By Annabelle Hatsav

As my phone fell to the ground, my body went with it. Everything went blurry and I couldn’t even understand what was coming out of my mouth. A fire lit inside my chest.

“She’s gone, I’m so sorry Annabelle.” I don’t believe it. I keep asking why, why, why? We were just texting a couple of weeks before this. We had plans, this was not meant to happen. God please tell me this isn’t true. I kept touching the gravelly pavement beneath me to ground myself, to feel that this was all real. I faced dark green bushes trying not to fall forward or draw attention to myself. This is not real, this is not happening. She is not dead, she is not dead.

I heard footsteps approaching me as my tears poured down my face like a faucet. “Are you okay? Do you need some water or anything?” A staff member asked me. “No, I’m fine, thank you.” I lied. Usually, I’m so good at pretending I’m fine, but I don’t think I could have put on a more convincing act.

One of my best friends texted me a message I never saw coming. “I heard what happened to Ava*, I’m so sorry and I’m here for you if you need anything.” I didn’t want to assume the worst. Please don’t tell me she died. Please don’t tell me she killed herself. Please don’t tell me she’s not here anymore.

Don’t jump to conclusions. “Ruby please tell me it’s not true, what did that text mean?”

“I’m so sorry Annabelle, Ava killed herself two weeks ago.”

The worst was true. My body was on fire as I started hyperventilating and sobbing in the driveway of my camp. Feel the ground, feel that you are real. I couldn’t breathe. I couldn’t do anything but cry.

Questions were popping into my head as I sat there. How long was she feeling that way? Should I have reached out more? Should I have made more of an effort?

Somehow it felt like my fault. When people talk about suicide loss they often talk about survivor’s guilt. It’s not the feeling that it should have been you, it’s the feeling that you could have done more to help. That it’s your fault until proven that it's not. Every interaction I had with Ava was rushing through my head and I was feeling the survivor's guilt heavily. I told my mom about it and she didn’t know what to say. I told my brother Matan about it and he was speechless. I told my therapist, and she assured me, it was not my fault. How could I believe her? The feelings pounded through my body every time I thought about her, which was every day for weeks.

I didn’t know what to do with myself, but I knew that I couldn’t be alone. All my friends were in a meeting on the other side of the camp, which I was late for. There was no way in hell I would go to that meeting. But I headed there anyway.

I dragged my feet through the freshly cut grass passing by a gathering of staff members. Don’t look at me. I couldn’t stop the tears, I knew I would eventually get dehydrated then my body would really start shutting down. One of my campers walked past me and saw my red puffy face so she asked if I was okay. I gave the classic answer: “Yes I’m fine, don’t worry about me.” And continued on my track to find a friend, anyone really. My friend Adam was playing basketball when I saw him. I knew he would come running to support me. He wrapped his arms around me and said, “Where do you want to go?”

We headed into the woods to a dock overlooking a lake,  a beautiful place where a lot of counselors would come to think. On the way there he held me as I was shaking and couldn’t stop. We hobbled so much shit in our path. He tried to make me laugh, I did, but I couldn’t stop my mind from racing. I watched the water ripple as I talked in my shaky voice. My head started to hurt as the water left my eyes so willingly.

Ava, my friend from middle school and high school, was two years younger than me. In middle school, we did crew backstage for the plays together. I was the stage manager and she was a perfect crew member. I was her mentor, I answered all of her questions and helped her with everything. I remember feeling so valued by her. She made me realize how much I could give to others, and how much she could give. Ava called me freckle. She said it was because I had six freckles (she counted), and I loved it. When I left to go to Paris for my freshman year of high school, she was worried we wouldn’t keep in touch. She said she would miss me a lot, and I told her I would too. We kept in touch and when I came back, I was so excited to see her again, and I would always answer her questions.

When she entered high school, I wanted to still be a good influence and mentor, but also her cool older friend at the same time. I tried my best and always made time for her, then I graduated.

I felt that I didn’t keep in touch enough after I graduated. I felt guilty for not texting her as much. We texted once in a while, and I always kept up with her on social media. But it wasn’t the same. A month before I left for camp, she texted me saying she was going to Wheaton College in the fall and that we should hang out. I suggested we hang out in New York before the fall because I missed her. She said she missed me too. I will always miss her.

Those texts ran through my mind for the next few weeks. I thought about how I could have asked her how she was feeling, we could have called. I should have done more, I should have asked more questions…I should have connected with her more. All the what-ifs were circling my brain and making me spin into a guilty state of mind. I had to remember, this was not my fault. How could I have known she was depressed?

I didn’t bottle it up this time, but I did keep it from my friends for a week. Being at camp and receiving this news was so conflicting because of the high-stress environment where I had to be responsible with a positive face on all the time. I couldn’t afford to mourn.

It was like I was floating above my body and observing what was going on below. The camp counselor in me wanted to keep it together so badly, but I had my moments. Thank God my co-counselor was one of my best friends and understood that I needed time for myself. But I didn’t tell my other friends until they asked me what was going on.

It was the worst, yet the best place to be to mourn. I knew I had so much love and support around me, but I just couldn’t ask for it.

I wrote in my journal after Ava died. I wrote letters to her asking her why she did it, begging her to forgive me. For what? I’m not sure. I messaged her on Instagram telling her I missed her. I spoke to her ghost trying to find some peace. I found out the funeral was recorded on YouTube, I never watched it, I’m not sure that I ever will.

Why’d you do it? I asked her over and over again in my moments of being alone. Please tell me why. Send me a sign. Anything.

Thinking about Ava made me think about how happy she was with me. She left my high school after I graduated to go to a different school. I wonder if that’s when she started having suicidal thoughts. Or maybe it happened before that. It’s so incredibly hard thinking about all the things she’s going to miss out on. Fuck my school for not doing enough. I had to direct my anger somewhere, so I chose my high school instead of myself.

I found out about the American Foundation for Suicide Prevention in 10th grade and how they host walks to raise money for suicide prevention all over the country each year. I loved the idea of seeing people who had similar experiences and feeling a sense of community, rather than feeling alone. The first year I went on the walk it was beautiful, I cried the whole time around hundreds of people wearing t-shirts with family members that died on them and crying with their friend’s arm in arm. I have participated every year since, and I never plan to stop. Ava made me want to fight even more for the discussion on mental health, and how anyone can prevent suicide.

I will never be the same. I call into question my own actions to my friends. Am I being a good friend? Thinking about each time I hear the news it never gets easier. My body catches on fire each time and I gasp for air reaching for something that slipped away moments before. I remind myself each day how lucky I am to have the support I need, and how I wish Ava had the support she needed. I can’t turn back time. I can go back to the moment of me sitting on the pavement in disbelief that she was no longer on this Earth.

I will miss her every day. I will never stop fighting for suicide prevention because it’s a part of me, my story, and so many others too.

Rest In Peace, Ava.

*A pseudonym was used to protect the privacy of the family.

