I Love You – JAMA A Piece of My Mind, by Cara Anne Poland, MD, MEd

Mom was ill for 7 years. She died in the afternoon. That same morning, after years of fertility treatments, I’d heard my son’s heartbeat for the first time. 

Ironically, I’d just given a lecture on end-of-life care. After the lecture, I looked down at my phone—service was always spotty in the doctor’s lounge, but that moment revealed a tidal wave of communication. Dozens of missed calls, voicemails, and 73 text messages telling me the news that Mom had died. I told the other chief residents I was leaving, I needed time. I needed more than that, but for now, time would have to suffice. Three days, they said. Take 3 days. So I did. I took those 3 days. 

Two weeks later, twirling a cheap, gray BIC pen in my fingers, nausea wracking my body, a few of my colleagues said that I wasn’t pulling my weight. Too stunned to form a coherent response, I stayed quiet. Was the nausea from my pregnancy or a silent seething at their behavior? My whole world changed forever in a breath, and I wondered where their compassion was. To this day, I hate those pens, the gray ones. 

The world, as it does, continued to turn. Seven months later, my son was born, preterm. “Two-twenty-two-twelve” (2/22/2012). Mom would have loved the alliteration, but 2s weren’t my number. Seven was, always 7. My life of 7s. Mom died in the seventh month of the year after 7 years of illness. During medical school my apartment was number 7 on the seventh floor, 7 intrauterine inseminations. Seven. Seventeen months and 1 day after mom died, my younger brother Max died from a self-inflicted gunshot wound. I should have known it was coming. I should have been there to prevent it. On average, suicidality lasts for 1 hour. It’s a preventable death. Survivors’ guilt. 

At the time, I was an addiction medicine fellow in Boston. I called my department chair with the news about my brother. He told me to go be with my family and to let him know when I was ready to return. 

Three weeks went by with funerals, family. I returned to work, but when my section chief saw my face, he put me in his car and drove me back home. In a panic about paid time off and administrative items, he assured me that all of this would be here when I came back. I opened the door to my apartment and held my young son in my arms. 

Where did the tears come from, I wondered as I held him: smelling his sweetness, feeling his warmth, hearing his sounds. Night after sleepless night and soaked in tears, my husband gently removed our baby from my arms, put him in the crib, and took me to bed. He held me through every cruel wave. My light, my rock. My boys saved me. 

Six weeks after my brother died, my grandfather died. I couldn’t bring myself to go to his funeral. Over a span of 2 years and 7 months, my family lived in 5 homes, my mom died, my brother died, my grandfather died, and my 2 children were born. It felt like every one of these highs met every one of these lows. Emotionally, my husband and I were in survival mode. I couldn’t bring myself to take my babies to the park or the zoo. I was depressed and overwhelmed. I wondered if life was worth living. I was diagnosed with an adjustment disorder. All of it was more than one person could handle. 

One April afternoon a few months later, I was evacuated from the subway after 2 explosions rocked the Boston Marathon finish line. The finish line and I had that in common, explosions. As I frantically tried to find my husband and son, I realized we needed to return home, to the Midwest. 

That June, we moved back home to Michigan to continue our careers and raise our young family. I remember at one point I flew back to Boston for a clinical conference. Keep it together, keep it together. Breathe. Returning home, I crumbled in tears on the hard tile floor of my kitchen. My daughter crawled into my arms clutching pictures of my family: one of my mom and my brother, one of her and her brother. They would never know each other, never know their hugs, their smell, their love. The missing link between generations would always be the void in her mom’s heart. Boston’s imprint wore heavy. 

As physicians, we’re taught to take care of others, but we also need to take care of ourselves. Yet at some point in our education, it’s trained out of us. Why does it become so difficult for physicians to recognize that life happens to each of us, too? Recognizing the fragility of life in an immediate way matters. As individuals, as clinicians, as educators, it is also our job to protect learners and colleagues when life hammers them. We, too, should put our colleague in the car and drive them home. Give them compassion, space, and reassurance. 

These days, I have a standing rule; from 4 pm to 6 pm during the workweek, I shut my phone off and don’t check email. It causes a mess at times but it’s worth it. I spend these hours with my children, at the piano my mom left us. I delight in this time as their little fingers float across the keys. Watching their brains respond to the challenge of the instrument, I hope they learn that doing something hard can be beautiful. I hope they learn that they too are beautiful. The kids learn to play using the Suzuki method. Shinichi Suzuki once said, "Music is the language of the heart without words.” Maybe playing Mom’s piano transcends the fact that they’ll never meet each other, instead, connected by songs played on the piano generation by generation. 

Mom insisted every conversation we had with her end with “I love you.” I never question that the last words I said to her and my brother were the same. 

“I love you, Mom.” 

“I love you, Max.” 

Can we give each other time and compassion to love ourselves? 

Read the full article in JAMA here. 

Full link: https://jamanetwork.com/journals/jama/fullarticle/2789965?resultClick=1