“And I was sick with heartache, and she was sick like Audrey Hepburn when I met her. But we would both surrender. True love is not the kind of thing you should turn down.” – January Wedding, The Avett Brothers

The second week of September was the epitome of emotional whiplash. Monday the 12th, we celebrated our one-year engagement anniversary in the ICU. We had gotten engaged in an apple orchard, so I brought in apple cider and cider donuts. She still wanted to keep fighting and didn’t want her doctors to give up on her. She was on four mcg/min of norepinephrine to keep her blood pressure up.

Tuesday: our scheduled family meeting was postponed to the following day. Meg’s mental health took a big hit that day. Ten mcg/min of norepinephrine.

Wednesday: We had a family meeting with her parents, oncologist, nephrologist, and critical care attending. Her hypotension was limiting how much fluid the continuous renal replacement therapy (CRRT) could remove. Meg had accepted that things weren’t going to get better, and she felt at peace. She finally agreed to get married. We started talking about having a wedding in the hospital chapel on Saturday. Sixteen mcg/min of norepinephrine.

Thursday: I stopped at the first jeweler I passed and bought basic wedding bands for myself and Meg that would be ready Friday morning. Bought a new suit that would be ready Friday evening. Meg was still feeling okay and had some food. Her blood pressure was needing more support and she was started on vancomycin and meropenem. I asked her team if the wedding Saturday was feasible. Due to her condition, her nurses explained that she’s too unstable to go down to the hospital chapel as we had hoped. We would have to do a ceremony at bedside with only seven visitors. Norepi 34 mcg/min, vasopressin 0.04 units/min.

Friday: I get a call from her father that she is needing more pressors and her doctors recommend doing the wedding today. She was in more pain today as the CRRT was no longer removing fluid and pressure was building in her abdomen. Stress dose steroids and caspofungin added. Norepi 46 mcg/min, vasopressin 0.04 units/min.

Please let this happen. Should this happen? I don’t know if this is the right thing to do anymore. It wasn’t supposed to be like this. Zugzwang.

We scrambled to get things together for the wedding to happen that afternoon. My mom managed to get a simple cake. I picked up the rings before heading to the hospital. Her mental status had faded from the day prior, and she was having trouble answering questions and staying alert. We were able to have the ceremony with our families at her bedside.

As soon as it ended, she slept, and she did not regain consciousness. Meg used the last of her strength to get through the ceremony and say she wanted to be my wife. She passed away the next morning with her parents, her aunt, and me at her bedside.

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“Opening your heart sucks.” –Duncan Trussel

Those who know me often describe me as reserved, calm, easy-going. I don’t wear my thoughts on my sleeve, and I try to keep things close to the chest. My demeanor has often been mistaken for apathy, which on occasion caused problems as a med-student. Some attendings didn’t give me the most favorable evaluations, stating that I looked disinterested and bored. Those who are closer have seen those walls come down to see what hides beneath the surface. It has never been easy for me to open up.

One day on the phone, when my brother asked how I was doing, I replied, “oh you know, just quietly suffering.” In his conversation about grief with Stephen Colbert, Anderson Cooper discusses how people often have an unmet need to address their grief. “People are suffering in silence, and there’s not a lot of outlets for that.” While we often at a loss for comforting words when someone experiences grief, sometimes all a person needs is acknowledgment of their experience.

Despite my best efforts to maintain my calm, cool persona, I couldn’t always keep up the facade.  As Suzanne Minor said, “I wasn’t allowing myself to experience the full spectrum of emotions and by doing so, wasn’t allowing myself to be in the same arena of life as everyone else. There was even a little pride involved in my apparent strength.” I shared this feeling of pride before Meg’s health took a turn for the worse. I had survived my intern year despite everything that was happening. I dominated my board exam, and I was on track to present my research project at a conference, all in the face of overwhelming grief. Though more often than I expected, I couldn’t hide what I was going through.

“Come on, there’s no way to stop the heartbreak,” Duncan Trussel asks, “what do you do about that?”

“You cry. You cry.” Deneen Fendig, his mother, replies.

I cried, a lot, in front of many different people. My family, Meg’s family, friends, co-workers, Meg’s doctors and nurses, my own doctors, therapists, program directors and chief residents from two different residencies; all of whom have seen me in my most vulnerable and exposed state. I hated the helplessness and feeling that I was an emotional burden on others. I’m thankful that I had so many supportive people around me.

