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Grief Medicine

If someone asks me how my first year of medical school went, half of the time I dismiss them with a one-word answer, saving them from a conversation they aren’t ready to have. The other half of the time, I tell the truth, just to see what they have to say.

“It was fine, except for when I watched my dad die in the middle of it.”

Often, the discussion starts to wither. Usually, I am met with an, “I’m so sorry,” and maybe a, “Let me know what I can do to help.” Once in a while, the person I’m talking to is an older adult and can say they relate, having lost a parent before themselves. However, the conversation usually turns, them hesitant to dig deeper and me wondering how much to share.

But the truth is, I am always ready to share. It is an experience that irrevocably changed my life course and identity. The earthquakes of the past year created a chasm so deep that I am forever separated from who I used to be, when I was obliviously ambitious and innocently self-centered.

Just one year ago, I was a typical first-year medical student, learning to adjust to a new city, new friends and a new breakneck-paced curriculum. My biggest worries were whether I was making enough social connections in medical school and whether I made the right choice in committing to this field at all. Although my first year started shakily, plagued with self-doubt and imposter syndrome, I had begun to get my bearings and become hopeful about my future in medicine. Then, a November phone call from my mom slid my life into unknown, unfamiliar and lonely territory.

“The doctor said your dad has Stage 4 cancer … and has about one year left to live.”

This news seemed incompatible with what I knew about my dad. When I left southern California to move to Boston for medical school, my dad was still cooking fresh meals every day, arguing with vigor and working long hours in the garden for fun. Even after hearing this update with my mom, I thought that my dad, a lifelong fighter, could still enjoy a few more months of life before disease took over.

However, it seemed things rapidly tumbled downhill as soon as the doctor’s words were spoken. When I returned home for winter break, I expected a warm welcome for completing a challenging first semester of medical school. Instead, I found my dad struggling to ambulate with a walker, feet swollen with edema, calling for me constantly to help him set up his bed, get him a snack and find the phone that slipped onto the floor.

During this time at home, I constantly asked my mom if I should take a leave of absence from medical school, and she would say that I should just focus on finishing my degree so I could move back to California. I asked my dad once what he thought about me taking a leave of absence, and he said “no” so forcefully that I didn’t ask again. When January crept in and signaled the end of my winter break, I returned to Boston hesitant, afraid I was making the wrong move, but telling myself I would at least finish the last exam of our musculoskeletal block so I could complete the course. Then I would decide what to do next.

But as it turned out, time had already run out. Only three days after I returned to Boston following my winter break, my dad was hospitalized. I video called my mom to see her crying over my dad’s unconscious body in the hospital bed, and I immediately booked the next flight out of Boston to Los Angeles leaving in two hours, one way.

What followed were two agonizing weeks of living out of a hotel near where my dad stayed in the hospital. I visited my dad during the day, clinging to the doctors whenever they came into his room and peppering them with questions, squeezing every corner of my brain for medications I had learned to try and figure out what was going on with my dad. In the evenings, I returned to the hotel room and tried to continue learning the muscles of the arm, hoping I could return to school when my dad finally stabilized. I learned medical terms like rapidly progressive, critical condition and hepatic failure secondary to metastases to describe what I saw in my dad, but these terms didn’t get close to what it truly was: an endless absolute nightmare.

In the end, there wasn’t a year left of life at all. It was barely two months after the diagnosis. My dad was on the wrong side of the average, and statistics never felt so cold, cruel and useless. My dad passed away the day after my 24th birthday. At that point, he couldn’t even say my name anymore.

In medical school, we talk about death quite a lot. Factually, as a result of what happens when your blood vessels lose their tension or your liver is overwhelmed, and ethically, as in what to do when a patient’s family wants them to remain on life support. We even talk about how emotionally exhausting and traumatizing it is to be a provider witnessing death on the front lines. But after watching my dad pass, my grief and distress were incomparable to anything medical school could cover in a course.

Medical school doesn’t teach you that death is not only the exact time the heart stops working, but a process that could span days, weeks or months, shredding you apart as you watch your loved one teeter between hope and tragedy. Although we learn about so many types of cancers, the kind that took my dad — cholangiocarcinoma — only got one slide in a 200-slide lecture in the two-month gastrointestinal system block. And it didn’t say anywhere on that slide that one day, your dad could be telling you that he can’t wait to attend your medical school graduation, and that just one and a half weeks later, he would pass silently, staring back with open eyes, as you hold his hand and cry inside of your sopping wet N95 mask.

At his funeral, his brother took the podium and revealed that my dad had wanted to be a doctor when he was younger. However, being fresh immigrants from Vietnam, their family couldn’t afford to support his medical studies, and my dad ultimately chose to study engineering. My dad hadn’t told me this, and suddenly his emotional investment in watching me succeed in my medical studies made so much more sense.

I had arrived at medicine after a meandering, wavering journey through every other discipline imaginable, but after that revelation, I felt immense peace. If a life’s purpose exists, this was it. I was meant to become the first doctor in my family, and my dad was meant to watch me begin my medical journey, even as he got sicker and sicker.

I returned to Boston the day after the internment of my dad’s ashes at the mortuary. And this time, I returned with a purpose. I didn’t even have much time to feel sorry for myself as I caught up on my missed exams and got back on track with the rest of my classmates. Even now, I can’t believe I did it. I finished my first year of medical school on time with everyone else in my class, a cardiovascular final springing us all into the most relieved summer of my life.

Often people are surprised, asking me why I didn’t just take time off. But I know my dad would understand, no explanation necessary. He was a person who survived being a boat refugee, traversing countries and then states until he ended up in California, trying on different careers until one fit. He was the type of man who tried to live as normal a life as possible with his cancer until the ruse was up. He would know that hard work towards a dream can be a better salve than listless days in grief. And he would see that the future doctor I will become is already starting to peek through, unable to be contained.

How was my first year of medical school? Fine, I guess. Even when my dad died in the middle of it. Despite it all, there were still delicately beautiful moments too. Showing my dad a picture of freshly fallen Boston snow while he lay in his hospital bed and him responding, “Oh, what a lovely change.” Returning to my Boston apartment and finding cards even from classmates I didn’t know that well, expressing sympathy and solidarity. Seeing my partner integrate himself into my family as he helped complete tedious chore after chore in the aftermath of our tragedy. As heartbreaking as the past year was, I could also find solace in the way the pieces in my life fell together. The medicine for grief, I learned, is to live through, between and alongside it. Talking about it openly, daring to be vulnerable and being brave enough to remember even the memories that hurt.

Image credit: Snowflakes (CC BY-NC-ND 2.0) by danna § curious tangles

Sarah Tran Sarah Tran (1 Posts)

Contributing Writer

Tufts University School of Medicine

Sarah Tran (they/them) was born and grew up in southern California. They attended Pomona College and graduated in 2020 with a Neuroscience B.A. and an Asian American Studies minor. They are currently attending Tufts University School of Medicine as a MD/MPH student, set to graduate in 2025. Their interests include community and social justice, claiming to be a writer despite not having enough time to write, and watching reality television with their partner.