About the Author

Annabelle is a third-year student at Northeastern University studying English and Communication studies. She loves writing non-fiction and poetry, and in her free time she enjoys baking, reading, and spending time with her cat.

By Emily Cheng

The air in my parents’ restaurant is hot and greasy and always loud, but that is how they know it is good. I first stepped into the restaurant when I was ten and didn’t know anything. My parents were owners of a Chinese restaurant, and I didn’t even know what a wok was. They brought me in to “work” when they couldn’t find a grandparent or uncle to watch over me. I would sit by my mother and do the simplest tasks, packing white and brown rice into Chinese takeout containers. With every container I finished, she would tell me “not enough, more, more.” Then, she would take the container out of my hands, scoop triple the amount I had filled, and pack it with the rice bursting out of the paper box. She would always give more rice than I thought we could afford.

 When it was not so busy, I eyed the chefs who held large metal woks and tossed food with them like it was nothing. I would learn that these woks were the key to a real Chinese restaurant. They needed special care—constantly seasoned in oil and heat to produce wok hei, the breath of the wok. Over the shouting of my mother and chefs in the kitchen was the sound of oil sputtering and popping at the addition of washed green scallions. I had convinced myself that this was the wok breathing life into food. And in this same way, the woks’ air would season the whole kitchen—its staff, the walls of the restaurant, and the greasy floors—imbuing itself into everything. 

***

In mid-October, my father called to tell me that they have decided to sell the restaurant and have found a buyer. They’ve spoken about it a few times, but it was something so distant it didn’t seem real. “I just wanted to let you know.” So simple, unsentimental.

I didn’t have enough time to think of an answer for him, so I only began to process after he hung up. Did we have enough money to live? It was the most obvious question, and I hope they had thought this through. How much was the restaurant? But more accurately, how can you assign a price to this? Overnight, everyone had seemingly become hard and unemotional when all I could do was feel. Feel for all the stories unaccounted for.

***

My father remembers his childhood at the restaurant as the worst time in his life. It is a Chinese tradition that the oldest son is the one who will suffer the most. He was the one to care for his younger siblings and the only sibling expected to help in the restaurant, tasked to hold the family together while his parents worked in the kitchen downstairs. 

After high school, he would return to the restaurant and help my grandmother take orders at the front. My grandmother, overwhelmed with stress and responsibilities, would verbally lash out at him in front of customers and the entire kitchen staff. Good for nothing! Stupid! Worse than garbage! Words to that effect. Words my father could not believe a parent could say to their child. 

When my grandparents retired, they urged him to take it over; they saw it as the greatest gift they could pass down. And as the oldest son, my father could not refuse. Traumatized by his childhood, my father spent nearly the next 40 years working at the restaurant. He has worked through countless invoices and business statements until he physically could not handle seeing numbers anymore. He started taking medication to help him through this, but eventually it stopped helping. At his lowest point, he stood at the top of the third floor of the restaurant office and attempted.

I remember my father before this time. He would come home and play with us and smile. He was so happy to just be with us, in the moment, alive. He has never been like that since. He had survived, but some part of him had died in the restaurant many years ago.\

***

Now, he’s cleaning up the mess from the past 50 years. He has been moving out his sister’s old books and his parent’s picture frames. As much as the restaurant has hurt him, his texts to our family group chat read a bittersweet. “Today I realized Cleaning out 30 years worth of stuff is quite exhausting.” 

The second floor of the restaurant is an office that looks more like a dump. It is a collection of everything discarded, but not thrown away. My father sends us a picture he’s found of him and my grandfather in the clutter of that office. It’s him as a kid. My grandfather has on a yellow polo, one arm wrapped around my father, wearing a matching polo in white. I don’t recognize my grandfather in this picture, but they’re both smiling. And for some reason, I find myself zooming on the icee my father is holding because seeing him as a kid brings out something so sad in me that I don’t want to feel it. All I can see now are his tiny fingers gripping onto a paper cup.

***

My mother has no fears. While my father works in accounting, my mother works in the kitchen, in the fire. She comes home with cuts and blisters. I’ll ask if she’s ok, if it’s painful, if she can still go back to work. She won’t give it the slightest attention. “It’s not anything.” Her hands are not rough, but strong, necessary to push woks, withstand burns, and raise children.

She was like this even before I was born. When my mother was pregnant with my older brother, she continued to work in the restaurant. She called orders and cooked and sweated in the humid New York summer air. 

For one order, it required lobster which they had not prepared that day. My mother, big-bellied but still strong, walked downstairs to the restaurant’s inventory to start preparing the ingredients. On the way, a coworker bumped into her, and she fell one flight of stairs down to the bottom. My mother was rushed to the hospital by my father who had already started grieving. When she was told she and the baby were fine, she had taken that day off, then returned to the restaurant the day after.         

She kept working all the way to August, until the moment before her water broke.

***

My mother has spoken with the Chinese man buying our restaurant and his lawyer. She’s been managing stipulations, lawyers, contracts, and all the things that she does not understand. And she feels herself getting older and smaller, fading into a shadow of her past self.

“You are in such a good place. To have perfect American English.” I can type these words, understand the nuances of English words, and find beauty in the language. But when she tries to negotiate with the lawyer, she gets pulled aside and her English is called “childish”—like she is playing games by changing her mind, but it is only that she is unable to explain her thoughts in American words. She tells me this is what happens when you are bad at English. 

For so long, I’ve been trying to learn Mandarin, but even with Sunday Chinese school, textbooks, and living in a Mandarin-speaking family, my fluency is still that of an elementary school student. Sometimes, I think about all the stories my mom wants to tell me but can’t. All the words that she knows in her perfect Chinese, the three dialects—Mandarin, Cantonese, and Fuzhounese—she’s fluent in. 

I know she is not a shadow of who she was. She is only waiting in the shadows, holding onto the words she knows. She is biding her time, planning her moves, and learning her options in an American world. And when she’s ready, she’ll strike. 

***

I am angry at myself for wanting to hold onto the restaurant. For even feeling sentimental towards leaving it behind. It has been the source of my parents’ despair for decades. I should really be celebrating, cheering, and jumping at the idea of it never being in our lives again. Leave it somewhere far, far away. For too long it has been a mass, growing and growing, becoming unbearable and draining my parents. Cut out a pound of the flesh that feeds on the pain of good people. Cut out this tumor.

But as much as it has hurt, it has supported three generations of my family. It is my grandparents’ true first-born, and my parents’ entire lives. As I’m going back home to see the restaurant for the last time, I am going to indulge in the gluttony, filling myself with the pain, hurt, love, death, and ends of my moments being there. It’s like I’m gripping onto a broken wok, seeing all of its scratches and imperfections, and trying to learn to let it go. I know using it will break it—the shards recutting the wounds of my family. 

So once more. Before I go, I’ll oil it one last time, give it heat, give it breath, give back all it has given to us. In return, we’ll slowly learn to move on and learn to feel the way it has breathed into our family new life.

