Tuesday, October 03, 2017

A Lost Pregnancy Announcement

A month ago, I was already planning a cute pregnancy announcement to post on Facebook for early October. But when we went to our first prenatal appointment last month, my midwife couldn't find a heartbeat with doppler. She sent me for a formal ultrasound, which confirmed that there was no cardiac activity - the baby (embryo, really) had died about two weeks prior. I spent the following week feeling oddly half-pregnant, impatient for the pregnancy to pass, anxious about what it would be like. Eventually - with little warning - I completed the miscarriage in a public bathroom at the hospital.

I know intellectually how common first trimester losses are, and since I've been sharing the news with friends and family, I'm even more aware of how many families just in my little local circle have gone through this. But I rarely see those announcements on Facebook. There's a taboo around even telling people you're pregnant until you get to the second trimester and you're out of the "danger zone." Hence this post - a little flag to say "This happened to us," and an invitation for others to wave and say "Us too!"

I think one of strangest parts of this has been the feeling that people around me - Mike, my Ob providers, friends and family, are more saddened by this loss than me. There were times the first day I found out that I could have cried, but I didn't. The only other time I wanted to cry was about a week after the miscarriage, when I saw a young woman in clinic for a confirmation of pregnancy visit; when I got out the doppler, she and I listened to the fetal heartbeat galloping along at just the right clip. "I wanted that," I thought to myself.

Mike took it pretty hard; it would have been his first biological child, and he was experiencing fatherhood - with Clark - in new ways because of it. Overall I've felt disappointed, but not devastated. Maybe it's because of my privileged seat within medicine; I was working on labor and delivery the month we found out we were pregnant, and I was reminded during every call shift how fragile a pregnancy is, and how many women had experienced miscarriages themselves. Maybe it's because losing an embryo felt ten times easier than losing a husband (and please know, this is not to minimize anyone else's pain and grief - there's no comparing suffering). Maybe it's because Mike and I were fortunate to get pregnant very soon after we started trying, and we're already blessed with a perfectly health son; I have reason to be optimistic about our future chances. I really do have faith in the timing of the Universe; our time will come, if it's meant to be.

Enormous thanks to those who have offered support, and who have told us "us too. And a huge thank you to Mike for sharing his grief and processing, for being vulnerable with me in very new territory.

Tuesday, January 12, 2016

Here's a link to a post about moving forward (not "moving on") with a new partner after the death of one's spouse. Spot on. Some favorite passages...
It can't be easy to be the man that came after.
I want you to know I don't wish things were different. I want you to know that I want you in our story. I want you to know that as difficult as life has been - every day with you tops my grateful list.

You don't replace the man that came before with the man that came after. You absorb the love, the lessons, and you morph into a deeper soul capable of rich love and special perspective.

Thursday, December 17, 2015

Widowed and engaged

Over 3 years since Scott was diagnosed, 2 years since he died.
Over 1 year since I met Mike, 4 months since he proposed.
Only 5 months until our marriage and my graduation, less than 7 until I start residency.
9 months until Clark starts kindergarten.

Last month was a hard one, not unlike November the year before, with a sadness that’s hard to articulate. Certainly it contained echoes of Scott’s last month - our joy when he was able to join us at the table for Thanksgiving dinner and swallow a few bites of mashed potatoes, the horror when he coughed blood into his napkin, the sadness when he had to go back to bed even before anyone asked for a second helping of turkey.

Over the last month, I’ve wished more often than usual that Scott could be here to see his son. Clark is four and a half now and asks great questions (Why do things look small when they’re far away and big when they’re close up? If triangles make buildings more stable, why do the triangle plates under the Earth’s surface still move?) He’s a railway affecionado and engineer who can describe in great detail the differences between various trains and then draw how one might assemble them. He’s constantly coming up with new track configurations that combine his wooden train tracks, plastic car tracks, marble maze gutters, and Magnatiles. He’s bigger and stronger; this month he hiked five steep miles through Muir Woods. (Last time we were there, I carried him the whole way, and Scott was with us.)

The November grief contained more moments of irrational anxiety - what if Mike and I are shot by a crazy gunman at the movie theater and Clark is orphaned? What if Clark gets cancer and dies? As an antidote, Mike and I tried to come up with equally irrational positive events. It was surprisingly hard. (Cue Scott explaining evidence from behavioral economics about how humans are more motivated by fear than desire.) What came from that exercise wasn’t a list of things like winning the lottery; it was an articulation of something I’ve known for a while now: that what I’ve got, and where I am, is perfect. I am in exactly the right place, right now. Some moments are heightened: reading a train book with Clark on a sunny park bench; running side-by-side with Mike through Lands End, all three of us on the couch, teasing and tickling and giggling and cuddling.

