“Destiny is a tree.”

I went into medicine to save people. I think most of us did. I went into medicine because growing up when working in a doctor’s office for a summer almost 20 years ago, a woman named Kathy, told me, “I’m here because your dad saved me. Without him, I wouldn’t be here.” The words imprinted lofty life goals on my life pattern and sent me into a world trying to understand the science of life, captivated in a mysterious art of finding purpose for my own existence. Then, in medical school, at some point, I became fascinated with the opposite, and entrenched with the immense emotional surges that I felt in discussing, handling and understanding death and the taboo discussion of “end of life” care. It was a turning point.

As a medical student I took extra time during my studies to engage in an elective focused on palliative care and death. I even completed an entire “ministry to the sick” certificate outside of school – it was quite an experience being a medical student among chaplains, the perspective was eye-opening, to say the least. I wanted to be a Pediatric Oncologist for some time, I wanted to guide families not only through difficult situations, but I realized early it was impossible to “cure” everyone, and that there was some gratitude and something beautiful about making peace with mortality. Life is something we all tend to take for granted, and I felt very alive and experienced pure vitality in acceptance of death. I early on made peace with my own mortality and frankly, find myself not personally afraid of death – when you think about something a lot, you either make peace with it or become anxious, and the former makes your day much better.

What i came to appreciate in my first few pediatric deaths was the peace that I found with families that went through these hardships. Helping others reach the same peace I’ve held for myself in acceptance of mortality was an incredible feeling, and deeply intertwined me forever in vulnerability for these situations. I will never forget my first death, a six-week-old, and how her mother would call me the “Doctor with the Boots” and how she was going to get a tattoo that, depressingly, said, “While your child is learning to walk, mine is learning to fly.” I navigated death from cancer, death from unexpected accidents and death from situations that we were unable to reverse with the utmost technology and science.

But, it has never gotten easier, and I don’t expect it to, to be the specter to these transitions of mortality. I carry very heavily with me, every ounce of hurt that I feel from the families I have encountered and the deaths I have been privileged to be part of. We can’t save everyone, but we can help those around them to make peace with life, because accepting mortality enriches the rest of the time surrounding us.

And so, when it came time to the first time I led a discussion with a family for a “redirection of care” for their child, many things became very anchored in my soul. Hearing a father say, “there’s nothing we can do,” and my quiet and slow responses… No, there is always something we can do. We can focus on the things that are important. We can focus on being comforting, being caring, and removing suffering. We can focus on the things that matter to you as a family. Eventually, we will all have a time, regardless of what you believe happens after.

I sat silently in a room with a boy and a girl that were clearly deeply in love with each other as they cried together. I sat silently as they held each other close. They had known this was coming, we had all been optimistic of a different outcome, but optimism is sometimes just hopeful and nothing that will materialize into more. I won’t ever forget the words I was given the week before by the same boy, as we were fighting to perform a miracle, as he began to come to the hard terms that unfortunately survival was unlikely, “Destiny is a tree.”

I thought about the ways in which I had been brought to that room and fought hard to hold back my own tears and remain professional. I thought about the endless choices I’ve been not sure of and all of the not desired situations I’ve been in, both professionally and personally. To think that somehow, I ended up in that room at that moment to offer those words has etched it’s way into my heart. It was a reminder that we are all interconnected, and our tree branches combine to create a beautiful network of existence. My job is not something I take lightly, and those that know me often think I am too frivolous, not serious and sometimes not focused; but, the reality is, I am constantly thinking about these situations and I am constantly looking beyond the eyes of the humans in front of me to stare deeper into the souls I am guiding through their own existence.

Death never gets easier, but it is what makes life worth living.

Dedicated to W.