle fucking bitch is breathing down my neck once more.  I know her all too well – she has nipped at my heels most of my career, and has kept me running for the past 20 years.  Running from friendships, running from family, running from loss, running from debt, running from jobs, running from guilt – running as hard as I can, just to run another day.

Now I consider many of you who will read this my friends, and the words I’m about to put forth might just blow your mind.  My apologies in advance.  For as much as I sometimes blather on in friendly and benign conversation, it is too often a mask to hide the sweat and tears streaming down my face from running nonstop.   These next few paragraphs are going to unload some things you may not want to know.  Fair warning.

For you see, I can’t run another day.  Today is the day I stop running.  I’ve truly had it with the role of being prey.  It’s time to turn around, square my shoulders, and tell despair she’s in for a fight.  It will be her or me – and it sure as hell isn’t going to be me.  She will growl and snarl and bite and claw.  And all I can do is laugh in her face.  For me, the pen is my sword and it is now Game On.

So why take the fight against despair public?  Because I am not the only one running.  Depending on which survey you read, upwards of 60 to 70% of physicians may be running their own race with despair.  And the dirty little secret is we largely have our own profession to blame, as select winners from the past few generations of physicians have become the very teeth of modern-day despair.  Those old docs gave up the race and made deals to buy themselves a little more time before they would let the wheels of modern American medicine start grinding us to bone.  Medical heroes turned villains, willfully.

And it is hard, if not damn near impossible, to get anyone outside of medicine to understand the assault on physicians.  Too many folks still think we all get paid vacations to play golf in the Caribbean, and that our Porsches and BMWs are outward trappings of immeasurable, luxurious success.  It’s hard to find a sympathetic ear when those are the preconceived notions we have to overcome.  I do not golf, have never had a free vacation, drive a Ford, and can’t get a free pen these days.  Hell, I couldn’t even get my last hospital to buy a bag of decent coffee beans for my team.  Hospital coffee is a cruelty in and of itself.  Seriously.  And as for the fancy cars, and boats and houses – all too often it is just docs trying to cover their own sense of loss, emptiness and void with material stuff.  I would hardly consider that a measure of true success.

Over the past two years, I’ve worked with more physicians than I can count who have been victimized by our own profession.  Our boards create more and more expensive hoops to jump through and fill the coffers for a select few – leaving us no choice but to comply if we want the illustrious “board certified” title behind our name.  Payors pay less while electronic medical records decrease efficiency and cause overhead to skyrocket, forcing tired and overworked doctors to see more and more patients just to not lose more money.  And the public is then complicit in the attacks.  Nameless Google reviews rail against doctors who then can’t answer the complaints for fear of legal repercussions.  The wild west of the internet is all too often the bane of our professional existence.

Reflecting on my own journey, I realize I have no choice but to fight to restore dignity to our profession.  I’m bound and destined for this fight, and each day I ignore the bell and settle for just hiding from despair, I’m at odds with my purpose.  I’ve written before about the loss of my Mom when I was a child and the impact it had on my life.  It was immeasurably painful, but the experience strengthened me and forged a resolve that matches anything this pitiful monster of despair can throw at me. 

I’ve been given the undesirable, yet invaluable, gift of “despair context” that so many of my peers do not have.  They feel the crush of growing and unrelenting despair, and its overwhelming nature puts them in harm’s way.  And for far too many – medicine kills them.  The profession of love, mercy, compassion and healing destroys them, and inflicts collateral damage on their friends, family, and colleagues beyond any measure.

Taking care of patients was just the start of my calling.  Helping my peers is now an equal part of that calling.  I will freely admit I cry on occasion, but not only for myself.  I shed tears for my brothers and sisters who don’t know how strong and resolute they truly are.  Too many are trapped by debt and circumstances in jobs that intentionally keep them down.  It’s almost as if there is a business class that teaches it is easier to control and manipulate a demoralized work force – except a depressed work force performs worse in every metric you can imagine.  Placing value and dignity on physicians could reap unimaginable rewards if CEOs had even just a little imagination.

And finally, there is Peg.  We were childhood friends and went to church together as kids. Her family was a pillar in my hometown.  She was a beautiful woman, inside and out – and she took her own life earlier this summer.   In fact, I’m weeping as I type these hollow, empty words.  Equal parts sorrow and equal parts rage.  Medicine – promises of cure and a disease at the same time.  So much conflict in one little word.