I remember having these heightened moments with Scott when he was sick. I often felt the knowledge of impending loss tempering the pleasure, like a chilly breeze on a sunny day. That “tempering” persists, not because something bad will happen, but because it could. And because a moment passed will forever be past - there’s no going back to three-year-old Clark, just like there’s no going back to pancakes at Delafield or log-rolling at Wellesley or dancing in The Nutcracker in Duluth. The trade-off for this loss of innocence (that’s what it feels like) is a gain in mindfulness, feeling truly grateful for the here and now.

I came across an issue of The Sun (August 2015) with an excellent interview with Stephen Jenkinson, an expert in grief and dying well. He says:
“If you’re lucky, something comes along and ruptures your artificial sense of well-being, which is preventing you from really living. If you’re lucky, something like this will show up - you don’t go looking for it - and you’ll never be able to see anything the same way again.”
“Death doesn’t burden your life. It animates your life. The centrality of death gives you the chance to live, because it says, ‘Here’s the bad news: It’s not going to last.’ And here’s the good news: It’s not going to last.’”

Alongside my grief is my growing relationship with Mike. I’ve struggled with how to write about my engagement here. This blog has been a place for me to outwardly chronicle my experience of widowhood and inwardly process chunks of grief. Looking out, I know that many who read this blog also love and miss Scott, and writing about my new relationship feels like a little bit of betrayal to Scott’s community. Looking in, holding onto my sorrow feels like a way to hold onto Scott, to prove to myself that my love for him is still real. I know that love will outlast sadness - many others have written about this - but it can feel strange to give up.

“Grief is not sadness. There’s sadness in grief, but grief is not exhausted when the sadness goes away. And it does go away, because you can only drag yourself around and rend your clothes for so long. Sadness has a shelf life, but grief endures. It’s not something that happens to you; it’s something you do. You can grieve, but you can’t “sad.” Of course, most of us choose not to grieve. We decide to stay busy, to join a protest, or whatever. It’s understandable, but none of this is grieving.”

I will be a widow forever. I love Mike and am so happy and excited to be entering into a lifelong relationship with him. But it won’t erase the experience of having lost my spouse.* So it is helpful to separate out grief and sorrow, and to value ongoing grieving as ongoing awareness of the transience of so much of our experience.

“Otherwise” cuts both ways. Things could be otherwise, and Scott would be here to to teach Clark how to swim. And things could be otherwise, and I wouldn’t be here, on a plane bound for Minnesota with Clark asleep on my lap. And as I move forward - widowed and engaged, donating Clark’s 4T shirts and replacing them with 5’s, preparing to graduate and preparing to start internship - what can I do but be present?

Things to read
* There was an opinion piece in the NYT a few months ago about marrying after being widowed and the misconception that one "moves on" from grief - beautifully written and well worth reading, even for all you non-widows out there.

This blog post that helps visualize and think through what it means that our time on Earth is limited. How many more books will I read? How much more time will I spend with my parents? Very powerful.

Excerpt from “Improvement” by Danusha Lameris
I’m grateful for small victories.
The way the heart still beats time
in the cathedral of the ribs.
And the mind, watching its parade of thoughts
enter and leave, begins to see them
for what they are: jugglers, fire swallowers, acrobats

tossing their batons in the air.

Sunday, July 19, 2015

Father's Day

Father's Day was bittersweet. Sweet in being able to celebrate with Mike, who is fully invested in being Clark's dad. Sweet in being able to celebrate with the dear Gruver-Kelly clan - a family I grew up with in Duluth, now transplanted to the East Bay; who have been surrogate family for me out here; and who remembered and toasted Scott. Bitter in remembering how much Scott loved Clark and adored fathering him, how fiercely he wanted his love for Clark to sustain his life and overcome his cancer.