About the Author

Emily is a student, writer, and her own personal chef, honed from her experiences at her parents’ restaurant. In her free time, she is an avid puzzler and admirer of her dog, Truffle.

By Ashley Brown

Held down. I remember light and I remember terror. My heart races. Stabbing searing pain three times. Three permanent tattoos across my hips. “To make sure we line you up for radiation correctly every time.” I stare at the ceiling, following the circle of light that changes colors. Changes colors just like my skin, now thin, brown, and brittle. On the ceiling, there is a circle that is a rainbow. Real rainbows are circles anyways. They burn the cancer from my body, just my skin is in the way. Every Friday, I sit in the car on the drive and then they burn me. Until my skin breaks and until I move through the degrees, end on third-degree burns. I wake up in the night and scream. A resident sees the burns and they change colors too, now a pale white. “We need to burn all of the cancer. We must continue.” They give me drugs now to numb me so that they can burn me. I drift away on morphine. They burn me and I burn.

I wore my first sports bra when I was six: it held my catheter, the tube stemming from my chest, in place. “This will prevent it from getting tugged by anything.” I dream of my sisters playing with me again and suddenly they grab the tube and pull. They pull and I unravel. I unravel, a spool of yarn untethered with each tug as my organs are pulled outside of my body. I still dream it.

I am at a sleepover and we want to watch a movie. I am 9 but the movie is rated PG-13. I ask to call my mom to get her permission. My friend laughs at me, but I don’t understand. There are rules. Don’t scratch your burns. Don’t play with your catheter. Rules are important. Knowing rules and following them mean I get rewarded. “If someone gives you anything but Tylenol, what do you tell them?” “I can’t have that. It is an NSAID, those are too hard on my kidneys.” I am very smart, very responsible for following rules. I hide my tears as we begin to watch the movie.

I am the new kid in a small school where everyone has known each other since kindergarten. They ask if I am in the wrong classroom. I look too young to be in 5th grade. At my new ice-skating rink, there is the group of big girls and the group of little girls. I am seen as too young, too bad of a skater, to be invited with the rest of the little girls. Besides, to get close to them, I would need to do synchro with them. You are not allowed to wear gloves for synchro and my circulation is too bad. My hands will turn translucent and then blue again. In every group number at our yearly Nutcracker, I am too young for someone to start a conversation with, too introverted to reach out myself. I am content with my own company at least. It does not matter that I actually am older than them. In high school, I get louder though. I beat others to the punchline. “I know, I look like a child. Maybe when I graduate high school, I will look 14! But hey, that’s cancer for you.” When I first get my driver’s license, I drop off my sister at rock climbing and go to pick up Taco Bell for her. At the drive through, the cashier sees me pull up and begins to laugh. “Are you old enough to be driving without an adult in the passenger seat?” I ascent wearily. She laughs more and tells her friend to come over here and see the youngest looking 16-year-old that he will ever see. I turn red.   

For the first five years after treatment, that is when cancer is most likely to recur. My body was a ticking time bomb. Every abnormal pain is the beginning of terror. Does this stomachache mean I have cancer in my stomach? Every year, I get strep throat and the lymph nodes around my throat swell into imaginary tumors. Any moment, my body could betray me, leave me without treatment options. “We can’t give you chemo again. There is a maximum dosage and you already received it.” I am told the next best thing we can do is find it early though, if it does recur. So, they hold me down again. They do CT scans, MRIs. All donut-shaped tubes, but at least these machines don’t burn me. They pronate my legs so that my toes touch and heels sit apart and then they tape me still. My heart pounds, tells me to run so that they can’t hurt me again. I focus on what I read about how kidneys work while they scan me. The doctors are always more comfortable when I want to learn more. It is something to talk about, something other than the silence, the small talk. I pass the five-year mark. Then they focus on the long-term effects of the cancer, of the chemo. They check my heart. Social workers ask how I am doing in school. I tell them I want to be a pediatric oncologist, or later a cancer researcher. They tell me what a good thing it is. I see them relax. I am saying the right things, I am telling the good story, the right one, the one they want to hear.

Am I healthy? Am I sick? I am healthy enough to the sight that any physical failing must be a moral one. I am healed, but I hurt. My kidneys grew with me during puberty, scarred and disfigured as they are, so I will not need another kidney until I grow old. Regular menstrual cycles, no matter how physically painful, mean that I am fertile, at least for now. But why would I want my own kids anyways? With my biology, I offer a 50% chance of damnation. My heart passes my yearly screening exams though and my liver continues unscathed. “You are doing so well.” They tell me that every year I go to my annual Long-Term Cancer Survivor Clinic appointments. How can I disappoint them? The doctors and nurses and social workers did so much to make my treatment manageable. To distract me from the horrors of it.

But that is not fair to me. 

Just because I have good grades, just because I am involved in extracurriculars, just because I have a long-term relationship does not mean that I am healed. It does not mean that my cancer basically never happened, just an unfortunate start.

Cancer is not my origin story either. In the pursuit of telling a good, satisfying, palpable story, I did not get the freedom to explore multiple visions of my own future. There was one path and it stretched on for years, a funnel into the perfect ending to my cancer story. Instead of exploring my interests, I obsessed over cancer and was lauded for my work ethic. No one thought to suggest that this might be a coping mechanism to understand my trauma. Even when I disliked every job related to cancer that I tried. I liked cancer most when I was learning about it, analyzing it at a higher level and connecting it to myself. But how could I tell people I did not see myself in a cancer career anymore? Because I only ever was interested in understanding it to understand myself? Because of trauma? But I am healed, that is the way this story is supposed to go. It is not like I do not have the talent. In fact, I would be wasting it if I do not stay in science or in medicine. It does not matter that I grew a distaste for so many other parts of it. Deviations are unimaginable.

But it is imaginable. Kids with cancer can grow up. It is not our duty to make others comfortable with that idea. I do not owe anyone a tidy ending. My ability to heal from my cancer was delayed, not hastened by the story of the long-term cancer survivor. I am not healed! I am tired of pretending that I am. But I will make up for the lost time, now that I can understand that I still bear wounds from my trauma, now that I understand that my story and my trauma did not end when I “beat” cancer. I am freeing myself from the shackles of other’s expectations. I feel the catharsis that I never found in the last 15 years of my life. I can begin to reintegrate cancer into my life story, but finally on my own terms.

About the Author

Ashley Brown is a senior at Northeastern University with a double major in Biochemistry and Health Humanities with a minor in history. She is currently applying to master’s in history programs where she plans to study historical cases of health inequities.

By Alexandria Raspanti

Women learn from a young age that their bodies are not inherently theirs. I was not an exception. I grew to understand that I live in a system where autonomy is earned. I was born to be sexualized, my breasts grew to grab, my clothes made to take off, body made to be used. I had a concrete understanding at age 13 that sex was a pivotal part of being desired as a woman. I sat in my bedroom watching the show The Girls Next Door and pushing my boobs up in the mirror. I daydreamed about looking like one of Hugh Hefner’s girlfriends. Tiny waist, pouty lips, bouncy hair, and big boobs. I thought that life would be easy for girls that look like that.

