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."

Sunday, May 04, 2014

Happy birthday Scott

Clark's birthday was bittersweet, and the feeling continued throughout the next week - Scott's birthday was the following Tuesday, April 22nd. That day was a busy day at school, and although Scott was on my mind throughout the day, I didn't have much of a chance to really absorb it until I got home at four o'clock. I decided to watch the DVD that Scott recorded last summer. It was my first time watching it, and it was wonderful and painful all at once. I heard his voice again - the voice I fell in love with. Scott was so sad to have to say goodbye, and his absence felt more acute than ever. But parts of it were comforting - he was doing his best to take care of us, to comfort us even after he left. He truly believed that even after his death, he would still be loving us, present tense loving us. I absolutely believe that as well.

Clark and I are at my parents' house in Duluth this month, so they can take care of us while I study for the boards. My mind is very firmly in the books these days. It feels good to be able to focus on studying, but I'm trying to make space for my emotional life (for lack of a better word) as well - still using my mindfulness bell app and trying to make time for meditation.

"With life as short as a half-taken breath, don't plant anything but love." - Rumi

Wednesday, April 16, 2014

Happy birthday Clark

Clark turned three today. I wish Scott were here to celebrate with us. I miss him.

Scott was a wonderful dad, and he and Clark brought each other enormous joy. Scott always had this over-the-top enthusiasm for fathering, an abundance of confidence in Clark's abilities, eternal patience with him somehow without crossing the line into overindulgence.

He loved teaching Clark new things, loved watching him develop new skills. Last fall I pointed to a jet flying overhead and said pointed out the "smoke" to Clark. "No, contrail" Clark corrected me. Scott had taught him the word "contrail" at age two.

Here's the poem Scott read at Clark's welcoming ceremony: "My Son," by Barbara Shooltz Kendzierski
You did not come to me as the moon, reflective
of me, or to orbit my life but as a star, radiant
with light and warmth and path of your own.
I will try always to remember.
I want neither to hold you captive to my dreams
nor to pressure you to color between lines I have drawn.
I hope never to distort your questions
to fit my answers; but sometimes
I will forget.
May the limits I set serve you
like the scaffold serves the skyscraper in its ascent,
then falls away when the time comes to let go.
May my words teach you to listen
and my listening teach you to speak
so in quiet it is your own voice you find.
May I be a mirror so you see yourself clearly
as child of a loving God who delights in your being.
The scaffolding fell away too soon. The mirror is foggy.
I don't know if it's a good thing or a bad thing that Clark will never know the extent of his loss.

Here's the poem that I read at Clark's welcoming, by Rumi.
Look at Love...
how it tangles with the one fallen in love
look at spirit
how it fuses with earth giving it new life
why are you so busy
with this or that or good or bad
pay attention to how things blend
why talk about all
the known and the unknown
see how the unknown merges into the known
why think separately
of this life and the next
when one is born from the last

Saturday, April 05, 2014

I celebrated my birthday last month, which prompted me to reflect on the past year-plus. A year and a half ago, as we were just getting introduced to Scott's cancer, I remember someone commenting that one day we'd be able to look back on this "year from hell." At the time, the comment struck me as unfounded. Granted I didn't know what was coming, and I still had a lot of hope that Scott would survive. But even when I considered worst-case scenarios, it didn't seem possible that the entire year would be one from hell. Now, looking back, my 33rd year was by turns tragic and stressful and painful and mentally and emotionally exhausting. But it was not bad. In part, the hard times were balanced by profoundly good times. I am so thankful for our trip to Hawaii; it stands out in my memory as a haven from everything else that was going on. We were so taken by the place - the beaches, jungles, volcanoes, sunsets - that we were able to stay very much in the present moment, enjoying each others' company. And, of course, I am so thankful for the incredible love of our community. I've written about that often, and it cannot be underestimated.But the hard times were also intrinsically valuable.

I was talking to a neighbor a few weeks ago, one I hadn't seen in several months, so I had to tell her about Scott's passing. I hurriedly went on to tell her that we're doing okay, that I have wonderful on-the-ground support from my classmates and administrators, neighbors, friends, family, etc. etc.
"Yeah," she interrupted me, "But it sucks."
"Yeah," I said.

I don't mean to gloss over the hard parts. I'd absolutely revert back to Plan A if I could. But Plan B isn't bad. My 33rd year was by no means my worst year. It was my most important year.

