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."