I met Aaron when I was 14. After one month of dating, grade 9 began. He decided that we were ready to have sex. I agreed that that weekend we would. We lay in bed and I knew that all I needed to do was get through this and wait for it to be over. It would not last forever. However, when the time came, the nerves interfered. I did not have sex that night, but he did. He left my house, went to a party, and had sex with another girl. I could never make that mistake again. I learned that my reservations make me replaceable. I was grateful to Aaron for not forcing me to have sex with him and finding someone else instead. I felt bad for wasting his time.

At the age of 15, I was in a turbulent relationship with an addict. I never experimented with drugs, but I was an expert on them. Day by day I cared for him, I stayed up at night checking his pulse, dipping his feet in cold water, wiping blood off of his face. I thought that mothering him would make him less inclined to hurt me. I don’t remember many of these events anymore, but my friends remember my recountings of them. By the time he left for good, I was 18 and he was gone, along with my childhood. He broke up with me when he was done with me. Psychopaths follow a specific routine in their romantic relationships: seduce, love bomb, bond, trauma bond, entrap, use up, and discard. Loving someone who could care less if you were breathing is an incredibly embarrassing and degrading experience. I wish I could say this is where everything changed, but it didn’t, not for a few years.

Older men have always found a liking for me, although it dramatically declined when I turned 18 and the thrill of an underage girl didn’t exist for them anymore. I was 19 and working at a hair salon, and I asked my boss if we could talk about my schedule. He said he would pick me up at 7 p.m. to talk about it over dinner. When I searched up the restaurant and saw the four dollar signs, I figured I should wear a skirt. “I love that you wore a skirt for me,” he said while I got into his car. He didn’t speak to me about my schedule that night. He told me about his ex-wife, his kids, and the nanny he cheated on his wife with. He told me that I was young and had never experienced a real man. When he dropped me off, he said “You’re not even going to invite me in? How rude.” Worried about my job, I responded, “Oh, would you like to come in?” We were in the elevator as I texted my roommate, “We’re coming up, be in the kitchen so I’m not alone with him,” and she responded, “Lexi, I just left the house.” We went into my living room where he climbed on top of me and started kissing me. He was 43 years old. I can’t even try to describe the feeling I had in my throat as I felt his tongue in my mouth. After a few minutes, I said that I had to wake up early tomorrow and that he should go. Reluctantly, he left. The next day at work he called me into his office saying he had my new schedule, and I walked into a pitch-black room. He said, “I just wanted to get some time with you.” I quit a few days later.

Eventually, I stumbled across a YouTube video on relationships with psychopaths. My eyes were glued to the screen, clinging to every word as she flawlessly described my first love. My breaths becoming heavier as she explained the hows and the whys. The questions I had asked repeatedly in my head for years. She talked about how they choose their victims, and patterns in their mannerisms. I truly UNDERSTOOD for the first time that it was not my fault. In that moment, I felt my soul clinging to my body for the first time, its hands grasping at the insides of my skin, holding me with pinching fingers in a silent promise to never let go. It was in that moment that I let go of my responsibility to men and took on a new responsibility. Myself. 

I found a lot of my power through learning. I came into college majoring in psychology with an interest in behavioral neuroscience as well as a minor in women, gender, and sexuality studies. I hoped to one day focus on the neurological underpinnings of psychopathy. My mission was to uncover irrefutable proof that abusive behaviors are unrelated to the victims themselves. Unfortunately, awareness alone cannot shield you from the harm inflicted upon you; it merely has the power to shape your responses.

I no longer fear people. I am not scared because everything that I would be scared of has already happened to me. There is a certain comfort in the aftermath of abuse – a comfort that stems from knowing that there is nothing you can’t get through. Abuse doesn't simply vanish; it lingers, leaving its mark. I deal with obsessive guilt, replaying daily scenarios in my mind, and endlessly questioning what I could have done differently to the point where I could barely leave my home out of fear that I would make a mistake. Yes, lessons were learned and at one point I would have said I was grateful for my experiences, but now, I do not. I believe that the growth I've achieved could have been attained on my own, without the help of my abusers. I now stand, not as a product of my abusers' influence, but as a testament to my own strength and resilience.

About the Author

Alexandria is a fifth-year psychology student at Northeastern University with minors in English and women, gender, and sexuality studies. After college, she aspires to go to law school and seeks to use writing as a powerful tool for advocacy and change.

By Ella

The luminous natural light shining into my all-white shower illuminates a heavenly gaze onto my bleeding, blistered body. I wouldn’t consider myself particularly religious, but today I'm certain there's a divine presence holding me upright as I feebly fight for stability. Today my open wounds leave a sea of crimson dancing down the drain, my neck frozen straight to combat the blaring whiplash. 

Today I believe in God.

Earlier, a pouring shower of glass had left me concussed and upside down. It was a tranquil roller-coaster ride, a seemingly peaceful experience as my body ascended and accepted the force. Constantly burdened by an intrusive inner monologue, I was surprisingly soothed by the sharp dissociation. It was a near-death car crash, but somehow one of the most relaxing experiences of my life.   

My life had been spared by a 1999 tow truck housing an unbelievably rare interior design that ultimately guarded my life. The sight of the truck alone was enough to send people at the scene into hysterics. I gather when a car looks like that, you are supposed to die. The eccentric EMT called it a miracle. God called it a favor. I call it my most bittersweet memory. 

Vacantly wiping the blood away, I am surreally empty as I shower. This is new for me, the chronic overthinker staring into the distance with sullen eyes. I hyper-fixate on the ceiling as I shower, void of meaning. Without any medication in my system, my dazed reflection acts as the most potent narcotic.

It's bewildering how fast life ebbs and flows. Just a month earlier, the suffocatingly humid air of Miami smelled like success and teen spirit. Up until a few days before, my mother had ardently refused to let me go, exclaiming how ridiculous and unsafe it was. We were 17. I agreed, even then. But I craved it, longing for the exhilaration of me and my friends dancing in the sun and acting older than we actually were. It all seemed so grand.

Suddenly, my friends were discussing reservations at trendy restaurants without a mention of going anywhere other than Miami. That must be why my mother caved on her own accord, quietly pulling up the airfare for that weekend while weakly uttering “I don’t want you to miss out”. Quickly, all my savings were down the drain, and I was packing my yellow polka-dot bikini in a small, battered carry-on.

On our first night there, we shuffled back to our hotel rooms eager to prolong the night. We energetically jumped on the massive white bed in our way-too-short dresses. My head hit the ceiling, and I rolled around laughing as background music roared on. It felt like a scene from an unrealistic teen drama, and I joyfully thanked my lucky stars I had made it. 

