Often people think about bucket lists when somebody close to them dies. That’s what happened for Candy Chang, an artist who, in 2009, created a space on a public wall in New Orleans with the prompt Before I die _____. Within days the wall was completely filled. People wrote things like Before I die, I want to straddle the international dateline. Before I die, I want to sing for millions. Before I die, I want to be completely myself. Soon the idea spawned over a thousand such walls all over the world: Before I die, I would like to have a relationship with my sister. Be a great dad. Go skydiving. Make a difference in someone’s life.
I don’t know if people followed through, but based on what I’ve seen in my office, a good number may have had momentary awakenings, done a little soul-searching, added more to their lists—and then neglected to tick things off. People tend to dream without doing, death remaining theoretical.
We think we make bucket lists to ward off regret, but really they help us to ward off death. After all, the longer our bucket lists are, the more time we imagine we have left to accomplish everything on them. Cutting the list down, however, makes a tiny dent in our denial systems, forcing us to acknowledge a sobering truth: Life has a 100 percent mortality rate. Every single one of us will die, and most of us have no idea how or when that will happen. In fact, as each second passes, we’re all in the process of coming closer to our eventual deaths. As the saying goes, none of us will get out of here alive.
I’ll bet right now you’re glad that I’m not your therapist. Who wants to think about this? How much easier it is to become death procrastinators! Many of us take for granted the people we love and the things we find meaningful, only to realize, when our deadline is announced, that we’d been skating by on the project: our lives.
But now Julie needed to grieve all the things she’d have to leave off her list. Unlike older people, who grieve for what they’ll be losing and leaving behind, Julie was grieving for what she would never have—all of the milestones and firsts that people in their thirties just assume will happen. Julie had, as she put it, “a concrete deadline” (“Dead being the operative part of the word,” she said), a deadline so unforgiving that most of what she’d expected would never come to pass.
One day Julie told me that she’d begun to notice how often in casual conversation people talked about the future. I’m going to lose weight. I’m going to start exercising. We’re going to take a vacation this year. In three years, I’ll get that promotion. I’m saving to buy a house. We want to have a second baby in a couple of years. I’ll go to my next reunion in five years.
They plan.
It was hard for Julie to plan a future not knowing how much time there was. What do you do when the difference between a year and ten is enormous?
Then something miraculous happened. Julie’s experimental treatment seemed to be shrinking her tumors. In a matter of weeks, they were almost gone. Her doctors were optimistic—maybe she had longer than they’d thought. Maybe these drugs would work not just now or for a few years but for the long term. There were a lot of maybes. So many maybes that when the tumors disappeared completely, she and Matt began, very tentatively, to become the kind of people who plan.
When Julie examined her bucket list, she and Matt talked about having a baby. Should they have their own child if Julie might not be around for middle school—or, if things went very badly, preschool? Was Matt up for that? What about the child? Was it fair for Julie to become a mother under these circumstances? Or would Julie’s greatest motherly act be the decision not to become one, even if it would be the hardest sacrifice she’d ever make?
Julie and Matt decided that they had to live their lives, even in the face of such uncertainty. If they had learned anything, it was that life is the very definition of uncertainty. What if Julie remained cautious and they didn’t have a baby because they were waiting for the cancer to return—but it never did? Matt assured Julie that he would be a committed father no matter what happened with Julie’s health. He would always be there for their child.
So it was decided. Looking death in the eye would force them to live more fully—not in the future, with some long list of goals, but right now.
Julie kept her bucket list lean: they were going to start their family.
It didn’t matter if they ended up in Italy or Holland or someplace else entirely. They would hop on a plane and see where they landed.
13
How Kids Deal with Grief
Shortly after the breakup, I told Zach, my eight-year-old, the news. We were eating dinner, and I tried to keep it simple: Boyfriend and I had both decided (poetic license) that we weren’t going to be together after all.
His face fell. He looked both surprised and confused. (Welcome to the club! I thought.)
“Why?” he asked. I told him that before two people got married, they needed to figure out if they’d make good partners, not just for the moment, but for the rest of their lives, and even though Boyfriend and I loved each other, both of us realized (again, poetic license) that we wouldn’t and that it was better for us to find other people who would.
This was, basically, the truth—minus some details and plus a few pronoun changes.
“Why?” Zach asked again. “Why wouldn’t you be good partners?” His face was a wrinkle. My heart ached for him.
“Well,” I said. “You know how you used to hang out with Asher and then he got really into soccer and you got really into basketball?”
He nodded.
“You guys still like each other, but now you spend more time with people who have similar interests.”
“So you like different things?”
“Yeah,” I said. I like kids, and he’s a Kid Hater.
“What things?”
I took a breath. “Well, things like I want to be home more and he wants to travel more.” Kids and freedom are mutually exclusive. If the queen had balls . . .
“Why can’t you both compromise? Why can’t sometimes you stay home and sometimes you go traveling?”
