If you follow me on Instagram, you know what I’ve been going through in the past months. I initially chose not to reveal what was happening when it was all starting because I was so overwhelmed, trying to keep up with medical school and trying to spend as much time with him as possible. But when I lost him, I made the decision to reveal the news, and I know since then, I haven’t spoken much about it. It’s been a whirlwind but it’s been almost two months now, and although I still feel absolutely devastated and spend a good portion of every day in tears, I want to share my story with the lovely people who have supported me throughout my blogging journey and put this online in the hopes that it’ll help some people who may unfortunately encounter a similar experience at some point (although I hope not, I would not wish this experience on anyone in the world). So, as hard as it is, I’m writing this to talk about my experiences going through this as a medical student and to tell you how I’ve been in the aftermath of the loss as I try to move forward through the impossible.
My boyfriend and I met in college, and we had been together for five years. He was the love of my life, my best friend, and my soul mate, and we knew that we wanted to spend the rest of our lives together. We had picked out some potential engagement rings together earlier last year, and we couldn’t be more giddy about where our lives would take us. We were so happy in love and we both felt so blessed that we had found each other. We were so excited about the rest of our lives together.
But in November, my boyfriend began to complain about some back pain. He said that he thought he strained a muscle while at the gym the week before (he was a fitness lover who went to the gym at least three times a week and had been a former D1 athlete in college). The back pain was manageable, and so we both didn’t think much of it, until Thanksgiving Day when he said the pain was excruciating and he could barely get out of bed. I took him to a PM&R doctor who ordered a MRI, and a week later, I finally understood what all the books and movies meant when they said a single moment in time could feel like the world was crumbling around you. I will forever remember the doctor, who seemed completely stunned himself, telling us that the MRI suggested metastatic disease.
I don’t want to get into the specifics about the course of his illness, but it was a short, devastating one. One positive aspect of being a medical student was that I was well connected with doctors, and I was able to get him to Memorial Sloan Kettering within a couple of days, where he received the diagnosis of extensive stage small cell lung cancer. I hadn’t learned about SCLC yet, so I immediately took to PubMed, and I was absolutely shocked by what I read. The epidemiology suggests that SCLC is mainly a disease of elderly smokers. Lung cancer is not common in non-smokers, but when it does happen, it typically is non-small cell lung cancer. Extensive stage meant that his cancer had already metastasized. The 5 year survival rate was 2%. I felt, again, like the world was ending.
I spent almost every night in the hospital, pouring over the literature. The first few weeks I was plagued with so much guilt. Shouldn’t I have noticed the symptoms? Shouldn’t I have figured out when he started having back pain that it was something more serious? I’m a medical student — shouldn’t I have known better? But I realize now that would have been impossible. By the time he exhibited any symptoms (the back pain), the cancer had obviously already metastasized to the spine, and there was no way I could have known anything was wrong when he had been completely asymptomatic prior to the back pain. Even the oncologists were shocked, and the doctors he had seen in the beginning of his back pain had run his blood work and done a physical exam and everything had been normal then. Everyone told us how sorry they were that this was happening because this rarely happened to healthy, young men like my boyfriend. But everyone was optimistic that the chemotherapy would work, and I believed them, because I had read the literature that said that SCLC was typically responsive to initial chemotherapy. I figured that I would at least have a couple of good months before we had to start thinking about the next steps and how to prevent a recurrence. Unfortunately, we got even more bad luck, which seems unbelievable. The chemotherapy didn’t work. His oncologist switched him over to immunotherapy immediately, but that didn’t work either. Ultimately, we only had three months with him from the time of diagnosis to his death.