After everyone went back to their room, I got in bed eager to doze off. It was close to 2 AM, and I stared vacantly into the darkness to calm my body. My inner monologue flowed relentlessly, only exciting my nerves to stay up. There was a creeping void inside my stomach that only seemed to grow as it got later and later. My strange uneasiness was only fueled as I began to fixate on time, physically feeling as if I was going to run out of seconds. Or out of air, as my chest tightened and the butterflies in my stomach sharpened their wings. I felt viciously hot as every manual breath stung my diaphragm. The heaviness weighing on me forced me to take large gulps, choking to find whatever air was left in my lungs. Laying immobile, I silently prayed for my well-being. 

My breath finally came back after what felt like hours, and I looked at the time. It was 4:37 AM. I then laid awake all night in an anxious, stomach-severing, pit of nerves. Finally, when the sun rose, I got out of bed nonchalantly to put on sunscreen and my yellow polka-dot bikini. I had just had my first panic attack (and certainly not my last) in a beautiful hotel room overlooking the beach. Yawning profusely from my lack of sleep, I didn’t tell anyone about my nightmare of a night. I assured myself nothing was wrong while consciously sequestering any sentiments of anxiety. Miami was picture-perfect, and I tried to be as well. 

Later that month, my body felt uneasy during the most celebratory of times. When I blew out my candles on my 18th birthday cake, my dad reminded me to “make a wish!” Every year I wished for the happiness and health of me and my loved ones, taking a moment to relish the warmth of those around me. But this year, my mood regressed sourly as I thought about the ways happiness and especially health can regress. An intrusive chain of thoughts urged me to think about growing older and the possibility of death waiting mercilessly around the corner. 

As I eat my chocolate cake, that familiar pit-like sensation returns to my stomach. I try to push it to the deepest parts of my being, wondering if it's inherently selfish to ruin your own happiness. 

It was in these moments that I always seemed to think of God the most, specifically when I needed something. I was the equivalent of that friend who only comes around when she has a bad breakup, forgetting about you when there's a new swooning love interest. I now think I was rather human, which doesn’t equate to a “get out of jail free card” but is certainly worth something.  

A month later, my parents prayed when I was in the hospital. I wonder if the people on the street had also prayed when they saw the utter collapse of the 1999 pickup truck. Even if they were selfless in their desires, they still wanted something. It's rather ironic. When my cuts sting in the shower, I do not feel the sentiment of needing anything. I grasp desperately for emotion or even words, without tangibly holding anything. 

And there it is. A subtle juxtaposition to all that I have ever known; a dissonance in the looming anxiety that had gradually piled up. Like a weatherman, I had lived life constantly dreading the storm, overanalyzing every mere drizzle of rain. But now it had rained and poured, and I was burnt out from caring at all. 

My minimal stability is jolted by a robust tap on the shower curtain. In my drowsy state, I cannot comprehend why my kitten is staring into my shower with bright blue eyes. My cat enhances my sense of disbelief, perching herself on the shower ledge and focusing her gaze on me. 

All of a sudden, I can't look away from the disturbing pool of blood juxtaposing the beautiful white marble shower. I realize the severity of the situation, the bitter truth separating before and after. I realize I'm in the after, because my body is gashed and there's broken glass everywhere. 

Upon seeing my kitten in the shower there's a silent catharsis. The shower covers the sounds as I begin to cry, naked and exposed. As cold tears pour, I mourn all the moments I shed away in worry. As if accepting my survival could take back all my previous doubts, I feel somber clarity. The anxiety reaching its peak throughout the last few months suddenly halts, seeming trivial now in the scope of things. 

I ask myself what it was all for, the stream of constant anxiety that has progressively plagued me. Now the coin had flipped, and my worst anxieties had come true. What now? Will my fear of everything rise like the tide, or will it flow back and retreat? 

 I’m not sure who I am with a constant rain cloud hanging over me. Maybe I'm lucky enough to have things worth missing, desires worth yearning for. I suddenly noticed my cat’s brown fur was soaked from the shower’s stream. She stays put, a strange phenomenon for felines who are typically hydrophobic. Somehow this validates that there's a plan for me, more life left ahead.

I think about God and all those times I anxiously craved something beyond minor. It's funny now as I delicately extract glass shards out of my hair. I wonder how many people prayed in the hospital at the same time as my parents. I wonder if those prayers were more genuine, more emotionally volatile than the ones in church.  

I implore myself to be better than I have been as the cold water sinks deeper into my open cuts. I reminisce on everything I'm grateful for, everything that has continuously gone right when I worried it wouldn't. At this very moment, I don’t feel like I need anything, for I am overcome by gratitude. I simply put my face under the cold tap to reinvigorate my feeling of being alive.   

Then, I put my hands together because this seems like a good time to pray. 

 About the Author

Ella is a third-year student at Northeastern University, studying psychology and behavioral neuroscience. In her free time, she is a part of numerous research groups on campus and loves creative writing and fictional storytelling.

Photo credit: Joy Stamp

The unit is separated from the outside world by two pairs of locked double doors. A blinking green light and a soft beep herald our passage through them into a no-man’s-land where a guard sits, patiently unlocking the doors as we come and go. When I enter the airlock the first morning, hang my coat and stow my backpack, it feels as though I’m in a sci-fi movie, an intergalactic explorer awaiting my first excursion into the uncharted expanses of space. The atmospheres equilibrate and, I will soon learn, norms are stripped away, decompressed. Not sure what to expect, the door chirps open and I step into my month-long rotation on the inpatient psych ward.

Each morning, residents, psychiatrists, nurses, social workers, and I pile into a tiny, windowless room with chairs pushed up against the walls in two rows facing each other. I am the only medical student among them, a wide-eyed interloper squeezing into a center chair. Patients are led in one by one to sit beneath a watercolor painting of goldfish in a pond while we ask them things like, “How is your mood today?” and “Did you need your Zyprexa to sleep last night?” A pleasantly psychotic woman, untroubled by her delusions of being a powerful real estate lawyer – she is homeless but insists that her office has faxed her discharge paperwork – doesn’t seem to notice that I’m there. With fifteen or twenty minutes per patient and our elbows and knees bumping up against each other, these encounters are concentrated in time, in space, in feeling, and they leave me jelly-legged and dazed when I finally stand up hours later. Every minute I’m cycling through the full range of human emotion, from proud to sad to irate to hopeful. I fidget in my chair as tremulous patients beg for benzos. I hold back tears as a suicidal businessman crumples wet tissues in his bandaged hands. Sometimes I just stare at the goldfish and wonder if this is what it’s like to be crazy.

One day a few months prior on a surgery rotation, I stood in the OR at the end of a long case, carefully running a subcuticlar skin closure.

“You’re a natural.” The surgeon, arms crossed, looks over my shoulder. “What specialty do you want to go into?”

“Neurology.” I watched the last stich pull the skin into a taught pink line the patient would remember me by.

“Neurology?” She sounded confused. “But don’t you want to fix people?” Her jaw was tight and face serious.