In the last year of Scott's life, I began to feel that the happiest moments were often the hardest to bear, as though I were being simultaneously warmed by the sun and chilled by a breeze. I feared (and sometimes knew) that those idyllic moments - a trip to the beach, a pancake breakfast, an afternoon coffee date - were rapidly coming to an end. I was nostalgic for the present. Now, looking back, many memories from my relationship with Scott get that nostalgic glow: dinners with friends in DC, Saturday morning butterflies before an Ultimate tournament, crazy cooking experiments. I miss our life in DC and our life in Davis; I miss his circle of friends from Amherst; I miss our young love, the newlywed period, embarking on the grand enterprise of parenting with him. I'd miss most of these things even if he were alive today; they're from a different era (except for his crazy cooking; I'm pretty sure that spark would have kept going strong). Is this another chunk of grief to process or just nostalgia? Maybe both. Maybe his absence accentuates the loss of so many other parts of our shared experience. Our common memories - things that were just between the two of us - are now held by one less, and talking about them with someone else feels like telling someone your overnight dreams. The listener wasn't there, so can't partake in the vividness. If Scott were here, he would have been able to join me in the memory; and he would have enriched it by reminding me of other details I hadn't thought about. (All of this makes me wonder how important memories are - so long as I remember his spirit and our love, is the rest more or less clutter? A topic for another time.)

I think Father's Day was also hard because the previous Father's Day felt so momentous (We were in Amherst for Scott's memorial service, surrounded by people who love him.), and because the year since then has been so full. Clark blossomed at his new preschool. I started feeling like a real doctor during my clinical rotations. Scott's nephew was born. As much as I believe in life after death and Scott's enduring presence in my life, he wasn't here, on the ground, viscerally engaged. There's a lot he's missed out on. And Clark now knows him from stories and photos rather than from breakfasts and dinners and goodnight kisses.

In a very strange way, it's reassuring to still feel this grief and longing and nostalgia. It's different from how it was during the first year postmortem, much softer. But I don't want to stop missing him. Many people have assured me that just because you stop grieving, doesn't mean you stop remembering. This makes intuitive sense, but I'm glad the transition away from grief is a gradual one.

Related reading

1.  Inside Out, the new Pixar movie, articulates nostalgia beautifully, showing how memories change and develop complexity over time. It's a fantastic movie; go see it if you haven't already. Here's a Washington Post article about the great emotional lessons of the film.

2. Here's a good article on nostalgia - the birth of the word, high school reunions, and looking forward.
You can go home again, at least to a place—whether Ithaka or a childhood manse—but you cannot go back in time, except in memory, or accidental encounters with old friends, or those occasional moments of high-spirited jollity, planned but not imposed. 
3. One of my very favorite essays from The New Yorker, on "what the dead don't know."

Monday, April 27, 2015

Plate tectonics

Clark has been interested in earthquakes lately, trying to understand the massive power of an earthquake as well as the concept of plates moving below us all the time. I've been thinking of it as a metaphor for my grief. There haven't been any major upheavals lately, more an awareness that things continue to move and rearrange themselves under the surface. Scott's death was a 9.0 on the Richter scale, a simultaneous disaster and a reliever of tectonic stress. There are aftershocks, of course, diminishing in frequency and intensity, but still disruptive that continue to subtly transform my landscape.

During my most recent rotation, I worked at the hospital where Scott had most of his oncology appointments. I had one or two moments of sadness, but more often just a certain hypersensitivity about being there. Walking through the front doors brought memories about particular appointments and events that happened there: not the big turning points, rather the mundane follow-ups. I found myself looking at patients and families, wondering how they were dealing with their cancer diagnoses, the hills and valleys of their journeys.

I've been spring cleaning, sorting through closets and donating or discarding things that don't belong here anymore.  Some things are easy - clothes I'll never wear, books I've outgrown.* Going through Scott's things is harder. What to do with his CD collection? I never fully appreciated his taste in music, so I'd be just as happy to donate it and let it bring joy to someone else. But will Clark find some meaning or connection in it 10 years from now? (And, will there be a practical way to play CDs 10 years from now, or should I just keep a list of the artists and albums so Clark and I can track them down and listen to them later?) What about his books, his photos? His wedding suit?

We celebrated Clark's fourth birthday this month and marveled at how much he's grown in a year. He's becoming literate and numerate, always thinking about phonics and sums. He's passionate about outer space. He rattles off the eight planets, constructs all kinds of rockets and shuttles from household materials, asks about nebulae, draws constellations. All of this new since Scott left.

Last week was Scott's birthday, and I found myself wondering what his life would have been like had he turned 38. I grieved for the lost connections and relationships. He had been hoping to collaborate with researchers at UCSF to continue his work in Uganda, and who knows what other relationships and opportunities would have sprouted. Who knows what adventures and experiments and mischief he and Clark would have found for themselves. Who knows how our marriage would have grown. Fruitless questions.