Right now, things are going smoothly. I finally completed one of the classes that I took an incomplete in last year, and I'm almost done with the other one. In the next few months I'll study for and take the Step I Boards. The score plays a large role in making you a competitive residency applicant, so it's something that one can, theoretically, stress about. I'm sure I will, but I'm not yet. I'm enjoying the day-to-day. Today is Saturday, and we're off to the zoo shortly.

Thursday, March 13, 2014

a permanent wound in the soul

I was having a hard time figuring out what to write about this week. This space has been a good place to explore and articulate my grief, but I haven't really felt like I've been grieving lately. It made me stop and think about what grief and grieving really are. Am I grieving when I have a happy memory of Scott? When I relish a beautiful moment with Clark? When I'm engrossed in my studies? I came across this quotation in Healing After Loss (Hickman):
After the dead are buried, and the maimed have left the hospitals and started their new lives, after the physical pain of grief has become, with time, a permanent wound in the soul, a sorrow that will last as long as the body does, after the horrors become nightmares and sudden daylight memories, then comes the transcendent and common bond of human suffering, and with that comes forgiveness, and with forgiveness comes love.
     - Andre Dubus
At first the notion that grief is a "permanent wound in the soul" struck me as a terrible thing. But I'm beginning to understand how the state of being wounded can be a state of connection. It seems like before, my grief was only about missing Scott and all of the different ways he was in my life and in the world. But now the edges of my grief are blurred. It's also about happy memories, about savoring experiences that Scott isn't here for and that I might otherwise have passed over, about making my life meaningful through my work. And it's about more than just me - it's about being able to connect with other people through forgiveness and understanding and love. I'm coming to see my grief as something much, much bigger than sadness, and I'm learning to value what it adds to my life.

This is not to say that I feel dramatically enlightened by grief. Day-to-day, it mostly feels like a subtle infusion. There are still sad times (though they've been much softer lately) and there are good times (Clark and I had an awesome getaway last weekend) and there are neutral times and boring times and frustrating times. But I do tune in to that wound now and then, and it feels valuable to me.

There's been a lot of grief in the Ultimate community recently, following the death of three players from Carleton College who were on their way to a tournament in California. (Here's a Star Tribune article about it.) Tiina Booth, who was Scott's high school coach, wrote a beautiful piece about grief: What I Think I Know. I encourage you to read it. Another response to the tragedy, Why We Play the Game, resonates as well.

Thank you for reading.
With love,

Sunday, March 02, 2014

Our wild rumpus

Just a little heartache to get off my chest tonight. I had a fragment of a dream with Scott in it last night, a very bittersweet moment, and I think I've been missing him a little extra all day long as a result. This poem by E. E. Cummings ("i carry your heart with me") came to mind this afternoon and has been with me since.

Tonight I read Where the Wild Things Are to Clark.
Here's how it goes after the wild rumpus:
"Now stop!" Max said and sent the wild things off to bed
without their supper. And Max the king of all wild things was lonely
and wanted to be where someone loved him best of all.

Then all around from far away across the world
he smelled good things to eat
so he gave up being king of where the wild things are.

But the wild things cried, "Oh please don't go -
we'll eat you up - we love you so!" And Max said, "No!"

The wild things roared their terrible roars and gnashed their terrible teeth
and rolled their terrible eyes and showed their terrible claws
but Max stepped into his private boat and waved good-bye

and sailed back over a year
and in and out of weeks
and through a day

and into the night of his very own room
where he found his supper waiting for him

and it was still hot.
At first I was struck by Max's loneliness, his wanting to be loved most of all, his being tired of having to be in charge.  I identified with the kid. Except I can't hop in a boat and sail away.

Now I think that Scott's the one who sailed away, back to his true home, to a place of love.