Nothing makes sense, even now. It still feels so incredibly unfair that this had to happen to him. Everyone knew him as the healthiest, most fit person they knew — and this incredibly aggressive, rare cancer had to hit him, a 20 something year old never smoker who religiously went to the gym and ate a salad for lunch every day. He was the kindest soul anyone knew, and I was plagued with so much confusion, anger, and guilt. It seemed like everything I had learned during my MPH was wrong. How could this have happened when all the data suggested otherwise? How could this have happened to us, and why did this happen to us? I had read When Breath Becomes Air in the summer — I actually finished the book on the beach next to him, and I cried into his arms as I told him how sad I was for Dr. Kalanithi and his family — he had been so young with so much potential, and it was so unfair. My boyfriend comforted me then, telling me that it was sad, but not to worry because he’d always be there for me no matter what and that I’d never be able to get rid of him so I shouldn’t worry. All of that seems so surreal, as if this were all some cruel joke or a never ending nightmare.
During his short battle with cancer, I learned a lot as a caregiver. People told me that he was lucky that I was a medical student who knew how to navigate the system, but I don’t know that I would agree. Yes, for him, I was glad that I was able to comprehend a lot of the jargon that’s often thrown around by physicians. I knew how to interpret labs, I knew about the procedures, I knew how hospitals worked. But I also always felt like I knew too much that I was constantly feeling overwhelmed. Sometimes it was hard to separate me, the medical student who loves a good literature review, from me, the loved one of a patient. I was always compelled to go into the literature to reaffirm everything the oncologists said. Often times I wanted to suppress my emotions and let my intellectual, scientific side preside, medicalizing the situation. But this was hard, because I had done cancer research before. My MPH thesis was about cancer patients, and I did extensive chart reviews. I went through hundreds of oncology patient charts, and I knew how all too often, the patients don’t survive. I remember crying as I did the chart review when I would come across a particularly young patient and a heartbreaking note from the social worker about how the family was coping after the death. During the past three months, I was obsessively consumed by these thoughts. All I could think about was what my boyfriend’s chart would say. All I could think about was what the survival statistics showed — how abysmal the survival curves looked. My medical background gave me the ability to be there for my boyfriend and his family for minor questions and an ability to navigate the complex process of a complicated, serious illness in the healthcare system, but my knowledge was also a curse. Often times, I wished for blissful ignorance. I wished I could have had the blind optimism and hope.
In medical school, we learn about grief, how to talk to families, how to have difficult conversations, how to deal with patient deaths. But nothing prepared me for losing a loved one, and especially not someone I thought I would be spending the rest of my life with. The grieving process has been difficult. Being in my twenties, I don’t know anyone who has lost a partner, and most of my friends haven’t even lost anyone in their immediate family. Grieving is hard, but grieving in your twenties is very, very hard because there is a pervasive sense of isolation. No matter how much you know your friends and family love you and care about you and want to help you, no one can truly empathize with you. Not only do you feel decimated and lonely because your other half is gone, you feel like it’s hard to talk to anyone, because as supportive as everyone wants to be, no one understands. But even though no one can understand, everyone has shown me how much love they have for me, and that’s been helpful — to know that even though I often feel so alone, I’m really not alone and there’s an army of people around me who’ll be there for me no matter what. Grieving while so young is hard, but if there’s one thing I learned during my boyfriend’s illness, it’s that love is the best thing we have in our lives — it was hard to see him sick and everything was awful, but one thing we never lost was how much we loved each other, and we never stopped telling each other that. I didn’t need for something so horrible to happen to know how loved I was and how lucky I was to have so many amazing people in my life, but now, I realize this more than ever, and I am only able to get through the days with the love of my friends and family.
As if grieving isn’t hard enough, there’s also just life that’s hard, because life goes on around you no matter how much you feel like your world is falling apart. And my life wasn’t exactly that simple, because life as a medical student is busy and challenging. Medical school is incredibly demanding, especially during second year. I had barely been able to study from December to March. I was going to all my required classes and taking all the exams and even fulfilling all of my extracurricular commitments, but I hadn’t been able to study for Step 1 at all because I was focused on my boyfriend. Once he passed away, I was left with a huge dilemma — do I continue on? Can I continue on?