I remind myself that I am still in relationship with him. I had a dream in which he got me out of an embarrassing bind. It was the first time I'd seen Scott in a dream, and it was both jarring (Where did you come from?) and extremely comforting. The dream came at the end of a stressful rotation, during which I'd neglected to meditate or to (consciously) draw on my spiritual resources in any way. Scott's dream-presence felt like a reminder that I can (and should) tap into that greater power of God-Goodness-the Universe for strength and support.

I'm nearly done with my third year of medical school, which is a notoriously difficult year. I was talking to my therapist about what a struggle it's been, how I don't feel like my brain even works the way it used to. He commented that burnout is a common (nearly universal) phenomenon during third year, and that I was probably burned out before I even started the year. It was a revelation; though I'm living a transformed life, it's surprisingly easy to forget the trauma. It's a relief to be on the other side of third year now, but I'm still anxious about everything required of me during fourth year - sub-internships, Step 2 board exams, residency applications and interviews. I'm pretty sure that if I've made it this far, I can get through one more year. But I've been thinking about how to go into with the mindset of thriving, rather than just surviving.** I certainly feel more stable. Mike and I continue to have a strong, committed relationship. I feel less and less like a single parent. My grief is quieter, less intrusive. The tectonic plates are still moving, and we're all still moving forward, adjusting, helping each other up and forward.

* I give credit to the strange but good The Life-Changing Magic of Tidying Up.
** I've been inspired by The Art of Possibility: Transforming Professional and Personal Life. Highly recommended!

Sunday, December 07, 2014

One year

Today is the anniversary of Scott's death.

Lately I've been thinking about this time last year - the day we learned that further chemo and radiation and clinical trials were no longer appropriate; the day he started hospice; the day the nurse told me she thought Scott had about a week left. The day the chaplain came over and helped each one of us add a handprint to a canvas so that we could remember a time when we were all together. Scott's last night, when the wind was howling and and my sister and I sat vigil, reading letters and emails to and about Scott, stories that we'll share with Clark. Scott's last morning, which dawned clear and calm, when he waited for all of us to be with him before he very gently crossed over.

It's been a mix of emotions - pain and grief for what's lost, relief that his suffering is over, and strangely a renewed sense of joy for my life as it stands today. Clark continues to be a light in my life, especially with his enthusiasm for Christmas lights and trees and decorations and snow.

I'm absolutely enjoying my medicine rotation and the confirmation that this is what I want to do with my life. Right now there are four cancer patients on our service, all with extremely poor prognoses. I can't help but compare their journeys to Scott's. Each man is in a different place - one getting ready to start chemotherapy, another preparing for hospice, another still trying to come to terms with the diagnosis - but there's a common thread. I find myself less triggered by their situations than I used to be, which is a relief. Waves of grief still hit once in a while, when I see or hear something that evokes a strong memory of Scott. But more and more, I feel a sense of resonance, familiarity, compassion. A sadness for the marriages that are ending. A remembrance of the feeling of total chaos that a serious diagnosis brings. The universality of "I don't want to die."

I am so thankful for this community, which continues to surround us with love, and continues to remember Scott. Scott told me that he would keep loving us after he was gone, and I believe him. I still love him.

Sunday, November 02, 2014

Day of the Dead

There's a big Day of the Dead celebration in the Mission every year, so we're headed there this afternoon to check it out. I've been thinking about Scott a little more than usual, with the anniversary of his death approaching.

Last week we (Sandy, Becky, Clark and I) went to Davis to see the Scott McNiven Community Service Award given to the first recipient. There was a lovely reception and a chance to visit a number of his professors and classmates. They presented us with a finished copy of Scott's dissertation - he'll receive his PhD in December. We also stopped by the library, where a group study room is being remodeled using his memorial donations; it's not finished yet, but it will be beautiful, and hopefully much-used. It felt good to be back and to reconnect, but it was also a very bittersweet closure. I took a short walk alone through the arboretum - a place I visited nearly daily when I lived there, and the place where Scott proposed,

The second year med students just started their unit on cancer, which includes a series of lectures and small groups on death and dying. I'll be speaking to their class this Thursday about my experience as a caregiver. I'm working on a list of things I want to make sure I touch on. It feels good to be able to share his story with another group of students and to be able to bring just a little more meaning to his death.