The rest of us can roar our terrible roars of grief. But we still have this wild rumpus to attend to for a little while longer.

i carry your heart with me(i carry it in
my heart)i am never without it(anywhere
i go you go,my dear;and whatever is done
by only me is your doing,my darling)
                                                        i fear
no fate(for you are my fate,my sweet)i want
no world(for beautiful you are my world,my true)
and it’s you are whatever a moon has always meant
and whatever a sun will always sing is you

here is the deepest secret nobody knows
(here is the root of the root and the bud of the bud
and the sky of the sky of a tree called life;which grows
higher than soul can hope or mind can hide)
and this is the wonder that's keeping the stars apart

i carry your heart(i carry it in my heart)

Thursday, February 27, 2014


It was stormy here last night - lots of wind and rain. Around eight o'clock, Clark told me that he heard two ghosts talking. I believe him, even though I don't know exactly what ghosts mean to Clark. It's not the first time he's mentioned seeing or hearing ghosts. He said the ghosts were talking about trees and that they looked like owls. He's not frightened of them. He hasn't indicated that his dad is a ghost.

I'm not quite sure what to make of it. I believe that Clark does have a very real connection to the spiritual world (and I wouldn't be surprised if it's deeper/stronger than my connection). His descriptions of the ghosts, as well as their location, jibes with a handful of other experiences I've had over the past few months. But sitting here now, looking out into a very black night, the thought of seeing a ghost is a little scary. Maybe - hopefully - if I actually experienced it, it would be comforting.

I've been less sad lately, but a little more stressed about all of the studying I need to accomplish this spring. I wonder if the latter is overshadowing the former. I've been experiencing fewer grief "triggers" lately, and I haven't cried in days. I realized something about triggers the other day. They're not external events causing sadness; they're expressions of the sadness in me that's looking for a vessel. It feels obvious in retrospect, but I didn't get it before. Sometimes my sadness needs to come out at random time, so completely random things (studying coagulopathies, for instance) can feel like they trigger a wave of grief.

That's about all I've got for tonight. Here are two little feel-good things for my sign-off:
First, 10 Painfully Obvious Truths (this one has been making the rounds on Facebook)
Second, kintsukuroi. (Thanks Wendy!)

Wednesday, February 12, 2014


One of the things we learn how to do in med school is to ask a lot of questions in order to characterize a patient's pain. Pain comes in a lot of flavors, and understanding one person's particular pain can go a long ways toward figuring out the root cause. When did it start? Is it a sharp stab or a dull ache? Constant or intermittent? What makes it better or worse? How bad is it on a scale from 0 to 10?

I was thinking today about how many of those characteristics can be applied to my grief, how mutable it is, and just how physically tangible it can feel sometimes. There were times when it was intense, overwhelmingly painful, and times when it was just a few stinging tears. The past few weeks I've felt a little emotionally raw, sensitive to small triggers. This week it's more of a heaviness, a constant dull presence. In terms of what makes it better or worse, I've become very aware that school stress (in particular, impending exams) make it worse, and finding someone who's able to listen makes it better.

I think the thing I'm missing this week is having someone to come home to at the end of the day to receive the little stuff. Someone to ask "How was your day?" and who will listen to me effuse or gripe or reflect or laugh about the small things that happened.

Sunday, February 02, 2014

Finding stability in vulnerability

I'm feeling more stable these days. Solid somehow. Enjoying school, enjoying Clark, enjoying my community. Nearly every day, I have a few tears. I got rear-ended yesterday on our way to the beach. Clark and I are fine, and the other party is taking full responsibility. Overall a very benign stressor, but I was shaken, and by the time I got home I just wanted to curl up in someone's - Scott's - arms. Instead, I had a hungry, sandy toddler to take care of. I cried while feeding Clark dinner, and then I had a nice long talk with my sister instead, which helped a lot. I had a moment last Thursday in the cafeteria where I suddenly needed to cry, and one today at the Super Bowl party. I've become adept at grabbing a friend for a bear hug at those moments. I think about Scott and the particular thing about him or our relationship that I'm missing, and I feel very present in my sadness, in my body, in the hug.

Before he died, I only ever cried alone or with Scott, or very occasionally with my therapist. Crying in public makes me feel really vulnerable - but I think having these moments in public is partly why I feel a little more stable and solid these days. When I can be in the moment, in the emotion, I feel like I'm standing on bedrock. I'm not sure what changed, why it's easier to show my tears now. Partly, I think I've learned a lot about my sadness. I can trust myself to go into it and come out of it again. I wonder if it's partly that a lot of the fear about Scott's dying is gone.