Peg called me before going to med school, as I’d already been there and done that.  I desperately wish I could remember what we had talked about when she called me those many years ago.  But the years have washed that conversation from my memory, and sadly we never spoke again.  Now she is gone.  It is inexcusable, immoral and senseless that healers are dying by suicide at higher rates than any other profession in this country.  Roughly one doctor dies each day at their own hand, and countless others will live shorter lives because of the self-neglect this career continues to breed.

You can search this subject on the internet and find stale, cold, and dispassionate talking points.  We treat the disease in our own profession as if we are watching a surgery in the old school surgical theaters.  The academicians ponder and study and talk and talk and talk, while the corporations consider risk analysis and liability exposures.  State medical boards still consider psychiatric stressors as character flaws. The human cost in all of this is an inconvenient variable that cannot be openly discussed.  As for me, I will rage and write. Emotion is precisely what is missing from the conversation, when it should be center stage.

The absence of consistent, safe, structured, and non-career threatening mental health care in our profession hearkens back to days before antibiotics.  It’s what the generations before settled for, and we now reap what they have sown.  Peg cannot die in vain.  The thousands of other medical students, residents and physicians cannot simply die in vain.   Medicine must stop eating its own.

Uncomfortable?

Good.

It means you care.

So today I stop running.  And despair, you might want to get a move on.  For it is now my turn to come after you.

Ready.

Set.

Go.

**These comments are strictly my own and in no way reflect the opinion of employers past or present.  Yes, they make me say this, but it seems pretty obvious**

I asked my wife, Lori, if she had read any of my blogs. Some, she replied. “It seems to me you might need medication.” I get it. A lot of death and sadness and job crap and not quite enough rainbows and lollipops. Fair enough. On the other hand, for me, writing about my experience is the best therapy – it’s free, and has limited side effects. The main side effect is Lori thinks I’m crazy (though that is nothing new). She is the more stoic one in our relationship, and I’m the emotive one. Opposites attract and I’m ok being dorky Phil Dunphy to her sophisticated Claire.

She should also be careful what she wishes for, as I then sat down to write this happy post. And what makes me happier than anything else in the world? She does. Ha!

I have no idea how I would have ended up if we had not crossed paths in residency so many years ago. As I write this, I actually tried to imagine who I would be today.  I had to shut that mental experiment down real quick. Nothing good there. Brian without Lori is like peanut butter without jelly. It’s ok, but only a fraction of how good it should be. In fact, I will heretofore refer to her as my better 75%. I would never have ended up as solid as I am today if she were not beside me. And some days she’s behind me, pushing me to be better. Other days, she’s in front of me, dragging me toward the best version of myself she sees. Without her, I’d only be 25% as good.

To be entirely honest, I can’t imagine where I’d be without her. It turns out she likes projects too, and fixing my broken heart and soul must have seemed like a fun challenge (sarcasm intended). There are two things I love about her more than anything – her family comes first and foremost in her life, and she never quits on anything (or anybody). I simply do not know a better person – and the fact she showed (forced??) me how to take myself less seriously and did not enable me to stay in dark and sulky places is the greatest gift I have ever received.

The 46 Project is all leading into something I will be building with her. A project bigger than both of us, but doable because of our strengths combined. It may take a year or two (or three…) to really develop, but it will be every bit worth the wait. I am eager to see it evolve, but for now it’s mostly ideas on a crazy looking spreadsheet drawn by me and her fastidious notes. She’s the brains, I’m the brawn (and the blubbering tears). She is, and forever will be, My Happy Post!

My planned four day retirement only lasted 48 hours.  I logged back in to our electronic medical record to complete some unfinished work.  What remained in my queue was a discharge summary for a patient I had seen a few weeks before.  Not sure why I hadn’t done it sooner, but I’m inwardly glad I had waited.  It felt poetic.  My last day in the hospital had come and gone, and so had my patient’s.  He had died, as I’ve seen happen in the hospital more times than I can possibly remember.  The words I was about to write would be the last physician note in his chart.  We call it a death summary, and in it we explain how the patient got from here to There.