I just started my internal medicine rotation at the VA, and I'm loving it. I've been eagerly anticipating this block for a while, and so far it's surpassing my expectations. I love thinking through the problems these patients have, and the residents and attendings really prioritize teaching me. I have a lot to learn in terms of disease process, signs and symptoms, and management and treatment, and in terms of organizing data and reporting it to others. But it's great - I'm excited to get to work each morning. The biggest downside is the busy schedule, which cuts into my time with Clark. He's a trooper, and I'm really fortunate to have so many family members coming out over the next two months to take care of him (and me).

He had a great time on Halloween. At school, the theme of the costume parade was "healthy eating," so each class dressed up as a different food. Clark's class went as ears of corn - yellow t-shirts that the kids decorated together, and tassled hats. For trick-or-treating, he was a zebra. (Last year he was a giraffe - he's sticking to an African theme.)

A few photos from the past month:
A weekend in Santa Cruz with our friends Brian & Marion and their kids Cora & Henry.
(October and still warm enough to go to the beach!)

Clark's class field trip to the pumpkin patch
At Fish Restaurant in Sausalito
At Fort Point

 Our Halloween costumes

That's all for now. My brain feels a little worn out from a busy week, and I haven't had a lot of time (as usual) for introspection. But in general, life is good. I'm happy to be where I am.

Tuesday, September 30, 2014

Changing seasons

Clark and I are in a good routine these days. He loves his new preschool and is making friends, telling me all about the things he learns there - what a chrysalis is, why leaves fall off trees, how he and his friends were pretending to be circus elephants. Most mornings he sits on the kitchen counter and makes hot chocolate (with my help) while I pack our lunches. His staples are rice and beans, steamed or roasted broccoli, string cheese, and three raspberries. (His favorite number is three, because he's three years old, and he always makes sure that we stock up on raspberries when we go to the grocery store.) He had a string of tantrums last week, which was exhausting for both of us, but it pushed me to set clearer boundaries and be more organized about bedtime and breakfast time, which was really good for both of us.

My news is that I'm dating someone! I've been thinking a lot about how to announce this. It's important for me to be open and honest about my widowhood, but writing about grief and sadness feels a lot more socially acceptable than writing about looking for new love. But as I've shared this news with people close to me, I've received only support, no judgment, which makes me a little braver in writing about it here.

I've been going on first dates for a little while now, which in itself has been a really nice break from being a student and a parent - a chance to meet new people and talk about things besides exams and construction vehicles. First dates are a nice escape, but they were starting to feel futile. And then I met Mike. During our first date, we connected in a way that surprised both of us. Since then, I've been enjoying the happy butterflies of a new relationship, the pleasures of having a sweetheart and of being someone's sweetheart. He buys me flowers and cooks me dinner, and he embraces the not-so-easy parts about my life, like my grief and my commitment to medicine and my son. Just as I was getting comfortable (?!) doing the single-mom thing and envisioning my life as such, this relationship came along and reminds me that maybe I will remarry, and maybe Clark will grow up with a dad - things I've thought about all along, but up until now were pretty abstract.

This relationship is still very young, but it's pushing my grief along in a new way. I have to remind myself that I will always have Scott and that forging a new commitment is not betraying him. That Clark will always have a connection to him. That I am not leaving Scott behind when I am excited for the future.

As always, thank you for reading. This space always helps me to articulate things I'm muddling through, and I'm grateful for people willing to listen. Much love.

Tuesday, September 02, 2014

Five years since our marriage, two years since his diagnosis, and Clark's first day of school

This Labor Day weekend marked what would have been our fifth wedding anniversary. There was some heartache, especially seeing so many other two-parent families out doing things together. Clark and I had a good weekend - a trip to the zoo on Saturday, a picnic on the Presidio on Sunday, Golden Gate Park and the Cal Academy science museum on Monday. We had gorgeous weather and lots of good time with our neighbors, but still there was that sense of loss for what life would have been like if Scott were here. This is a dangerous game to play, because the hypothetical life I imagine is always an idealized version, leaving real life - even so lovely a weekend as this one - pale by comparison. So I am mindful of the beauty of this life, and within that, I miss him. I miss his joy, his ability to see the big picture, his way with Clark.