Comedian Duncan Trussel hosted his mother, Deneen Fendig, on his podcast who was dying from stage-four breast cancer. Their conversation is one of the most enlightening and heartbreaking things I have ever listened to. Deneen had been dealing with the diagnosis for years and was approaching it from a perspective of peace, learning, and love. I wish I could write the entire transcript into this paper.

When talking about feeling closed off with sadness, Deneen says:

‘It breaks your heart open. Our hearts have been closed because we’ve defended ourselves against pain and this is the kind of thing that opens them.’

‘It hurts, does it always hurt? Are you just in a constant state?’ asks Duncan.

‘Even the hurt transforms,’ says Deneen. ‘When you inquire into the hurt, you know what you are experiencing is love, the real deal […] That kind of love aint’ going anywhere. And that’s what you find, that I may leave this plane of existence sooner rather than later, but the love isn’t going anywhere.’

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“Even if we’re not changing on the outside, we’re changing on the inside constantly. There’s some stuff about me that I’ve been ignoring for a long time. I’m afraid of that stuff, but it’s part of who I am. As long as I know the shape of my soul, I’ll be alright.” —Adventure Time

I did not want to go back to work when the dust settled. How was I supposed to work in the same hospital where my wife just died? I wanted to flee back to Vermont where the compartmentalization was easier, but I knew it wasn’t realistic. When I went back, the familiar ache of pretending everything was fine crept back in. Some days are harder than others. You never know when a wave of sadness is going to rush in.

“What made you transfer to this program?” someone would ask.

“Family stuff…” I’d reply vaguely.

There is no separation of my personal life and work life. There are reminders about what happened all over the hospital and in so many aspects of medicine. It’s inescapable, and I constantly get flashes of different ways she suffered.

“You know what’s not fun?” I said to a friend, “the infectious disease doctor presenting a case for noon report and knowing the answer is PTLD and answering anyway because no one else is saying anything.”

“I know the answer from my personal trauma,” she replied, as if impersonating my psyche.

I tried to avoid eye contact with the ICU whenever I walked by, but the worst was going back to the cancer center. It had been three months since she had passed when I saw a patient in the cancer center for the first time. There were too many bad memories, too many reminders. I hate that place. I felt tears welling up in my eyes because I really didn’t want to be there, but as always, I found a way to stuff it down, act like everything was fine, and present the case to my attending.  Sometimes you just have to find a way to get through the day.

I knew residency would be hard, but now I find myself struggling with depression and burnout that makes me regularly question my decisions. I’m still not sure how I managed to push through it; looking back it almost seems foolish. Adrenaline and cortisol were somehow keeping me going, but the sunk-cost fallacy seemed to keep me from dropping out.

“You’ve crossed the finish line, won the race but lost your mind. Was it worth it after all?”

Imposter syndrome has become a familiar feeling, to the point I have trouble accepting positive feedback.

“You’re doing good work,” an attending told me.

“Are you sure?” I said back to him, skeptically.

As I have become my own biggest critic, I must remind myself that I have come a long way in my training.

This experience has allowed me to empathize with patients and their loved ones in a way that I wasn’t able to before. Understanding that those with cancer often face so much more than just the cancer itself. Confiding with younger male patients that it’s okay to be emotional even when there is an expectation not to be. “I’ve cried a thousand times and I’m going to cry some more,” said Macho Man Randy Savage. “There’s one guarantee in life and that’s that there are no guarantees.” Being able to level with patients, knowing what it’s like to feel pain, can be valuable, even if it is emotionally taxing to do so. I always hope that I’m helping someone when they open up to me, even if it does set me behind in my clinic schedule.

I’ve also become more understanding of families that aren’t ready to accept the withdrawal of advanced supportive measures. In medicine, we are biased in how we see end of life care and how suffering can be prolonged, but it’s important to remember not everyone sees it that way and emotions are irrational. In Family Portrait, Dr. Joseph Fins says, “Their demands for ‘futile care,’ which can be perceived as delusional and irrational are the result of the same forces that led me to hope against hope […] we should be more tolerant of families as they confront their own tragedies. It is never as simple as the philosophers would have us believe.”

Anderson Cooper asked Stephen Colbert if he has any advice for those experiencing grief:

“Try not to be alone, talk to somebody if you can. Don’t be afraid to talk about it.  Don’t be afraid to talk to somebody who has lost. … don’t be afraid that this moment of loss will last forever, your memories and love for that person will last forever and the pain will change, like wine, into something else and that grief can become a form of wisdom about your human experience that you can share with other people. But for now, accept help when it’s offered if you can. Be patient with yourself and if you have the opportunity, talk to somebody about it.”