Some deaths are good, some deaths are horrible.  This death was beautiful.  My patient’s body was riddled with cancer and they knew he was going to die soon.  I saw him in the morning after his overnight admission and he was having severe pain from all the fluid in his belly.  The opiates helped some, but he was still suffering.  I ordered a procedure to drain off the fluid and several liters were removed.  I went back to see him after this and he clearly felt much better.  He had a smile and a laugh.

And the room was filled with people.  I don’t know if the fire marshal has a rule on the number of people we can cram into a hospital room, but I think he had passed the max.  He looked so much better, I said my goodbye for the day and left.

The next morning, I walked in and fully expected to see more of the same.  He had looked so good!  This was not to be the case, the blinds remained closed and the air in the room was filled with the heaviness of death.  His family was grateful for our care and shared how wonderful his day had been.  He had exhausted his body with visiting and after all of this, they knew he was ready.  The raggedy respirations were starting to take hold and I thought his mind and soul may have already moved on.  He did not live to see tomorrow, and that was a blessing.

I’ve seen countless patients die.  It is one of the incalculable job hazards we face as hospital physicians.  In my first week as an internal medicine resident, I had a patient die in the ICU every other day.  Just a few weeks ago on the hospitalist oncology service, I again had a patient die every other day.  The point is, I’ve seen death a lot.  And it always strikes me that patients’ bodies seem to shrink just a little into death.  That the person they were has already moved on, and just an empty vessel remains at the end.  And so it was for him.  Dark and quiet at the end of the hall – away from the commotion that always streams from the nurse’s station.  Peaceful.

His last day on earth.  My last words in his chart.  Amen.

Well, at least I am until next Monday. But for the next three days, I’m going to enjoy retirement #1.

Nearly all of my career has been as a hospital doctor. From residency until yesterday, that is how I have identified myself professionally. I decided to do the math, and it comes out to 5659 days. That’s how long I have been in the trenches fighting the onslaught of disease. And the onslaught never stops. It’s a big number to be sure, but no where near as big as it how it feels. It also makes me feel like the next 5659 days will be very doable! Every job has stress, but the worry and concern of trying to make people better and not hurting or killing them in the process has been a heavy burden and I’m truly ready to lay that burden at the feet of my Lord and move on.

What most people fail to understand is that medicine is not simple, algorithmic equations. The drug I use to treat three people with the same straightforward pneumonia could cause no problems in one, extreme delirium in the second, and a fatal arrhythmia in the third. No shit. This is what your doctor has to consider every time they put you on a drug, as there is no such thing as a 100% safe medication. So yes, it’s been a long 5659 days. I’m sure I’ll get around to sharing some war stories as part of The 46 Project and it’s offshoots, but for the rest of today, I’m not going to think anymore about the past.

My new gig starts in three days. And just like old trees die in wildfire, new trees immediately start sprouting from their ashes. It will be nice to start anew and learn to see medicine from a different vantage point. Come Monday, I’ll be a baby tree.

But for today, I’m retired.

If The 46 Project is to be successful, it’s important to look at what I do, how I spend my time, and figure out what really adds value to my own life.  If something takes up time from me and my family, but brings no value in return, then it needs to be jettisoned.

I have two true passions in life outside of medicine – music and photography.  I’m sure I’ll get around to discussing music at some point, but it’s complicated.  My love of photography is a little easier to explain.  I’ve recently spent (too much) time watching some YouTube personalities and their work. 30-year-old me would have been filled with envy at their talent, skill, and all-in level of commitment. Middle-aged me thankfully just sees inspiration and a free way to get some useful tips on lighting, composition and editing!

When a guy named Peter McKinnon talked about the first real photograph he took, and how it instantly grabbed him as a passion, I could relate. It didn’t quite hit me as the religious experience career choice he had felt, but definitely struck me as a form of expression I wanted to learn more about.  I can’t draw or paint, but I can push a button!

Like so much of the good and bad in my life, this obsession has it’s roots when 12-year-old me lost my mother.  After she died, I carried a small photo of my family in my wallet everyday for the next 20 or so years.  One really good photo.  Wallet sized.  I still have it.  The last real photo of my family before disease started to take grip in my mom.  Once I started my own family and life had moved far along its tracks, I made the conscious decision to stop carrying that photo.  It would not survive another 20 years in my pocket, and it was important I preserve this memory of my memories.