This was nothing new. From the beginning of medical school we are taught to diagnose and treat. We recite mnemonics for the acute management of myocardial infarctions, and can name first, second, and third line therapies for asthma. We titrate blood pressures to evidence-based levels, and feel weirdly satisfied when our heart failure patients pee after a dose of diuretics.

We are taught to grow from the first year student who can report that something is wrong to the doctor who can do something about it.

On the psych ward, my patients’ foggy insights clouds my own. I find myself in the thick of the confusion with them, trying desperately to “fix,” to “cure,” to achieve some venerated end I had been conditioned to strive for, and driving myself insane with an inexplicable rage when I can’t. A woman with a functional tic can’t accept that her problem is not the result of medical errors and refuses psychiatric intervention. A kind man with bipolar disorder and an addiction who got high and tried to crash his yacht tinkers with his medication doses and stares silently out the window at the sailboats dotting the river below. A deeply depressed attorney can’t allow himself to just feel sad. Seeing them every day is excruciating: each carefully articulated question I ask falls flat, and simple conversations quickly turn into circular back-and-forth’s that devolve to the absurd. Every day I feel like banging my head against the wall, and each night I drag home the weight that others can’t carry.

Shelly* is 30-something, wiry, all clavicle and bony knees– breakable, almost – with thick glasses that magnify her round eyes and give her a permanently forlorn look. She wears Victoria’s Secret sweatpants with a black sweatshirt and Ugg boots, her long brown hair pulled into two braids that fall down her back.

The night before her arrival, she had lined up her anxiety pills, her mutinous artillery of serotonin and GABA, in one last attempt to create order in her chaotic life, before swallowing them one by one. However, her final act of treason was interrupted, and she ended up with us. When we first meet, she is reticent, eyes downcast, giving up only a word or two in barely a whisper. But soon, she opens up.

Two young women in a foreign land, we hit it off: she shows me the drawings she makes in the journal she guards tightly against her chest with crossed arms as she walks around the unit, and talks about seeing her dog when she gets home. She is tougher than her small frame lets on, both physically and mentally. After a week of dutiful CBT practice, she is deemed ready to go conquer her automatic negative thoughts on her own, out in the real world. On the last day of my rotation the two of us sit under the goldfish, talking about going home, about passing through the airlocked doors back to the outside world. Suddenly, her face clouds and she begins to cry for the first time since she’s been here. I hand her tissues.

“What’s wrong?” I break the silence.

“I feel like a failure,” she says through tears. “I’ve worked so hard, what if I’m not actually better? What if I go home and it all starts again?”

I pause.

“Well, at least you’re trying, right? That’s pretty good.” I watch her think about this for a moment, brow furrowed, tiny fists balled in her lap.

“Yeah,” she smiles a little to herself, eyes looking thoughtfully at the floor. “I guess that’s something.”

Back between the doors, I wait for the green light one last time. Four weeks, ten discharged patients, dozens of prescriptions, and countless long silences later, I don’t think I fixed anyone. I sat with them, though, through all the tears and all the tic-ing, and heard what they had to say. Maybe this is how we help: we shelter, we stabilize, we listen, and we together we take steps, however small. We may not always be able to fix. We may not know what happens when our patients leave the quiet of the pond for the rough ocean waves. But we try. Well, I reassure myself, I guess that’s something.

* Name has been changed

Emma Meyers is a third year medical student at Harvard Medical School. She grew up in New Jersey and graduated from Columbia University with a degree in neurobiology. She plans to do a residency in neurology. Outside of medicine, Emma enjoys art, reading fiction, hiking, cycling, and traveling.

"Three Pairs" by Nicolette Overton

“It was incredibly hard. I learned more than I ever thought possible.”

My childhood friend Allison had asked me about my third year of medical school, which is notorious for being challenging, overwhelming, exhausting, rewarding, and exhilarating.

The first two years of medical school are typical school with weekday classes and unit tests every few weeks. Then during third year (called “core clinical” year), we are immersed in the day-to-day work of being a physician. We spend approximately 8 weeks working with resident teams in the hospital in each of the core medical disciplines: internal medicine, surgery, pediatrics, obstetrics/gynecology, and psychiatry. At the end of each rotation, we complete a national exam.

I went into third year expecting to apply, reinforce, and build upon the book knowledge accrued during my first two years of medical school, blissfully unaware of the uncertainties and philosophical challenges inherent to a patient’s medical care. But during third year, I mainly had to learn acceptance. Acceptance that medical decisions are rarely obvious, that internal validation need not be secondary to external validation, and that the best patient care starts with proper self-care.

As medical students, we have a vague understanding of the limitations of medicine. A Wall Street Journal article entitled “Why Doctors Die Differently” by Dr. Ken Murray details the phenomenon of medical professionals utilizing fewer medical services than the average American when making end-of-life decisions. Medical professionals witness patients receiving interventions that prolong the days, but sacrifice the quality, of life. People who work in medicine see the tolls that CPR, feeding tubes, and ventilators place on already vulnerable patients. The general public has been primed by the media to see these treatments as more often life-saving than not. Those without medical backgrounds hear what is possible; but medical professionals recognize what is realistic. During medical school, we are taught the contraindications to certain procedures or treatments. There is rarely discussion about what to do in that murky in between: when something can be done, but may not be in the patient’s best interest.

I will never forget a patient I had on internal medicine whose daughter demanded he be “full code”, meaning that if the patient went into cardiac arrest he would receive CPR and a breathing tube to be kept alive. The patient was 88-years-old, with metastatic colon cancer and an infection in his blood. I felt for the daughter of the patient. She had no other experience with this sort of care. I also felt for the medical provider, who described that giving this patient CPR would be inflicting immense pain and suffering (ribs break during CPR) to a patient who had an already poor prognosis.

These situations were common in the hospital. In these moments, I felt as if I existed in limbo. I resided in the in-between space; I was both the medical professional and the patient’s daughter. It was from this vantage that I realized everyone has the same goal: self-preservation while acting in the patient’s best interest. Each side just approaches the situation from a different angle.

End-of-life discussions were the moments when I grew the most. All of the physiology, pharmacology, and anatomy that I fervently studied meant very little when trying to quantify the quality of a patient’s life. I came to understand that sometimes, the best thing to do is step back, assess the bigger picture, and ask ourselves what we are trying to accomplish.

I also took stalk of my own life during third year. I have always put pressure on myself to be “the best” and honed study skills over the years so that I know what I need to succeed. In third year, the evaluations by our attendings and residents are also factored in to our final grade. The way a student’s personality, interests, and sense of humor jived with a resident’s often reflected the student’s grade more than anything else. In the beginning of the year, I would often change my interests and style to fit that of the attending. I approach medicine from a bio-psycho-social perspective, but many of the doctors with whom I worked did not. Often, a doctor would scoff at the socio-economic factors involved in the patient’s health. I would feign disinterest, if only to appease the resident. As the year went on, I came to value my opinion of myself more than any one attending or resident’s opinion of me. Patients went out of their way to thank me for my help and ask for me to be there with them during procedures, which reassured me that my approach is valid. Though I did not always receive the best numerical grade, I was able to sleep better knowing that I provided patients with what I believed to be the best possible care.