I had two very cool conversations with Clark about Scott last week. On Wednesday morning, Clark and I were cuddling on the couch, right after he woke up, and he asked me where his dad was. We talked about it for a little while, my vague answers not satisfying his questions. Eventually, I said, "Clark, is there anything you want to tell your dad?"
"Yes." said Clark. "His head."
"His head? What about his head?"
"Inside his head."
I realized that Scott had his surgery on that day exactly two years ago, performed by a neurosurgeon and a head-and-neck surgeon, to remove the tumor. I don't remember talking to Clark about his dad's surgery at all - it certainly hasn't been part of our narrative over the past year. The following day, Thursday, as we were going to sleep, Clark started talking about a booger in his nose (like three-year-olds do), and then started talking about how the booger came from "something that died... deep inside my nose." It really felt like a reference to Scott's sinonasal tumor, even though - to my memory - we only ever discussed Scott's cancer in very general terms ("a very bad disease that made his body stop working").  I truly believe that Clark and Scott have a connection. I don't expect Clark to remember much, if anything, about his dad, because he was so young when he died. There are stories and photos to help fill in the gap, but maybe this connection will endure. If nothing else, I'm really glad that I'll be able to tell Clark that he had this link to his dad.

I made it through my surgery rotation. It wasn't as tough as I feared, but I'm glad to be on the other side. I was getting pretty run down toward the end, for a variety of reasons: 12-hour days working in a field I'm not interested in, less-than-perfect team dynamics, two headcolds, not a lot of time with Clark, not a lot of time to exercise, not a lot of time for quiet introverted recharging time. No time to write a blog post, and even if I had found time, I'm not sure I would have known what to write - these posts are usually the result of a few days' or a week's worth of introspection and incubation, until eventually things percolate to the surface and I find time to articulate them. I felt like I didn't have time (or energy) to pay attention to what I was incubating. I was definitely experiencing sadness about Scott - some of it triggered by things in the hospital, some triggered by pretty random events - but somehow it felt like the byproduct of stressors than like "real" authentic grief. But I made it through the rotation and have learned some things about surgery and teams and myself. A huge thank-you to to my classmates, who were always ready to listen and hug, and a huge thank-you to my parents and parents-in-law, my sister Margaret and my Wellesley sister Kate for taking such good care of Clark and I over the course of the eight weeks. I wouldn't be able to do this if it weren't for such a profoundly supportive village.

Now I am one week into my psychiatry rotation and am thoroughly enjoying the change from surgery, as well as the service itself. Today is Clark's first day at his new preschool, which he and I have been anticipating for weeks. One of his teachers called today just to let me know he was having a good first day - I wasn't worried, but I was glad for the reassurance.

Sunday, July 13, 2014

Launching into third year

I just reread my last post (from three weeks ago, when we were coming home from Maine), and it feels like a lot has happened since then. The first week back after vacation was Intersession, the first time I'd seen all of my classmates together since April. It was emotionally chaotic for me - a lot of joy in seeing my friends again, but also a lot of grief erupting from seemingly random triggers. Our class schedule was mellow, which was good because I was emotionally pretty taxed.

Then my mom arrived and my surgery rotation started. Going into the rotation, I had a lot of fear of the unknown - you hear horror stories. But now that I'm two weeks in, I'm feeling much better. The people there are genuinely interested in helping us learn (doctors, patients, nurses, administrators), and their expectations are manageable. I fainted my first morning in the operating room and got wheeled off to the recovery room before the patient I was supposed to be helping. (I've been conscientious about hydrating since then. The hours are tough: 12+ hour days every day this week.) I really miss having breakfast with Clark - I have to leave before he wakes up - but most nights I get to have dinner with him, and then he and I go to bed at the same time: no later than 9pm. I find myself thinking about Scott often (and about his hospitalizations in particular), but there hasn't been a lot of sadness.

My mom took excellent care of Clark and I, and yesterday she flew back to Minnesota with him. He'll be there for two weeks having all kinds of adventures. (Apparently he's commented numerous times on how blue the sky is; it's been really foggy here lately.) I was sad to see him go, but I've had a pretty excellent weekend. On Saturday I meditated for the first time in weeks, played pick-up Ultimate for the first time in years, visited a friend, read a novel. Today I stayed at home all day and studied, did yoga, watched soccer, took a short hike through the woods by my apartment. I should have studied more, but it was pretty amazing to wake up and realize I could do whatever I wanted.

The last piece of news is that I passed my Step 1 Boards! My score is not competitive, but I am hugely relieved to have made the cut-off. I feel like I can finally really commit to all the plans I made the year ahead... although I still include the "God willing" addendum.

Tuesday, June 24, 2014

Presence & Absence

I was thinking about presence and absence a lot last week and have been composing this post in my head in fits and starts. I was hoping to tie things together, but I think it's just going to have to be an "odds and ends" kind of post.