I ultimately chose to return to school because I knew myself, and I know I don’t do well with having too much free time. I thought keeping busy would help me, and for the most part, that’s been true. Studying has been a good distraction when my mind threatens to go to dark places. School gives me a reason to force myself out of bed every morning. I’ve felt so grateful to my school’s administrators and faculty and my classmates for being so supportive. There are days when I do let myself stay in bed, not able to do anything, let alone try to read First Aid. But there are also days when my friends sit with me at the library, bring a smile to my face as we joke while we study, and I feel almost like I might be able to feel like myself again, one day, some day.
I wanted to be an oncologist even before he got sick, and when he was sick, I thought the experience would either make me run as far away from oncology as possible, or I’ll come out of this with a renewed passion for oncology. The latter happened. I’m pretty sure now that I want to be an oncologist so I can provide the same compassionate care that I saw his oncologists provide for him. His doctors were nothing short of amazing and inspirational, and I’ll always be grateful for them and aspire to care for my patients in the same way one day. I will never forget the palpable pain in his oncologist’s voice when we had that difficult last appointment, and the tears in her eyes as she consoled me when I sobbed outside of the exam room, frantically asking how much time I had left with him and asking her advice on what I should do about Step 1 and whether he’ll make it to that day because I was supposed to celebrate with him. His care team, although they couldn’t achieve the outcome we all wanted, truly gave it their all and worked around the clock to not only treat his disease but also to help me and his family as much as they could. It was so apparent that they were deeply compassionate, empathetic people who genuinely cared about their patients’ wellness as a whole, not just the symptoms or the disease, and the entire family unit. My boyfriend told me back in December that he hoped that being in the hospital with him so much would make me a better doctor. He was kidding, and I remember joking and laughing that I already was going to be a good doctor anyway, but I’ll never forget those words. I wanted to become a doctor for the same reason everyone else does — to help people — but now, it’s personal.
Every day is still hard. The grieving process is not easy or pretty. I often feel like I’ll never be myself again. I miss him so, so, so much — more than I ever thought was possible. But I’ll always have the memories of the love and happiness we shared, and I’ll love him always and forever, for the rest of my life. This wasn’t the future I had imagined, but this is what it is now, and the best I can do to honor his memory is to move forward for him, because that’s what he would’ve wanted. The world seems so much darker without him, but I’ll look at every sunrise and sunset with a newfound appreciation for life and think of him and imagine him looking out for me with his gentle, kind smile until we meet again. So I’ll move forward, as hard as it is to do without him, to live my life to the fullest and work even harder than I have before to become the best physician I can be in his memory.
I love you, T, forever and always.
For resources on grief and for others who may be going through similar unfortunate circumstances:
- Sheryl Sandberg’s upcoming book, Option B, is something I am really excited to read. She has established an online community here for others who may be forced to choose their Option B’s.
- The Dinner Party was suggested to me by a friend — it’s a way for young adults who are going through a loss to get together and have dinner. I haven’t been able to do it yet, but I would like to, and I think it’s a wonderful idea.
- Support groups exist, both online and in person if you can find one. I attend one online and in person, and I think it has helped me so far because I’ve met other people who can empathize with me in ways that my friends and family can’t.
- There are a few books out there about similar circumstances. I read Nora McInery Purmont’s “It’s Okay to Laugh (Crying is Cool Too)“, and Dan Schapiro’s “And in Health: Couples Fighting Cancer Together“
- For young adults fighting cancer, my boyfriend read “Planet Cancer.” There are also a few websites and support groups out there. Being a cancer patient at such a young age is also an incredibly scary, isolating experience, so I would encourage support groups (my boyfriend was just too sick to join one during his disease course) and speak to social workers. His social worker was incredible and I cannot thank her enough.
Most of all, don’t be afraid to seek help and take care of yourself — therapists, social workers, psychiatrists, friends, family, professors, mentors… whoever it is, find someone you can talk to honestly and openly. Repressing your feelings during grief is not good, so don’t be afraid to be vulnerable and talk to someone you trust. Remember that you are loved and that it’s important to take care of yourself, as much as eating and sleeping seem impossible. Lean on those around you. Take it not just one day at a time, but an hour at a time if you need to.