Third year forced me to consider the big questions. I needed to come to terms with the impossibility of being “the best”, realizing that it can be easy to become so hyper-focused that we neglect what’s truly important. I faced my fears: not only will I not excel at everything, but I can’t expect myself to. I realized that ethical gray areas exist, and that what I typically worried about didn’t really matter. I had to start balancing self-care with self-actualization, and for that I would not trade anything.

Alyssa Wohl is a now fourth-year medical student from New York. She is hoping to work as an Adolescent Medicine doctor. She enjoys chocolate, yoga, and spending time with her two pugs.

This patient on my mind—let’s call him Sam—is smart. Sharp might actually be a better word. He knows what he should say to get out of here, and he probably even knows how to do it gradually enough so that we believe him. Sam knows our attending thinks he’s afraid of people caring about him, for instance, so he could play that up and pretend to let him in, fabricate a healthy exchange. These are the thoughts I have about Sam on the walk home, typing furiously away at my notes in my phone, with the hope that they’ll stay in the document and out of my head. I think about Sam, what he says, and what he actually means.

Sam has made multiple attempts to kill himself. He’s had a tough life, and I won’t attempt to explain the root of it all. He accepts his pain as constant, and he does so without drama. He fits the criteria of involuntary commitment because he’s at what’s considered an “unacceptably high risk” of hurting himself if he’s discharged, and he’s waiting for placement at a state hospital, where he’ll be for an undetermined amount of time. Sam keeps asking what the point is, saying that he’ll kill himself when he leaves, that he doesn’t envision a future for himself. Still, he repeats all the things he knows will keep him here. Why does he set himself up to be institutionalized, if he really wants to leave and end it? Does he want help, but is so incapable of asking for it, that he’ll say whatever will compel us to keep him here? How can we connect to him, if that’s the case?

At first glance, Sam looked to me like a lot of teenagers do, with this angst sort of hovering over him, sulking around with huge headphones on and refusing to show up to morning rounds. I’d catch him at groups, sitting with his hands glued in his pockets or folded against his chest. When I say Sam is smart, I mean I think Sam is probably a lot smarter than me. He’s cynical, with a sort of wisdom and a dry humor that ages him and makes him easy to relate to. Sam will laugh at you when he knows you’re trying to “doctor” him, an effective way to puncture and deflate your ballooned ego.

He brightened up a little while we played scrabble during group one afternoon, making me think for a moment, I don’t know, maybe there’s a chance for him. It’s frustrating, maddening even, to see a guy as sharp, as funny, as “normal” as he is, describe how painful life can be, and watch him carry that pain so complacently. But I can’t be mad at Sam for being in the kind of pain he’s in, I can’t even blame him for wanting to hurt himself. The fact is, I’ve only been here a few short weeks. Who am I to say he’s being selfish or pessimistic? Through his charm, in a way, Sam throws a wall up around himself, one you feel like you can’t tunnel through no matter how “real” you are with him. How can you really know him? How can you understand what he’s going through, and how can you know what to do to fix it?

I like to check off boxes, to feel like I’ve accomplished something. I like to feel as though I can walk out of a patient’s room having made a genuine attempt to contribute to their care. With Sam, it feels impossible to do that. At the end of the day, I am one of a batch of students with stiff, starchy white coats that cycles in and out of this locked unit for six weeks at a time, eager to “let these patients in,” but it’s likely that nothing will change for Sam and his painful reality in that time.

I pursued medical school with an idea. I even wrote about it in my application. I wrote that I wanted to become a doctor so I could meet people from all over, each with a story of their own, and that I could take a little piece of them with me and that all those pieces would add up to something meaningful. I think this became a part of my mindset growing up. My dad was in the military, and he traveled all over the world flying huge carrier airplanes. My siblings and I lived on a military base with my mom, and with each trip we waited for him to bring back all kinds of souvenirs and stories. I started to dream up all the places he went to, and the people who lived there. I kept a picture of a pyramid he took while he was in Egypt on my bedside table. I imagined people with lives so different from mine, and I convinced myself that as a doctor, I would find the most opportunities to encounter all these people, to get to know them and become a part of their stories while they became a part of mine.

When I met Sam, I began to wonder if all those pieces I’ll take with me would eventually show me how futile this job can feel. It started to feel like so many of the pieces we take are the ones full of pain and hopelessness, frustration and grief, and fear. My short experience with Sam puts a stark but simple realization back into view. I can’t fix his life, or hand him some profound new way of dealing with it. And it’s not about what feeling of accomplishment I can gain from working with him. All I can do is try my hardest to know where’s he coming from. I can educate myself on all the options he might have—medications, therapy, or anything else I can think of. I can help lay them all out for him and try to be prepared to answer any questions he might come up with. I can be honest with him, and I can listen. I can try my best to know what he cares about most, what he fears most.

Maybe that’s unsatisfying, but I think that’s sort of the point. You have to keep trying, whether or not the feeling of self-satisfaction ever comes.

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Jacqueline Hodges is a third year medical student at Tufts University School of Medicine. She is from Gainesville, Virginia and graduated from the University of Virginia, where she majored in biochemistry with a minor in global public health. Jacqueline is pursuing a dual degree in medicine and public health at Tufts and plans to do a residency in internal medicine. Outside of medicine, her interests include graphic design, hiking and traveling, and eating Korean and Southern food.

Spring 1997

I eye up the worn and tattered catcher’s mitt 20 feet ahead. It’s a warm May morning and the elementary school bus is coming down the street in 10 minutes. But, more importantly, baseball season is finally here. Mom is down in the catcher’s stance, “Fire it in here!” she shouts and then grins at me as I start my wind up. I pull my gloved hand up to my face and tuck my right hand in, resting the ball in the heel of the glove. I take a short step to my right and shift my weight slightly over my right foot. I swing my left leg up high and, pushing off my right leg, send everything I’ve got into the pitch, whipping the ball at mom, as she squats in the grass with the mitt held open wide. The ball smacks into the glove’s weathered pocket with a “Crack!” “Isn’t that the best sound, And!?” she exclaims, firing the ball back to me and readying herself again. We have to get 10 pitches in before the bus comes. There is no secret to being good at something. You just have to love to practice. That is her philosophy. Now it is mine too.

January 2011

It’s now junior year of college and my morning routine has shifted away from baseball. Now I get up, eat oatmeal, and review notes before class. Fewer “heaters”, a lot more books, but the same philosophy: love to practice, love to learn. I write frequently in the journal I keep on my computer. So far it is mostly ramblings -- on my dying faith in the Catholic church (what’s the point of God?), on my breakup with my high school girlfriend (what’s the point of love?), on my fascination with cell biology and chemistry (what’s the point of studying anything else but the pure molecular basics of life itself!?)