I haven't been doing a good job of articulating this, but I've also been experiencing many moments of joy. There are many mornings when my heart swells just walking into the lecture hall - I'm so glad for the opportunity to take my place among my classmates. The other day I was walking outside when a gust of wind blew a flurry of tiny white petals into a small snowstorm. The sunlight was silver coming through the clouds, and everything zoomed out for a few moments, and the scene in front of me, this world, felt like a piece of something more expansive that I'd known before. Last week I had a dream about being at some sort of summer camp for world religions. But it wasn't a place to just learn about different religions; it was an opportunity interact with their Truths in an incredibly tangible way. I don't remember more than a few glimpses from the dream but it was so cool.

Thanks for reading. Writing here is therapeutic for me, a good way to explore some nooks and crannies of my daily experience. It's funny, 95 percent of the time I feel completely normal - just focusing on school, Clark, car repairs, whatever. I don't feel like I'm grieving much at all. But it's helpful to reflect on my grief (or at least the things I choose to throw into the box labeled grief), to synthesize it, find connections within it. Thanks for reflecting things back to me.

Tuesday, January 28, 2014


A few minutes after Scott stopped breathing, I put my ear to his chest.
It was the most profound silence I've ever experienced.

This afternoon I had a chance to practice my physical exam skills with a classmate in preparation for an upcoming test. I listened to her heart, as I do in virtually every physical exam.
I want to remember that hearing a heartbeat is always a gift.

Monday, January 27, 2014

On quality time with Clark, and the future, and the present

My weekend was restful and restorative. I got to spend quality time with friends, and I got to spend a lot of quality time with Clark. He and I went to the beach on Sunday morning, and we spent most of the rest of the day hanging out at home together playing with Legos and trains, reading books, making muffins. I didn't get much studying done, which is perfectly alright for now.

The issue of finding a new partner has been on my mind lately, the issue of whether, when, how to start dating. I feel like I'll be ready sooner rather than later. I'm hesitant to write much about it here, partly for fear of judgment - from myself and others. The flowers from Scott's memorial service haven't wilted yet. Shouldn't I still be mourning his loss? I am. I am. And I'm also looking forward, and I'm learning how to hold these things simultaneously. I wanted to mention it here in the spirit of full disclosure - this is what my grieving process looks like.

In the midst of so much thinking about past and future, I've been particularly enjoying a new "Mindfullness Bell" app that rings periodically throughout the day, to remind me to appreciate the moment. I love feeling more present, and it's amazing how quickly I've started to become more mindful at other times during the day. I'll be in the middle of something and think, I wish the bell would ring, and then realize that I don't actually need the bell in order to just pause for a moment and take everything in.

Friday, January 24, 2014

Life post-memorial, feeling just a little more vulnerable.

The week since Scott's memorial has felt much longer than a week. Overall I'm still doing well, but there have been more moments of sadness. It feels like my grief is a little more accessible now. I don't feel like I was repressing it earlier, or that I was in denial about my feelings (my therapist agrees with me on this). It just feels like a door has opened.

The memorial was beautiful. It felt so good to see so many people, to feel such a strong focus. I'm happy I was able to read the reflection I'd written (see my previous post) and that Clark was able to sit through the entire service (on my dad's lap, aided by a new toy car and two cookies).

After the reception, many of us regrouped for a game of Ultimate. Scott and I met playing Ultimate and many of our best friends are also players. I was rusty after not having played for three years, but I had so much fun running around in the sun with some of my favorite people in the world... and as soon as I got to the sideline, I was deeply sad that Scott wasn't playing with us. The happiest moments are the hardest to bear. I know that Scott was there in spirit, but I wanted to hear his voice and see his smile. I wanted his arm around my shoulder, my arm around his waist. 

The rest of the weekend was wonderful, and restful - dinner with my friends from DC and Amherst on Sunday night, breakfast with Davis friends on Monday morning, a trip to the Korean spa on Monday afternoon with my neighbor.

School on Tuesday was hard. I stepped out of small group as we started discussing a case of a pregnant woman with a recurrence of cancer in her lungs. It was the first time I left a class early like that - normally I can set my jaw and focus - but I didn't have the energy for it that day. Shortly after class, my classmates and I all found out what program we'll be in for third year. I learned that I'll get to spend my first three rotations (July - December) at the VA, which was my top choice. It was good news, but thinking about third year without Scott by my side is still hard. Hard to imagine how it will all work out logistically, hard to stomach moving on to the next part of my life without him.

