Abstract
Before I ever experienced loss, I was taken by a fear of what could go wrong with my body and the bodies of the people I held dear. I feared that harm would strike my loved ones, and even grew superstitious over preventing death I had no reason to believe was coming. I was given a comfortable, safe, and healthy lifestyle in Palo Alto, California, which, as far as my fears went, statistically placed me and my loved ones among the least vulnerable people in the world. As spoiled and privileged as it sounds, I still found myself frequently falling into rabbit holes of magical thinking to ward off tragic fates, and still struggled to accept the lack of total certainty that we would always be alright. That is—oddly enough—until people I loved inevitably began dying, and my grapple with death began to take on more productive forms.
My premed pursuit of medicine evolved when my 22-year-old cousin succumbed to H1N1 complications on the last day of my freshman year of college. Seeking guidance beyond my family and friends, I was drawn to a palliative care class in hopes of making some kind of sense of several levels of shock. I was amazed by a physician's ability to remedy a broken body, but as my cousin's illness ultimately precluded cure, I stood to learn from clinicians who continued to heal despite imminent death. I shadowed a palliative care doctor for a year and watched an abundance of parents, children, partners, and friends forced to make peace with catastrophe. This was a space imbued with genuine care, and I was inspired by my mentors who faced illness in its insurmountable form.
These experiences that situated me closer to death were both painful and educational. As the son of a physician, I always tried to view the world through a logical lens. Yet I still struggled to accept the human body's impermanence. Sometimes, this meant prayer—despite having no true identification with organized religion. As a college freshman, it meant falling victim to the human tendency to ascribe meaning to anything that hurts us, and chalking up my smiling, kind, and innocent cousin's death to a tragedy that happened for a reason. As a college graduate armed only with a premed education, it meant rationalizing the loss of a friend and father figure by pointing to a few of his unhealthy eating habits and their role in cancer pathogenesis. Over time, science classes, clinical experiences, and the humanities undeniably gave new shape to my attitudes toward death, but I still never felt I was getting it quite right. One year into medical school, my perception of the human body has undergone a significant metamorphosis. Naturally, so too has my relationship with death.
Although the first year of medical school seemed to represent only a small fraction of my education, this time included unprecedented formative experiences. Gross anatomy laboratory was one example of a privilege totally unlike any before (and one provided by generous former patients and their families, whom we can never adequately repay). I nervously anticipated the first sight and smell of the donor's dead body. When the time came, however, I was surprised to have felt undisturbed. Week after week, we sliced, sawed, and disemboweled our lifeless donor while I faced far fewer negative emotions than I expected I would. I suspect part of my calm could be explained by the lofty standard of professionalism I sensed I ought to live up to amid such a unique learning opportunity. Perhaps part of it was denial—it certainly would not have been the first time I handled an emotional challenge with an artificial poised demeanor even I could not see through.
Outside of the laboratory, however, death became palpable at a new intensity, one that surpassed anything I had known from palliative care shadowing, hospice volunteering, or even the loss of a loved one. I certainly emerged from those opportunities and experiences with a deeper understanding of suffering and dying. I understood from them that death can strike anyone, even people I had friendly conversations with or held dear. However, these circumstances did not involve detailed explanations of the biological mechanisms that kept us alive, and they certainly did not provide me with the chance to see with my own eyes the organs and tissues responsible. Before medical school, the human body largely remained a black box. I was, therefore, afforded enough distance from the tragedies I witnessed to allow me to do what young people often excelled at: distracting myself from inevitable mortality. Understanding anatomy, physiology, and pathology weakened the privilege of ignorance. The fantasy of an attainable immortality—a persistent presumption I held that was gradually waning in medical school—took its greatest hit ever during my first year. The body became a complex machine, both astounding in its durability and frightening in its potential to break. I felt this at unexpected moments. A particularly strange occurrence took place during nights, as I started waking up briefly terrified for my life. The sound of my own heartbeat scared me for a just a few seconds before I oriented myself. Lubs and dubs reminded me—again and again—that I was trapped inside a body I had little control over. Then I'd come to my senses, and I'd go back to sleep.
In the early stages of the COVID-19 pandemic—when all we knew was that the fast-spreading virus was killing those >60 years, and all we saw was New York and Italy in near-cataclysmic conditions—I thought of death a lot. I, like many other 20-somethings, seriously considered the possibility of my parents' mortality. I questioned whether the “asthma-like symptoms” the Lebanese village doctor diagnosed my dad with when he was a boy was a pre-existing condition serious enough to kill him, were he to be infected. I thought of my cousin losing her life to an infection with a low mortality rate and wondered whether the young people I knew could be among the outliers inexplicably attacked by this stronger virus. It was difficult to bask in any level of reassuring, blissful ignorance with the education I was receiving. I was concerned, and my ongoing training justified my fear. Yet I also felt incredibly lucky to be able to navigate this difficult global moment as a future physician. I could feel myself evolving. I was better able to remain up to date with frequently emerging scientific literature, and to differentiate fact from fiction. Family members lacking a medical background sometimes looked to me for a reliable take on the latest coronavirus news—I hadn't been in that position before, and calming others brought me composure. On a small and internal scale, I began to settle into my eventual doctor responsibilities. To do that, though, I had to recognize my own good fortune—my classes proceeded through the pandemic, my family members were able to continue working relatively safely, and my loved ones were generally in very good health. The security I sensed from these sources of privilege gave me great capacity for empathy, and empathy delivered me from my anxieties.
Those in the medical field are familiar with a lot of frightening ways things can go wrong for a person, and as a rising second year medical student, perhaps I speak out of turn when I surmise that applying this information to the care of others brings a provider great peace. One day, when I know a lot more than I do now, I will be capable of treating patients. I will help them overcome certain illnesses, and I will do everything I can to support them through diseases that become unconquerable. I imagine that is when I will accept death.