It’s a strange, contradicting, emotionally volatile confluence of events and circumstances that make today particularly…draining. Infinitely exacerbated, firstly, by a total lack of sleep. In hindsight I should have been prepared for that. I was scheduled for, and participated in, night shifts in the ICU all week. I trusted (naively, and with willful ignorance hoping to satisfy my re-invigorated predilection of doing absolutely nothing as often as possible) the anecdotal advice of a fellow 4th year who assured me that nights involved sleeping, ignoring pages, and leaving no later than 3am after having spent the first 8 hours of the shift mostly sleeping anyway. But you can be assured my supposed respite granted me exactly no sleep and no disregarding of endless pages, codes, falls, intubations, and deaths. It’s an ominous sign when in the first hour of the week the attending refers to you as an “intern” and refuses to accept that “quiet” is a forbidden adjective to describe the pace of the shift… I digress. Suffice to say that 10 hours of sleep between Monday and Thursday guaranteed a tumultuous response to both wonderful and saddening news on this day.
Match day is today (I guess yesterday as of me finishing this…). That day of the year when an unnecessarily stressful, anxiety-inducing system releases the results of its cryptic calculus that matches 4th year med students to residencies across the country. The catch is: the system knew well in advance of today what those results are. In fact, it was reveled on Monday if these students matched at all, cliffhanging their geographic location and program to exert more sadist control over its future doctors. VERY fortunately for me – the military match was almost 2 and a half months ago. A simple email (at my top choice!) that let me and my very small cohort revel in the fruits of our 3 and ½ years of exhausting undergraduate medical education. So, I spent last night gifting to my friends all of the positive energy I could muster (and Pizza Luce of course) to assuage what is an undoubtedly a nerve-racking night and following morning. Physically distanced tacit avatars adorned the screen of 200+ 4th year medical students’ computers this morning to join in ceremony as the results were delivered.
I was not in attendance. I was driving quickly down to Rochester (the state patrolman thought he was “fair” giving me only a ticket for speeding, and nothing for my expired and insurance and license. I thought he was a prick for pulling me over at all). I drove to Mayo to meet my parents and advocate for my dad in the conversation between him and an oncologist. The first of many visits to a man whose abjectly horrendous bedside manner conveyed no empathy uttering “3-6 months” as a prognosis for metastatic cancer. It’s not in my professional, or even personal, interest to disparage a future colleague – but really what the fuck is wrong with you?
It wasn’t exactly a surprise to me. Hepatocellular carcinoma and cholangiocarcinoma are generally bad, and I’d already read the pathologist’s report from the lymph node biopsy that this is what they’d discovered last week. The same cancers thought to be confined to a now explanted liver 4 months ago. The term diagnosis is meaningless, however, without a prognosis. Who cares if you have cancer if it doesn’t do anything to you?
3-6 months – that was a surprise to me. And still is. My cursory search of UpToDate and PubMed hasn’t given me any actual data on how this “doctor” prognosticated a patient’s cancer for whom he hadn’t even suggested a treatment regimen yet. We would have to wait another hour before seeing an actual doctor, my father’s transplant physician who basically strong-armed the hospital to get him a liver, to be assured of (perhaps) a year, perhaps more, with the right chemotherapy.
The moments between the oncologist’s grave callousness, the hepatologist’s much needed encouragement, and the goodbyes said to my parents as the valet returned my dad’s truck were intercalated with moments of vicarious joy reading texts from friends sharing the match results. I oozed with excitement for my friends, but Newtonian reciprocity matched my joy with visceral heartache as my sleep-deprived and emotionally taxed neurons fired aberrantly. Thoughts of my friends starting their new careers all over the country denigrated to images of my father’s future – losing hair, strength, mentation, all over again – found cerebral real estate in my mind as we waited in the clinic lobby. And just as quickly my bleak imagination vacillated to hopeful future. I stifled tears as I thought of the pride I know he’ll feel being with me when I graduate. A moment that just a months ago, before the transplant, I justifiably doubted he’d survive to. A ceremonious event made all the more special now that this new lease on life may have been cut short once again.
“Making serendipity happen.” Our medical school dean shared this phrase moments before my class was revealed the match results. A sentiment guiding us to accept, whatever the results, our residency locations with an open-mind and heart, so as to ensure that we find our purpose in wherever we end up. How prescient, how serendipitous, it was for me to allow the words of a wonderful friend last Fall to teach me, ever so gently, the concept of grace. To hear those words in just the right way, at the right time, to allow grace and forgiveness to find a home in my soul. How serendipitous it was, in those precious few months between my father’s transplant and now today, that these new lessons helped me intentionally forge a bond that for decades has been delayed by my petulance, pettiness, and grievances – however “justified” those grievances were. The inertia of our identities as permanent is responsive only to the incessant bombardment of serendipity that allows us to accept growth and change – for the better.
I don’t know what the future will bring. I don’t know how I will exercise my newfound practice in unconditional love to my father, my family, my nieces and nephews. I don’t know how I will handle loss, when it comes, now that I’ve built (however frail) courage to be vulnerable to losing the receivers of that love. But I do know that the arc of fate is not permanent – the cultivation of our own serendipity is not divinely exacted on us but appears more often the more often we recognize it. It happens all the time, all around us. Sometimes we receive it as the subtle passing words of a friend discussing grace, or we share it unknowingly to an acquaintance. But those fleeting moments of serendipity are also just that: forgettable events destined to impact nothing unless we fan their flame. Unless we give those chance encounters our attention when we perceive them. Unless we give space to, and act on, uniquely profound sentiments or ideas. Or even simply say yes to a new friendship from a colleague’s email. Those moments in life that engender greater awareness, love, grace, and compassion surround us – as long as we keep open the space to let them in.
It’s difficult to write this, and harder to feel it, and harder still to stay awake. So I’ll leave it at that.
Take care my friends – you are all loved deeply!!