I am thankful for the friends who have had lunch with me and Skyped with me into the wee hours of the East Coast morning. I'm looking forward to a massage and therapy and more coffee dates and dinner dates this weekend and next week. I'm thankful for Clark, who told me this morning that monsters have sharp teeth so that they can eat sütlaç (rice pudding, his favorite Turkish dessert).

Last thing: a short list of resources I've been appreciating recently.

Healing After Loss: Daily Meditations for Working Through Grief by Martha Whitmore Hickman. For each day, there's a short quotation followed by a paragraph-long reflection and a 1-sentence mantra. It touches on many aspects of grief, and I'm surprised by how much of it resonates.

The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss by George A. Bonanno, PhD. He discusses how common resiliency is. I know that I'm allowed to feel whatever emotion I feel, but for a while it felt strange to not be distraught. Reading him makes me feel like I'm a normal person, dealing with grief normally, which is comforting.

Outrageous Undoing, a blog by Marian Lansky. This is one of my favorite posts so far. I don't understand all of what she writes about, but I do understand more than I would have a year ago. She helps me think about things being bigger than I can fathom. She helps me feel connected to Scott, and to people here.

A Celebration of the Life of Scott McNiven

Scott's memorial service last Sunday was beautiful. I'd been looking forward to it for a long time, and it absolutely fulfilled my hopes. It's impossible to translate the experience to this blog, but I wanted to at least share the readings that were included in the service.

The gloom of the world is but a shadow. Behind it, yet within reach, is joy. There is radiance and glory in the darkness, could we but see, and to see we have only to look. I beseech you to look.
And so, at this time, I greet you. Not quite as the world sends greeting, but with profound esteem and with the prayer that for you now and forever, the day breaks, and the shadows flee away.
- Fra Giovanni, 1513

2 Corinthians 4:16-18
So we do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For this slight momentary affliction is preparing us for an eternal weight of glory beyond all measure, because we look not at what can be seen but at what cannot be seen; for what can be seen is temporary, but what cannot be seen is eternal.

Success, by Ralph Waldo Emerson
To laugh often and love much;
to win the respect of intelligent persons and the affection of children;
to earn the approbation of honest critics and to endure the betrayal of false friends;
to appreciate beauty;
to find the best in others;
to give of one’s self; 
to leave the world a little better, whether by a healthy child, 
a garden patch or a redeemed social condition;
to have played and laughed with enthusiasm and sung with exultation;
to know that even one life has breathed easier because you have lived –
this is to have succeeded.

“…You would know the secret of death.
But how shall you find it unless you seek it in the heart of life?
The owl whose night-bound eyes are blind unto the day cannot
unveil the mystery of light.
If you would indeed behold the spirit of death,
open your heart wide unto the body of life.
For life and death are one, even as the river and the sea are one.
In the depth of your hopes and desires
lies your silent knowledge of the beyond;
And like seeds dreaming beneath the snow, your heart dreams of spring.
Trust the dreams, for in them is hidden the gate to eternity…
For what is it to die but to stand naked in the wind and to melt into the sun?
And what is it to cease breathing, but to free the breath from its restless tides,
that it may rise and expand and seek God unencumbered?
Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance…”
- Kahlil Gibran

Just Now, by W. S. Merwin
In the morning as the storm begins to blow away
the clear sky appears for a moment and it seems to me
that there has been something simpler than I could ever believe
simpler than I could have begun to find words for
not patient not even waiting no more hidden
than the air itself that became part of me for a while
with every breath and remained with me unnoticed
something that was here unnamed unknown in the days
and the nights not separate from them
not separate from them as they came and were gone
it must have been here neither early nor late then
by what name can I address it now holding out my thanks.

A Prayer attributed to St. Francis
Lord, make us instruments of your peace.
Where there is hatred, let us sow love; where there is injury, pardon;
where there is discord, union; where there is doubt, faith;
where there is despair, hope; where there is darkness, light;
where there is sadness, joy.
Grant that we may not so much seek to be consoled as to console;
to be understood as to understand; to be loved as to love.
For it is in giving that we receive; it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life. Amen.

Interwoven among the readings were reflections by people from Scott's life: his dad Sandy, his longtime friend Nate, his close colleague Dan, and me. Here's my reflection.

Scott, my love. My first love and my true love. I am so sad that you are no longer by my side, but I think that you can still hear me – if not my exact words, then maybe their echoes in my heart.