Mom had been our family archivist, and I moved the photo albums and scrapbooks she had created for me more times than I want to remember.  Moving is not fun and I had one more big family move looming on the horizon. So when I was about 40, I finally brought myself to break down the photo albums my mother had crafted in those first 12 years of my life.  Her labor of love was represented by each photo, carefully held on the fine black paper by 4 gold corner stickies.  Hundreds of photos, all laid out by her hands.  I wept as I finally pulled each from their decades long home and placed them in a box to be digitized at a local photo lab.  These books were bulky, and heavy, and the pictures were showing age.  It was time to simplify and I did not want to move those books again.

As I pored over these hundreds of photographs, I was struck by how few actually had both of my parents in them.  And how desperately few there were of me and Mom.  I wept again.  Hundreds of photos, with so few showing my family as I knew it to be.  The family I really wanted to remember.

Weeping in my son’s bedroom, my compulsion to pursue photography in some shape or form was truly born.  I carry on her tradition of being the historian of our family – but I also make a conscious effort to be in more of those memories than she was.  Not for vanity, but for posterity.  I’ve seen in my life and the lives of countless patients that we cannot take our time together for granted, and should something ever happen to any one of us, I want to know that we have captured our lives together beautifully to help keep those memories alive as long as possible. I know from experience that memories in the mind’s eye fade over time, but one look at a photo and those memories come flooding back, and the fading image in my mind’s eye is now back to vibrant Technicolor.

Yes, I know I annoy my kids with the camera.  I’m ok with that.  They are only kids once and I’m going to capture these moments.  But should I do less?  Oh no, we don’t get better at much of anything by doing less.  It brings me inner peace, and love, and joy.  So I think for The 46 Project, my conclusion is to do better and shoot more.  A lot more…

I woke up this morning vividly remembering my dream. I’m sure I dream often, but they are generally lost to the subconscious – never to be known. Today was different, and I’m still teary-bleary eyed as I type this.

In my dream, I was visiting with a young doctor who was contemplating going to work at the same place I had started my career. She was seeking advice on whether or not she was making the right decision. I paused and reflected before I answered her, and then passionately laid out how my dissatisfaction began to arise from having too many conflicting tasks. More importantly, I had conflicting tasks that took me away from what should have been the most immediate priority of caring for my patients. And at the time, most of my patients were hospitalized children – an especially vulnerable population.

Ultimately, the inner conflict of knowing what I personally and professionally needed to be doing versus the work I was mandated to perform led to an irreconcilable internal crisis. I would either compromise my values to maintain the status quo or I would have to move on. Being no one’s water boy, it was time to move on. My advice to the young doctor was to stand up for herself, and for what she knew to be right if that conflict ever visited her. And then I woke up.  I grabbed my coffee and stared into the mirror at the lines in my face and the gray in my beard.  I wish someone had told me the words I shared with that young, imaginary doctor.  I might have been less tolerant of the conflicts I faced and been more decisive in my actions.  As it is, I’m doing the right things, just further down the road than I had hoped.

And as I stare at middle-aged me in the mirror, I am once again at the precipice of a new beginning.  Once again, the conflicts arose, pitting idealistic me against the realities of modern healthcare.  I am not alone, as talk of burn out is all the rage in medicine these days.  Many of my immediate colleagues move on to other patient care venues, while across the country, hundreds, and ultimately thousands, of physicians will be leaving medicine entirely.  I’m somewhere in the middle, as my new career remains in healthcare, but I will no longer be at the bedside caring directly for patients.  It turns out one of the biggest casualties of burn out is one’s own sense of remorse, as I cannot help but find myself eager and excited to move on and start healing my soul.  I could either keep sacrificing my dignity and purpose to the gods of medical administration, or I could take a chance on myself and begin anew.  In the end, is this a choice at all?

Many of you reading have probably never thought about the business of medicine. Well, the dirty little secret is that most doctors also aren’t well-educated in the business of medicine either. In fact, we bristle at the notion of calling it a business. We simply finish residency and then go to work, trusting in the end that we somehow made a good investment in ourselves to take on crazy debt in pursuit of a calling. And for the vast majority of physicians, it is a calling. I know I never sat down to determine if it was a good investment – it was just what I had to do – no matter what the personal cost. And the personal costs – emotional, spiritual, and financial – were very high.