I mulled this over. “Maybe we could, but it’s like that time you were assigned to work with Sonja on that poster and she wanted to put pink butterflies all over it, and you wanted it to have Clone troopers, and in the end, you ended up with yellow dragons, which was pretty cool, but not really what either of you wanted. Then on the next project you worked with Theo and even though you had different ideas, they were similar enough, and you still both compromised, but not as much as you had to do with Sonja.”
He was staring at the table.
“Everyone has to compromise to get along,” I said, “but if you have to compromise too much, it might be hard to be married to each other. If one of us wanted to travel a lot and one of us wanted to stay home a lot, we both might get frustrated a lot. Does that make sense?”
“Yeah,” he said. We sat together for a minute, and then suddenly he looked up and blurted out, “Are we killing a banana if we eat it?”
“What?” I said, thrown by the non sequitur.
“You know how you kill a cow to get the meat and that’s why vegetarians don’t eat meat?”
“Uh-huh.”
“Well,” he continued, “if we pull the banana off the tree, aren’t we also killing the banana?”
“I guess it’s like hair,” I said. “Hair falls off our heads when it’s ready to die, and then new hair grows in its place. New bananas grow where the old ones used to be.”
Zach leaned forward in his chair. “But we pull the bananas before they fall off, when they’re still alive. What if somebody PULLED YOUR HAIR OUT before it was ready to fall off? So doesn’t it kill the banana? And doesn’t it hurt the tree when we pull the banana off?”
Oh. This was Zach’s way of dealing with the news. He was the tree here. Or the banana. Either way, he was hurting.
“I don’t know,” I said. “Maybe we don’t intend to hurt the tree or the banana, but it’s possible that sometimes we hurt it anyway, even though we really, really don’t w
ant to.”
He went quiet for a while. Then: “Am I going to see him again?”
I told him I didn’t think so.
“So we’re not going to play Goblet anymore?” Goblet was a board game that belonged to Boyfriend’s kids when they were young, and Zach and Boyfriend sometimes played it together.
I told him no, not with Boyfriend. But if he felt like it, I’d play it with him.
“Maybe,” he said quietly. “But he was really good at it.”
“He was really good at it,” I agreed. “I know this is a big change,” I added, and then I stopped talking because nothing I said would help him right then. He was going to have to feel sad. I knew that over the next few days and weeks and even months, we’d have many conversations to help him through this (the upside of being a therapist’s child is that nothing gets shoved under the rug; the downside is that you’ll be totally screwed up anyway). Meanwhile, the news would have to marinate.
“Okay,” Zach mumbled. Then he got up from the table, went over to the fruit bowl on the counter, picked up a banana, ripped it open, and with dramatic flair, sunk his teeth into it.
“Yummmm,” he said, a strangely gleeful look on his face. Was he murdering the banana? He devoured the entire thing in three big bites and then went to his room.
Five minutes later, he came out carrying the Goblet game.
“Let’s give this to Goodwill,” he said, placing the box by the door. Then he walked over to me for a hug. “I don’t like it anymore anyway.”
14
Harold and Maude
At medical school, my cadaver’s name was Harold. Or, rather, that’s what my lab partners and I named him after the group next to us named theirs Maude. We were in gross anatomy, the traditional first-year human-dissection course, and each student team at Stanford worked on the cadaver of a generous person who had donated his or her body to science.
Our professors gave us two instructions before we set foot in the lab. One: Pretend that the bodies belonged to our grandmothers and show respect accordingly. (“Do normal people slice up their grandmothers?” one freaked-out student replied.) Two: Pay attention to any emotions that came up during what we were told would be an intense process.
We weren’t given any information about our cadavers—names, ages, medical histories, causes of death. The names were withheld for privacy, and the rest because the goal was to solve a mystery, not a whodunnit but a whydunnit. Why did this person die? Was he a smoker? A red-meat lover? A diabetic?
Over the semester, I discovered that Harold had had a hip replacement (clue: the metal staples in his side); his mitral valve had been leaky (clue: enlargement on the left side of the heart); he’d been constipated, probably from lying in a hospital bed, at the end of his life (clue: the backed-up feces in his colon). He had pale blue eyes, straight yellowing teeth, a circle of white hair, and the muscular fingers of a builder, pianist, or surgeon. Later, I learned that he’d died of pneumonia at ninety-two, which surprised us all, including our professor, who declared, “He had the organs of a sixty-year-old.”
Maude, however, had lungs full of tumors, and her nicely painted pink nails belied the nicotine stains on her fingers from her habit. She was the opposite of Harold; her body had aged prematurely, making her organs seem like those of someone much older. One day, the Maude Squad, as we called Maude’s lab group, carved out her heart. One of the students lifted it gingerly and held it up for the others to examine, but it slipped off her glove, fell to the floor with a thud, and split apart. We all gasped—a broken heart. How easy it is, I thought, to break someone’s heart, even when you take great care not to.
Pay attention to your emotions, we’d been instructed, but it was far more convenient to close them off as we scalped our cadaver and sawed open his skull like a cantaloupe. (“It’s another Black and Decker day,” our professor said when he greeted us on the second morning of that unit. A week later, we’d do a “gentle dissection” of the ear—meaning chisels and hammers, but no saws.)