Scott, love became tangible through you. I remember the moment I fell in love with you. It wasn’t love at first sight, because I have a terrible memory for faces, and I actually didn’t remember who you were when you returned from a three-week trip to Guatemala. But I do remember our first kiss, and sometime after that – I can’t remember what time of day it was or even what season – I remember looking into your eyes and feeling an overwhelming joy to be with you. “What? What is it?” you asked, because I just kept looking at you, unable to stop smiling, not knowing what to say. I couldn’t name it at the time, but I think that day was the first time I felt my soul connecting to yours. I am so deeply honored and privileged that you chose me to be your wife.

Scott, your love became tangible through Clark. Early on, I wasn’t sure whether or not I wanted to have a family, but I knew that you would be an incredible father, and that was what tipped the balance for me. The utter delight you derived from being with kids, your integrity, your appetite for adventure – I couldn’t let you miss the opportunity to be a dad. And what a dad you were. No one could make Clark laugh like you. No one had such faith in his physical abilities. You always insisted that he could stand the day he was born; you had him walking by 9 months, and he’s been running ever since. You indulged and encouraged his every culinary whim, like the time he asked for pesto on oatmeal for breakfast. I tried to dissuade him, but you said, “What’s wrong with that?” I really didn’t have a good answer, so I capitulated, and Clark ate every bite. Scott, I love being a parent, and I am a better, more relaxed and trusting parent because of you. Clark is such a light in my life. Your joyfulness and thoughtfulness are so apparent in him. He misses you and asks about you. He’s happy when I tell him that you aren’t sick anymore. He will always know that you love him. Present tense: that you love him so deeply.

Scott, your journey over the past year and a half has helped me to understand how each of us functions as part of a greater whole. I don’t understand all of it, but I get glimpses: how we support and strengthen each other; how we hold each other’s grief and joy; how we love one another. I know that I and many of my classmates will be better doctors because of you. Your remarkable selflessness made it possible for me to continue my medical education throughout your illness, and because of you, I have a deeper understanding of why we practice medicine. I will care for patients, and I will care about them. Because of you, I will love my patients more.

Even when you were very sick, you continued to support and strengthen me. You gave me hope – at first hope that you would recover, and later hope that Clark and I would be alright no matter what. You allowed me to see the breadth and strength of our community, the love that connects us. That Saturday morning when you were dying, I saw in my mind’s eye love from near and far pouring into you, helping you break your ties to this life. I saw love propelling you like a jet engine into the light of the next life.

You made love tangible in the communities you drew around you everywhere you went: in school, at work, on Ultimate teams, in Amherst and DC, Guatemala and Uganda, Davis and San Francisco. Many people here today have their own stories of how you brought love into their lives. So many people wrote to me about how you changed their lives. We are happier because of your humor and joy and goofy absurdity. We are less anxious about small things because of your ability to see the big picture. We are less judgmental toward others because of your open-hearted acceptance of us.

Scott, you made a difference in this world. Your death was untimely, incomprehensibly so. But that does not change the fact that the world is a better place because of you. Thank you for that. We love you.

Sunday, January 12, 2014

Pieces falling into place

I feel like things are finally, wonderfully, falling into place.

I spent most of last week wrestling with whether or not to transfer to the University of Minnesota at the end of this year. I've decided to stay at UCSF. It was a hard choice - lots of factors to consider, and lots of people (chief among them Clark). I'm so thankful to my parents who are incredibly supportive of me staying in California; to my brother and my neighbors for their ridiculously generous offers regarding childcare; to the University of Minnesota for being willing to accept me as a transfer (I would have been the first one in seven years); to UCSF for being so accommodating of my needs; and to everyone who wrote to me and listened to me as I was working through this. I'm glad I put so much energy into making this decision, and I am glad it's decided and that I can start planning ahead for the first time in a long time. I am so happy that I will be staying at UCSF with my dear classmates and faculty (God willing, of course).

Scott's memorial service is also falling into place, and it's going to be beautiful. Last night I was finally able to write a first draft of what I'm going to say. I'm excited to see so many members of our community face-to-face. Our family has been experiencing a lot of love and positive energy from people over the past year and a half, spread out in time and space. It will be intense, but good, to feel that energy and love coming together next Sunday. There will be a lot of grief coming into focus as well; this will also be intense but, I believe, good.