Scott's memorial service was a week ago Saturday, and it went beautifully. Scott was remembered in many ways by many people. I spent the day surrounded by our community, sharing hugs, catching up. I was reminded, again, of the power of physical presence, the importance of simply showing up. It was beautiful to have so many people together in time and space, our energy focused. (I know that many people wanted to be there and couldn't, and that many were carrying Scott in their hearts that day; in writing this, I certainly don't mean to draw a contrast between who came and who didn't, and I certainly do appreciate the love sent from afar.) Thinking later about Scott's absence in the midst of this party thrown especially for him, I was struck that any one of the people who came might not have been there, for any number of reasons, including illness and death. It made me stop and acknowledge - honor - their presences. I kept having this this urge to to always be conscious of the presences of others, but that state of mind is really hard to maintain. It's easy to get swept back into the rigors and rituals of everyday life, egocentric living.

I spent Saturday evening with the Amherst/Delafield crew. It was wonderful to see all of them, to have that community together in body and in spirit... except that one body was missing. We had a big group hug as I was leaving, and I wanted so badly for Scott to be there. Peter suggested that he was right there in the middle of our circle, dancing. His absence felt almost tangible enough to be called a presence, the way our memories of him filled the space we encircled. Still.

On Sunday we drove to Ogunquit, Maine, where Scott's Grandma June has a house. I've been joining the McNivens there for maybe eight years now, but this was my first time without Scott. The first day was hard. I woke up at 4:30 and couldn't get back to sleep, so I took a sunrise walk on the beach. It opened up space to grieve. I do my best crying alone, and the beach is virtually deserted at 5am.

A strong Minnesota contingent - my parents and sister, five aunts and uncles, and five cousins - came to the memorial, and most of them came up to Grandma June's house in Ogunquit, Maine afterwards. I was grateful for their presence. It meant a lot that they made the trip out (again, the power of simply showing up), and it was really great to get to introduce them to Ogunquit: the beach, the tides, the seafood, the porch. Besides that, it was wonderful to just be on vacation with them and to have so much relaxed time, rather than quick catch-ups over Christmas dinner. I'll remember this vacation with them fondly.

Previous years, I've been able to relax pretty instantly upon arrival in Ogunquit, but this year it took me a while. My brain was buzzing with post-exam stress (I'm not confident that I passed Step 1), post-memorial exhaustion, a good dose of anxiety about my upcoming surgery rotation and about third year in general. Walks and talks with family and friends helped. Yoga helped. Naming it helped. Playing with Clark at the beach helped.

Clark and I are flying home to San Francisco as I write. I feel like I've been gone much longer than a week. A few more days in Maine would have been nice, but it will be good to get home and regroup, to get ready to launch into third year, to see my classmates again. I'll try to hold on to some of the slowness for a little while longer.

Saturday, June 07, 2014


Today marks six months since Scott died, but it feels like it's been much, much longer. Clark and I are having pancakes this morning, in memory of the many lazy mornings making and eating pancakes at Delafield - sometimes with dozens of friends, sometimes just Scott and I and an hours-long game of Scrabble.

I was studying in the library yesterday when I realized that it's been almost exactly a year since we learned that the cancer had spread to his lungs. That day feels more immediate somehow than the day he died. I remember receiving the news from his oncologist, the word "incurable." We went out for coffee - it was bitter - and for a walk through Golden Gate Park. Certain parts of our route that day still echo for me with a memory of the weight in my limbs, the feeling that the ground had dropped out from under us.

Yesterday as I was leaving the library for lunch, I saw someone who looked just like Scott, sitting where Scott would always meet me for lunch dates. I had to look again, to convince myself it wasn't really him. It was crushing, enough to make me stop studying for the day and find a friend to help shoulder the burden. I got to talk and cry, and I got exercise and sunshine and a change of scenery, a sense of being brought back to the present. Good medicine.

Scott's spirit is strong here this morning. Truly his father's son, Clark asked for rooster sauce on his pancakes.

Thursday, May 29, 2014

On Eating Elephants

I had an anxiety dream the other night. Unpleasant while I was in it, but I had to laugh when I woke up for the complete lack of subtlety. I dreamt that I was at Scott's upcoming memorial service, reading my reflection. Except I couldn't read it because the font was tiny and the text was full of utterly unpronouceable drug names.