In this moment, my relationship with cancer is so ordered and neat and sterile. It is a series of PowerPoint presentations in air-conditioned classrooms. A set of logical experiments, producing clear data from which succinct conclusions are drawn. It is graphs and figures and tables and genes and proteins and signaling pathways. I have a poster outlining all the known cellular pathways that contribute to cancer on the wall beside my bed. Cancer biology is what I do, not something I fear.

April 2011

That ordered, neat, sterile, intellectual relationship with cancer collided with the powerful, unpredictable, emotional, force of real life on a beautiful spring morning later that semester.

I am home for the weekend from school, with my mom. Our morning ritual is to have a cup of Irish breakfast tea together. Always with a splash of evaporated milk and a half teaspoon of honey. We started this in high school when she was teaching 9th grade and I would hop a ride to school with her each morning.

I made my cup and walked out to the back porch where she was sitting, her mug beside her, at our small wrought iron table. If that table could talk, it could tell the entire history of our family. It has sat on the cracked slab of concrete we call the back porch ever since we moved in on Evelina Road

“Good morning, Andrew” my mom says as she smiles and looks up at me from the crossword puzzle, looking not quite her usual chipper, enthusiastic self.

 I don’t remember exactly what we talked about at first, but, eventually, she said to me, “I’ve got some news, And. I went to get this thing on my leg checked out and they said I’ve got some bad cells.”

 To me, immersed in a Cancer Biology class, bad cells equal cancer. No need for further description. I just took an exam on this very topic.  How ironic is that? “Bad cells” stop doing their jobs. “Bad cells” disobey orders. “Bad cells” exhibit the 6 characteristics of cancer, which I can hardly remember in this moment.

“What did the path report say?” I ask. “What kind of cells? How fast are they replicating? What stage is it?” In this moment of internal turmoil, I grasp for what is familiar to me – the science and the cells -- rather than looking for what might be helpful for my mom. She recognizes my angst and -- despite the fact that she received the diagnosis, she will receive the treatment, she will be confronted with  her own mortality in the coming weeks-- she opens her heart and comforts me.

June 2011

You would never find mom inside on a sunny day. She’d be ticking off miles walking all over town with her best friend, hitting the tennis ball with a fellow teacher, or kneeling in the garden behind the house, back bent, hands covered in mud, transplanting some black-eyed Susan’s or pulling weeds. But on this “glorious summer day”, as she would most certainly have proclaimed it, there she was, inside. She was curled up with blankets in her bed, her hair, frizzled and wild, pushing out over the covers. She was now a few weeks into interferon treatment for her cancer. On the days of her infusions, she collapses into bed with chills and whole body aches. It’s jarring seeing my mom so visibly weak. She could not help the shivering. She could not bite her lip and just power through the aches. The interferon was pummeling her and I hated the medicine for doing that, even though I knew, theoretically, that it was helping. I went into the room and wrapped my arms around her without anything to say.

Eventually she completed the treatment and the chills and the aches stopped. The scans came back “clean”; but that might have been the easy part: getting cancer off the scans. The real hard part is getting it off your mind. Mom told me that the greatest challenge after treatment is not becoming obsessed that every headache or cold, sharp pain or little rash is a sign that the cancer is back.

For the rest of us, at least superficially, things seemed to be “normal” again. We didn’t really talk about cancer. We didn’t use the term “remission”. We just assumed “cured.”  It was logical. Plain and simple. Mom had cancer. Mom endured the treatment. Mom beat it. Like we knew she would. We could all move ahead with our lives now, thank you very much.

April 2015

Until last spring, April 2015. She went in for her yearly PET scan. She came back with “findings” that needed to be explored with a biopsy. “This really is not happening,” I remember thinking to myself, “Why not?” came an internal reply.  The worst was confirmed: metastatic melanoma, stage IV cancer (“That’s the last stage,” I remember telling my older brother when he asked me how many stages there are).

September 2015

Now I’m in the first year of medical school. Tomorrow we will be talking about melanoma in class. I am doing the reading to prepare and I come across the survival statistics. Odd that I have never actually looked this up myself before. The five-year survival rate for a person with stage IV lung metastases is 17%. I stare at the accompanying figure, a Kaplan-Meier survival curve. Looking out at the 16-month marker on the x-axis: not many survivors. Were all those dots on the chart really someone’s mom or dad, or brother or sister? I keep reading, “Malignant melanoma is the cutaneous neoplasia with the greatest mortality rates and one of the malignancies with the highest potential of dissemination. The prognosis of patients with metastatic melanoma is grim…” Time for a shower, I think,. Enough studying for tonight. I walk down the hall of our dorm in my sandals, head straight to the showers and turn the water on hot. I get in and stand there for a few moments, letting the water pour over me. “The prognosis is grim,” I think to myself, “17% survival at 5 years.” “Shit,” I whisper. I am hit with this longing to see my parents and be with my brothers. I picture my mom’s funeral. My brothers carrying the casket. I picture my dad speaking at the wake, thanking everyone for coming. There’s my mom’s sister and brother. There’s her best friend. There are her nephews waving goodbye to her. I picture my mom on the back porch with a cup of tea, looking toward the sun. The hot water runs over me and I weep. I cover my face, but what is the point? I can’t stop it; the tears flow, falling off my face, joining the water droplets from the shower, crashing into the tile and falling down the drain. I want to follow them down there.

September 2016

I pull a mask over my face, slip a pair of gloves on while I make my way over to the metal table to join my classmates, who are peering over specimens while a pathology resident asks a question: “What do you guys think this person died of?” I pick up the cold tissue in my hands. Definitely a lung, though it is collapsed now, greyish-tan color – bland, lifeless. The tissue is dotted by small dark specks, some as small as a pencil’s tip, others the size of its eraser. I roll these little specks through my fingers. They are smooth, but irregularly shaped. They are hard and stick well to the tissue. They are uniformly black. “Is that from smoking?” a classmate ventures. “No, but good guess!” the resident replies excitedly, “That black stuff isn’t from particulate matter. Think about what cells can make that sort of pigment.” Another student speaks up, “Skin cells. Melanocytes produce pigment!” The resident, who nods in approval, concludes, “Yes, this patient died from metastatic melanoma.” The group shuffles to the adjacent table where diseased kidneys await us. I stand with the melanoma lung in my hands and roll my fingers over the small bumps again and again.

As a medical student, I’ve learned enough to fear diseases like cancer, by studying their pathology, watching tumors excised from abdomens in the operating room, or as I did recently, holding the nodules of metastatic melanoma in my hands.

But as a son, the disease is not so much what I’m afraid of…loss is. The cellular morphology isn’t scary. Even the scans aren’t that scary. The thought of being without someone irreplaceable, like my mom, is what is terrifying.

Sometimes I try to live only as the medical student, sometimes only as a son. This experience, I’m learning requires both, and, as a great poet has said, the only way forward it seems, is to live like the river flows, carried by the surprise of its own unfolding.*

* John O’Donohue

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Andrew is a second year medical student at Harvard Medical School.