We opened each lab session by unzipping the bag containing our cadaver and pausing as a class for a minute of silence to honor the people who were letting us take their bodies apart. We started below the neck, keeping their heads covered as a sign of respect, and when we moved up to their faces, we kept their eyelids closed, again out of respect, but also to make them seem less human to us—less real.
Dissection showed us that living is a precarious thing, and we did our best to distance ourselves from this fact by lightening the mood with obscene mnemonics passed down from class to class, like the one for the cranial nerves (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal): Oh, Oh, Oh, To Touch And Feel Virginia’s Greasy Vagina, AH. While dissecting the head and neck, the class would shout this out in unison. Then we’d hit the books and prepare for the next day’s lab.
Our hard work paid off. We aced each unit, but I’m not sure that any of us were paying attention to our emotions.
When exams rolled around, we did our first walkabout. A walkabout is just that—you walk about a roomful of skin and bone and viscera as if examining the wreckage from a horrific plane crash, except your job is to identify not the victims but the individual parts. Instead of “I think this is John Smith,” you try to figure out if the fleshy thing sitting by itself on a table is part of a hand or a foot, then say, “I think this is extensor carpi radialis longus.” But even that wasn’t the goriest experience we had.
The day we dissected Harold’s penis—cold, leathery, lifeless—the students at Maude’s table, having a cadaver with female organs, joined us to observe. Kate, my lab partner, was meticulous in her dissections (her focus, the professor liked to say, was as “sharp as a nine blade”) but now she was distracted by shouts from the Maude Squad watching her work. The deeper she sliced, the louder the shouts became.
“Ouch!”
“Eww!”
“I think I’m gonna puke!”
More classmates came over to watch, and a bunch of male students started dancing in circles and guarding their crotches with their plastic-protected textbooks.
“Drama queens,” Kate muttered. She had no patience for squeamishness—she was going to be a surgeon. Refocusing, Kate used a probe to locate the spermatic cord, then grabbed the scalpel again and made a vertical incision along the entire base of the penis, so that it split open into two neat halves, like a hotdog.
“Okay, that’s it, I’m outta here!” one of the guys announced, and then he and several of his friends ran from the room.
The final day of the course, there was a ceremony in which we paid our respects to the people who had let us learn from their bodies. We all read personal thank-you notes to them, played music, and offered blessings, hoping that even though their bodies had been dismantled, their souls were intact and open to receiving our gratitude. We talked a lot about the vulnerability of our cadavers, exposed and at our mercy, cut open and scrutinized, millimeter by millimeter, samples of them literally put under a microscope as we removed their tissues. But we were the truly vulnerable ones, made more so by our unwillingness to admit it—we were first-years wondering if we could hack it in this field; young people seeing death up close; students not knowing what to make of the tears we’d sometimes shed at the most unexpected moments.
They had told us to pay attention to our emotions, but we weren’t sure what our emotions were or what to do with them, anyway. Some people took meditation classes offered by the medical school. Some thrived on exercise. Others buried themselves in their studies. One student on the Maude Squad took up smoking, sneaking out for quick cigarette breaks and refusing to believe he’d end up tumor-ridden like his cadaver. I volunteered for a literacy program and read to kindergartners—how healthy they were! How alive! How intact their body parts!—and when I wasn’t doing that, I wrote. I wrote about my experiences, and I became curious about other people’s experiences,
and then I started writing about these experiences for magazines and newspapers.
At one point, I wrote about a class called Doctor-Patient that taught us how to interact with the people we would one day treat. As part of our final exam, each student was videotaped taking a medical history, and my professor commented that I was the only student who’d asked the patient how she was feeling. “That should be your first question,” he told the class.
Stanford emphasized the need to treat patients as people, not cases, but at the same time, our professors would say, this was becoming harder to do because of the way the practice of medicine was changing. Gone were the long-term personal relationships and meaningful encounters, replaced by some newfangled system called “managed care” with its fifteen-minute visits, factory-like treatment, and restrictions on what a doctor could do for each patient. As I moved on from gross anatomy, I thought a lot about what specialty I might choose—was there one in which the older model of the family doctor survived? Or would I not know the names of many of my patients, much less anything about their lives?
I shadowed doctors in various specialties, ruling out the ones with the least amount of patient interaction. (Emergency medicine: exciting, but you rarely see your patients again. Radiology: you see pictures, not people. Anesthesiology: your patients are asleep. Surgery: ditto.) I liked internal medicine and pediatrics, but the physicians I followed warned me that those practices were becoming far less personal—to stay afloat, they had to cram in thirty patients each day. If they were starting out now, a few even said, they might consider another field.
“Why become a doctor if you can write?” one professor asked after he had read something I’d written for a magazine.
When I was at NBC, I worked with stories but wanted real life. Now that I had real life, I wondered if, in the modern daily practice of medicine, there’d be no room for people’s stories. What was satisfying, I discovered, was immersing myself in other people’s lives, and the more I wrote as a journalist, the more I found myself doing just that.
Maybe You Should Talk to Someone Page 9