I feel like I'm trying to eat two elephants these days. Elephant #1 is studying for my upcoming Boards exam. There is so much to commit to memory. Pharmacology, biochemistry, physiology, anatomy, pathology. Everything we covered in the first two years of med school, all fair game over the course of a seven-hour 322-question multiple choice exam. It's a beast, and it's happening exactly two weeks from today. I'm fairly confident I'll pass, but it would be nice to get a high score, as this is an important number for residency applications. I wish I had an extra month to study but I'm looking forward it being over and done with. I'm trying to remind myself that I will do exactly as well as I need to do for whatever needs to happen next.

The second elephant I'm working on is, of course, grief. I've been sad since coming back to San Francisco, missing Scott more regularly. I was making coffee for myself on Sunday morning and suddenly remembered how, for years, I would make coffee for him and me every morning. I'd froth milk in our "Mom" and "Dad" mugs, divide coffee between them, and wait to take my first sip until we'd toasted each other, "To you." I stopped making coffee for Scott a while ago - he stopped waking up early with Clark and me because he needed more sleep, and even once he was awake the bitter flavors were often too much for his chemo-ravaged taste buds. I've been making coffee for myself for a long time. But that ritual suddenly felt like an acute absence. We did it at Delafield, in Davis, here. And somehow the thought that I won't get to make coffee for him again is giving me a lump in my throat right now. Our mugs are still hanging in the kitchen, within easy reach.

This elephant, unlike the Boards, has no clear endpoint. To be honest, I'm a little annoyed to have to be digesting this chunk just now. Can't I just focus on one elephant for a while? But having it so prominently in my life provides balance, perspective. It's good to remember that there is so much more than a Boards score, now and always. And anyways, pretty soon after Boards I'll launch into surgery, which will be a whole other animal. I think I'm set up to have a life full of elephants for the time being.

Scott's East Coast memorial service is in two weeks and two days. It will be good to see people there, to connect.

Saturday, May 17, 2014

A confession of willful ignorance

I came across this article, "The Day I Started Lying to Ruth," written by an oncologist about his wife death from cancer. Many parts of it resonated - the idea of unfulfilled aspirations and promises, explicit and implicit; the medical decisions that never felt like true choices, because of course he was going to try everything possible, what else was there?; and the strange loneliness now of having "plenty of people to do things with, but nobody to do nothing with."

But the article also made me grateful for my relative medical ignorance throughout the majority of Scott's illness. Unlike the author, I didn't know what the end would look like, or even basic facts about his cancer type. That first month after Scott was diagnosed, I looked up one paper on neuroendocrine carcinoma, and the survival statistics were terrifying. I consoled myself that the paper was old (outdated, I decided), and didn't read anything further. I think Scott was surprised, maybe a little hurt, that I didn't take more interest in the medical details of his cancer. For me, it wasn't a completely conscious decision to avoid learning about it, but I was aware of a gaping hole in my knowledge and did not take steps to fill it. It was easier to just think, "Scott's cancer is really rare. There's not enough research to be able to draw any conclusions." Ignorance wasn't exactly bliss, but it was at least protective.

By the time we covered cancer in school, Scott was very weak. Learning the details of neuroendocrine carcinoma hit painfully close to home, but I didn't need protection from the information any more. I already understood that he wasn't going to be among the very small minority who surived five years.

Scott was diagnosed two weeks before I started med school, and he died during our cancer unit; my medical education (and practice) will always be inseparable from his experience as a patient. There are times when I see him very clearly in patients. I've been thinking a lot lately about whether and how I'll hold on to that compassion when I move into third year (and beyond) and start seeing a lot of patients and being a lot busier. I know that Scott will always be part of me, and that the things I've learned over the past 18 months will never be unlearned, but I wonder how accessible it will be. I worry about those lessons not being so close to the surface, about lapses in memory, about other things coming along and tamping down, crowding out what's inside right now.

And then I remind myself not to worry, because I'm thinking about him now. And the future has't arrived yet, only the present. A grey fox just jumped the fence into my parents' backyard and rooted around the grass below the birdfeeders. And a red, red cardinal was out there earlier, singing. The trees are just starting to bud. There's still ice on the lake, but it comes and goes depending on the wind. The full moon the past few nights has been casting bright rays through my bedroom window. I'm glad to be where I am. There's still grief in looking back and in thinking about unfullfilled aspirations and promises. But I will not lose what is in the past. I will not lose Scott and the life I had with him. As for what might have been, a friend suggested this: "Pray that the dream comes back to you another way."