So here I am, now 19 years out of medical school, and I’m starting over.  Not because I am any less passionate about caring for the sick, but precisely because of how passionate I am.  You see, the other dirty little secret is that nearly all our education is in the treatment of disease.  We spend countless hours learning about infectious diseases and cancer and heart disease and strokes and dementia and on and on and on.  We piece together the symptoms of our patient with their physical exam and labs and x-rays and give them a diagnosis.  Then we deploy our other greatest expertise to treat them – drugs.  If I had to put a number on it, about 95% of our education centered on Diseases and Drugs.

The overwhelming focus of my career (and those of my peers as well) has been the diagnosis and treatment of disease.  I performed these services in the confines of systems that need sick people to stay in business.  Without disease, the doors could never stay open.  And this is the ultimate paradox in healthcare.  Early in our careers, we young doctors would often say to ourselves that we are the only profession that altruistically wants to put itself out of business.  Middle-aged me now admits this is far from the truth.  Medicine is big business, and sick patients keep healthcare dollars flowing.  Sad, but oh so true.

It is in this context  that my wife and I started a journey this year born out of our own medical nightmares.  We are both doing well, but have been awakened to how ignorant we were of what it actually means to have and maintain HEALTH.  I’ve often said the most dangerous doctor is the one who has no idea what he doesn’t know, and here I was realizing I had a blind spot in what it takes be healthy and to actually compel patients to take non-pharmacologic actions to improve or even eliminate their own disease.  The insights we continue gaining to improve the health of ourselves and others is far more motivating than the diagnosis and treatment disease.  And while we can never prevent and fully stamp out all disease, it certainly seems like a better goal than just putting up with disease to keep the doors of our clinics and hospitals open.  More on all of this later!

This is the start of what I’m calling The 46 Project.  I like projects, as defining methods and goals is far more practical than the nebulous notion of just wanting to be a better, more loving, healthier person.  I haven’t really started a project I was intimately passionate about since college.  In fact, the last real project I completed was accomplishing everything it took to get in to medical school.  Huh.  Weird.  I’ll also be revealing some other tangential projects as I go along.  I have suppressed and suppressed long enough, and some ideas just won’t die in my mind and need a chance to be born.

Most people would look at the family, career and possessions I have at age 46 and think, “That guy has it all!”  And they’d largely be right.  I have a wonderful family and I’ve done a lot of good in caring for patients, but I have also spent too much time on the acquisition of things (and the resultant time and cost of maintaining these things) and have been too willing to go with the flow to avoid conflict.  If I’m brutally honest, I’m also pretty damn frustrated at how I physically feel at this inflection point.  The lack of time I’ve dedicated to self-care is a reflection of my own misplaced priorities.  I have built little in terms of lasting legacy, and I know quite well I’m capable of doing a great deal more than just treating one diseased patient at a time.  So, The 46 Project begins.

I checked my right brain at the door when I started medical school in 1995.  Writing, performing music, and acting didn’t make it in.  How could they?  I had very little free time and why would I want to cling to touchy feely distractions?  I was prepared to sacrifice personal interests and passions to clear my mental decks.  I wanted to dedicate all my brain power to the promise of learning critical information that would empower me to care for the ill.  It was a left brain dominant exercise for sure.   And walking the hill at my graduation from KU, I remember thinking I had given up my love for art and beauty in the world to fill my mind with far too much clinically irrelevant minutiae.

I had screwed up very, very badly.  No doubt, many of my peers made the same mistake I did when we started med school.  Until recent life events smacked me upside the head (much, much more on that later), I had given up on my right brain enthusiasms.  On an EEG, it would have been a virtual flat-line.  The creative, inventive, passionate side of me was in squalor and disrepair.  What I thought had been an informed decision to become a brilliant doctor (and I only use that adjective as a hypothetical description, not necessarily my reality!) left me as a doctor who only used half his brain.  That, dear reader, was one of the stupidest things I’ve ever done.

Certainly, there were limited benefits to this decision.  If I spent my career as a right brain dominant person, then I would have been crushed by the emotional nature of the work and flamed out long ago.  I even managed to find the love of my life, and I take great joy in being with my children.  Being with my family is the primary motivation that gets me through my week.

