Over time, I learned some of the words I was supposed to say. On rounds, I cheerily greeted a man with an open wound bisecting his swollen belly up to his sternum. Peering at his insides through layers of bubblegum-pink flesh, I asked about his youngest daughter and documented his bowel movements. I gossiped about ex-boyfriends with a woman as a tumor scavenged her insides and gnawed tunnels through her skin. I told her I liked the freckles across the bridge of her nose; her daughter had them too. “I’m bulletproof,” she told me, as we waited for her to die. She was 2 years older than I was. As I saw more people die, I began to associate the experience less with movies and more with real life.
One man had come into the emergency department burning. His entire body was charred, even the inside of his throat; his tattoos, somehow, were not. Though death was inevitable, the medical team tried desperately to save him. That night, I showered twice to get the smell out of my hair and his screams out of my head.
I wondered if I could ward off trauma with good behavior. I started driving home more carefully at night, staying under the speed limit on wide-open roads, slowing down at yellow lights at empty intersections. I added my mom and my partner on Find My Friends, intermittently checking that they were where they were supposed to be and not in an ED or a ditch somewhere. I imagined a hundred scenarios for each call sent to voicemail. I went out of my way to recycle, in case karmic justice did too.
Around 1 a.m. one night, I sat alone with a dead man after he’d undergone a last-ditch thoracotomy. He was unnamed, presumed to be unhoused, and completely naked except for mismatched socks — green and neon pink. He had been struck by a car that had kept on driving. I, a medical student whose most laudable contribution was staying out of the way, had been tasked with sewing him up, “for the morgue,” the attending said. “It doesn’t have to be pretty.”
I had never been so close to a dead person, and I was afraid to look at his face. Someone drew the curtain shut, leaving us alone. I pushed his lung, still warm, back inside his skin, now cold. He fit together. When I finally looked, he was wide-eyed, as if he was just as surprised as the rest of us to find himself there. Reaching inside him felt like a deep violation, an uninvited intimacy. I gripped the hemostat clamp so hard that my thumb started to blister. I have never tried harder to get my sutures just right.
As I worked, I wondered: Had he suffered while alive, and did he suffer as he died? If you die and no one knows, what does your death mean? If no one grieves your death, what did your life mean? It took me 45 minutes. Someone more experienced could have done better, surely. But I tried to be gentle. I wondered if he could see us, from wherever he was, and I hoped he knew I was doing my best.
On the first day after a year of clinical rotations, I went on a silent meditation retreat.
For 7 days, there was no external stimulation: no phones, no books; talking was forbidden, even eye contact discouraged. We were to coexist with 60 other women with eyes downcast, willows wafting together in an imperceptible wind.
Just after a monthlong trauma surgery rotation, the newfound silence of the retreat was jarring. We had 8 hours of community meditation practice each day and a lecture on the Buddhist Dharma around dusk. Some women, already expert meditators, seemed to quickly find inner peace. With little prior meditation experience, I wandered the wilderness of my mind, wondering if the Buddha ever dozed off when he meditated, especially after lunch. Didn’t he ever get tired of sitting cross-legged? By the evenings, I struggled even to sit up straight. I envied his open hip flexors.
The meditation center’s campus boasted miles of loosely maintained wooded trails that branched and interweaved like cobwebs. I explored in my downtime. Whenever I thought I’d stumbled upon an untraveled path, a stone carving of the Buddha’s head would materialize — sometimes resting on a tree stump, sometimes embedded in the trunk. The frequency of these sightings felt intentional. Though only his head appeared, the Buddha always seemed to be in repose, his eyes never fully open. I wondered if half-lidded eyes permitted profound insights, or if he was just sleepy.
On my second day, following a new trail, I arrived at a stone structure on which dozens of notes and pictures had been taped. A laminated sign indicated that this was a shrine for the departed, who were honored in an annual ceremony. A few small figurines — a Mickey Mouse keychain, a baseball-player bobblehead — were tucked into cracks. I counted 27 notes addressed “to Mom.” It was gutting to contemplate the pain of losing a mother, my mother, and yet…here that experience seemed so ubiquitous, even mundane. How the world must have stopped for each of these people — how unmoored they must have felt when, somehow, life around them carried on.
I took to visiting the shrine each day, almost compulsively. I reread any visible letters and cried each time. I fought the urge to dislodge notes wedged in crevices, wanting desperately to see what words had been written without any intention of having them read. Though I encountered no one else, each day I discovered new additions: for a husband, a mother, a son. The silence in the meditation hall took on a new flavor — there was now sorrow, a sense of longing. One new addition to the shrine stood out: a note with a photo of an older couple. In the photo, I recognized the woman who sat behind me every day in the meditation hall. She wrote to her husband of 60 years, who had died 3 months earlier: “Rest, my love. The journey, for now, is done.”
I found myself drawn to her. Sneaking glances, I looked for signs of wear, anything that might betray an interior rotted from grief. How did she go on? When she sat across from me at lunch one day, I studied her. As she spread avocado on a piece of bread, I noticed the gold wedding band on her finger. She motioned for the salt and smiled when I passed it to her. I looked for tears as she chewed her toast. She finished eating and left.
The Dharma teaches that pain is inevitable but suffering is not. The cause of suffering is wanting the world to be different from how it is now. It’s human nature to want some semblance of control, some promise that life has meaning, things work out, good people prevail over bad. The more we cling to this lie, the more it shackles us.
Although I felt naturally inclined toward emergency medicine, my main hesitation was this: the more time I spent in the trauma bay, the more convinced I was that bad things would happen to people I love. Tragedy was like a rabid dog: as long as you didn’t look it directly in the eye, you might get out unscathed. I distanced myself from toddlers thrown through windshields, elderly couples horrifically rear-ended, a nameless man with unmatched socks who was cut open and stitched back together by my own fumbling hands so his heart wouldn’t tumble out onto the floor of the morgue. What a mess that would have been to clean.
But perhaps when we understand that pain is inevitable, when we reckon with our own mortality and the mortality of everyone we have ever known, some space opens up. I wonder if making physical contact with trauma every day gives us greater capacity to sit with others in their grief and not cower. I wonder if any form of contact with people — whether joyous or heart-wrenching — makes us feel more alive in our humanity.
On the final day of the retreat, hours away from being released back into the Real World, we were asked to create and share one-sentence mantras meant to anchor us to some truth. From behind me came the woman’s voice, revealing her mantra.
“It’s like this now.”