It's been 5 weeks. I love you, Scott.

Tuesday, January 07, 2014

A month out, and trying to make a major decision

One month. My thoughts are on his memorial service and on where I'll be 6 months from now.

On Saturday we sat down to discuss the details of Scott's memorial service. The friend who is helping us (and who will be officiating) was wonderful - comforting, steady, had a good grasp of what we are aiming for. The service is going to be lovely. I'm still struggling with what I'll say, but I'll get there.

Clark's daycare provider mentioned to me that Clark seems different since we've been back - happier, nicer to the other kids.

School continues to be good for me, I've had a few rough moments at school. I had anatomy lab on Monday morning. I got through nearly the entire lab just fine, but as we were cleaning up, I started thinking about Scott's body having been donated to the UCSF Willed Body Program (the program that supplies cadavers for our anatomy lab and for other research). I had already been missing Scott on the walk to school that morning, and making the connection triggered a wave of sadness. I'm not sad that Scott donated his body (I'm proud of him, and so grateful). I guess I'm sad that his body is a cadaver now, so absolutely lifeless. Amid the tears, I soon found myself engulfed by hugs from classmates and comforted by hot tea and dark chocolate.

Another small bit of grief this morning, following lectures on fertility. Since chemo made him infertile, Scott and I briefly considered intrauterine insemination as a way to get pregnant last spring, before we learned about his lung metastases. The doctor we met with last spring was one of our lecturers this morning. Listening to him speak didn't sting as much as I anticipated, but there's still a dull ache from knowing that Scott and I can't get pregnant again, from the knowledge that I probably won't ever get to be pregnant and give birth again. We're in the "Life Cycle" block now, so there will be a lot more coming up about pregnancy and babies. It's certainly not as intense as the last block (which was all about cancer), but not quite the escape that school used to be.

My major struggle, though, is in trying to decide whether or not to transfer to the University of Minnesota for the last two years of medical school. It's something I've been considering for a while, but now that I'm faced with needing to make a decision (and the decision must be made in the next week or so), it's gut-wrenching. Having family support from my parents and siblings in Minnesota would be amazing, but thinking of saying goodbye to my family here - classmates, faculty, neighbors - is so hard.

In the midst of this, I found myself thinking of a short essay by Dr. Rachel Naomi Remen, one of my teachers here, and a source of great inspiration. (She founded a course for medical students called The Healer's Art. Read about it here: NYT article.)

I've been thinking a lot lately about the fact that I don't know where my life is leading me. There are twists I can't see coming. I can plan, but I can't control.

This is called "Promises, Promises" from Dr. Remen's book My Grandfather's Blessings
It is possible to befriend uncertainty, to remind yourself and others of the fluid, ever-changing nature of things. To remain awake to all possibility.
Like many Orthodox Jews, my grandfather never made an appointment or spoke of any event in the future without adding the words "God willing." It is is actually a teaching of Orthodox Judaism that one does not make any promise without this tip of the hat to the authority of God. So whether someone said "I'll see you next Tuesday," or "We will have dinner in an hour," Grandpa would invariably respond, "God willing." God might, after all, end the world sometime between now and the chicken soup. There was never any fear in his voice when he said this, just a simple reminding of himself and those around him of the nature of things.
Life required us to hold things loosely, not to be attached to a particular outcome. The lunch appointment, the pot roast, the graduation, or the marriage - all were in God's hands. To be alive was to wait for the will of God to reveal itself. And one waited with curiosity. A sense of adventure. Much in the way you read a detective story at bedtime, struggling to stay awake in order to discover what is true, to see how things will turn out.
If the fulfillment of every promise or plan rests on God's approval, then God's hand is hidden in everything that happens. According to my grandfather, all tragedy or blessing was a part of some unknowable and dynamic purpose. One might not always get one's own way, but one trusted the Way absolutely. At any given time, the will of God might be unknown, but the presence of God was certain and was the only certainty anyone needed in order to live.
These days, my appointment calendar has places for entries three years ahead. There is a certain hubris in this, and, even as I write my commitments down, I remember this other way of living. I exchange letters of confirmation, I make plans, I even buy plane tickets, but deep inside I hold these things loosely. Lightly. I make my promises, and then I wait to find out. In my heart, I still hear my grandfather say, "God willing."