Keeping some distance and being slightly dispassionate on the job is how most of us survive.  We also find individual tools to keep us going.  My primary coping skill is sarcastic humor.  Without the ability to laugh at myself and the impossible situations I sometimes find myself in professionally, I’d have been carted to the loony bin long ago!  And in the hospital, where I’ve spent almost my entire career, it hits every single one of us in the face at times.  And some days, just when we manage to pull it all together after being sucker punched emotionally, we find ourselves knocked to the ground again.  Medicine can be the most rewarding, as well as the most cruel, profession in the world.

Nobody who works in a hospital gets by unscathed – from the highly trained and professional code blue team desperately working to resuscitate the 23-year-old expectant mother who won’t live see her baby – to the housekeeping crew who cleans up the blood soaked floor and walls from the family of 5 killed in a car accident – it can be terrible.  Personally, I’ve seen bad things TNTC.  That means “too numerous to count” for all of you normal, non-medical people of whom I have been increasingly jealous over the past decade.  If I let my right brain run amok, I’d never get out of bed.  I’d never go to work again.  None of us would.  It would simply be too much.

Compartmentalization is a key to survival, but the expectation and demand for compartmentalization is also destructive to us personally and professionally.  The internet is littered with hundreds, if not thousands, of vignettes from physicians, nurses and support staff who have given their all at work, only to find themselves inadequately cared for with respect to their own mental health.  And with the nearly universal philosophy of “doing more with less,” the pressure cooker is only going to increase in intensity.  More on this later, after some additional research.

As for now, in reading this, you are an unwitting victim of my need to practice writing again.  It’s akin to watching a 46 year-old former minor league baseball player at batting practice after not playing for 23 years.  Sure, he can swing the bat, but it’s a helluva lot slower and sometimes ugly to watch.  And like the ball player who dreams of getting just one chance to play in the Bigs, I’m dreaming of making a larger difference than settling for just one-patient-at-a-time.

What I can only now call some “healthcare-related concepts” have fired up my right brain.  Maybe too much.  The din of exploding ideas inside my head is deafening at times.  But other than asking my lovely wife to marry me, the conscious decision to bring my right brain back from the brink of death might be the smartest thing I’ve ever done.

PS – for any of you neurologists or neurobiologists out there, I am well aware that the left brain, right brain concept is not very accurate clinically.  Get over it.  I’m emoting.

It has been a struggle to get out of my own way.  I’m sure many of you have the same feeling.  My health and well-being have suffered mightily from the stress of taking care of others in my work as a physician.  I have not taken care of myself.  Period.  My career does not make me unique in this situation, as the patients I treat every day suffer from similar emotions of frustration and despair.  Many of them are trapped in far more serious situations, with truly life-threatening diseases, and they see no visible way out.  They are losing, or have lost, hope.

I went for a walk today to clear my mind and ponder my path forward.  I glanced at my watch and realized to my dismay that today it had been 33 years – almost to the minute – since my life was changed forever.  The moment the school secretary took 12-year-old me from Mr. Rhodes’ classroom, down seemingly endless hallways to the principal’s office.  Sitting there was my father and our dear family friend, Nancy.  The only words I remember from that day are, “Your mother has gone to be with God.”  After that—void.

When I was younger, I would dread May 7 starting weeks in advance.  It represented the wrecking ball that tore down the walls of my childhood.  It represented the sudden, inescapable knowledge that mortality is real and my innocence was lost.  It tormented me and tortured my mind.

And then the healing measure of time passed over me.  Little by little, the gaping wound of loss began to heal and scar covered the hole in my heart.  Twenty years down the road, I would sometimes remember my loss a day late.  And then the wound would rupture open and bleed from the guilt of having forgotten.  However, I’m certain Mom would have been thrilled I was finally almost whole, and that May 7 was no longer a day filled with emptiness.  Sometimes, May 7 could be just another day.  She would want me to remember how much she loved me, and that she never wanted to go.  But she would want me to move past despair and focus on hope.

And so, 33 years later, I will despair no more.  I chose to be a physician because of what happened that warm spring day.  My fate was cemented in that moment, and I know she is proud.  And so, 33 years later, I dedicate my future work to her and the patients who see no way forward.  The patients who measure their life in days and breaths.  The patients who are about to give life to another in birth.  The patients who grip my hand to calm their fears, and the patients who hug me in joy.  The patients who just need to talk, and the patients who would certainly die without my help.

33 years to fully realize what my life’s work is about and to know how I must shape my future.

33 years…