Now Is the Time to Attend to the Relationships That Matter

Yes, we need to wash our hands. We also need to love out loud.

Photo: EyeEm/Getty Images

Before the Covid-19 pandemic, it was easy to feel disconnected from the experience of serious illness, especially as a young or otherwise well person.

As a palliative care physician, my experience is quite the opposite. Every day I care for patients whose reality is life-limiting illness, and this spring I found myself at the bedside of patients dying of coronavirus. With Covid-19 cases in the U.S. surpassing the five million mark, this pandemic has upended our once protective narrative of separation. It has brought death into our homes and forced us all to acknowledge it directly.

Though my work as a physician prepares me more than most, it was not until my own sister’s life lay in transient shadows that I realized how impossible it is to be prepared for the unexpected loss of someone we love. Looking back, it was then that I started to learn that living with emotional intentionality may just be our only way to try.

Last year, my sister Morgan, at only 35 years old, suffered a near fatal heart attack caused by a spontaneous coronary artery dissection. One minute, my family waited for her at a chic bar in Detroit to celebrate our mom’s birthday — and the next I watched deadly tracings race across her heart monitor before she was rushed to the cardiac cath lab.

I have learned the true question inhabiting the underbelly of loss: Am I living with intentionality in my actions and in the love I show? If not, am I willing to face my own potential regret when tragedy inevitably arrives?

We did not see her again for eight terrifying hours and were told it was unlikely she would survive the night. My grief was incomprehensible. Morgan had been perfectly healthy, and worse, we had argued senselessly only hours before. Now, I did not know if I would ever speak to her again.

I slept on a vinyl couch next to her hospital bed in the cardiac ICU for weeks, waking to every beep, sinking in the landscape of uncertainty. I pleaded why her, why us, searching for an answer; but in the tacit bodily unfairness we all will experience or bear witness to, there is no reason it shouldn’t be her or any of us. I see now that asking “why” was merely a proxy for my grief.

In the year since, through the lens of palliative care and with the grace of Morgan still alive, I have learned the true question inhabiting the underbelly of loss: Am I living with intentionality in my actions and in the love I show? If not, am I willing to face my own potential regret when tragedy inevitably arrives?

Prior to this pandemic, my work in palliative care centered on helping patients with serious illness to look deeply at their lives and plan ahead. Together we explored goals and values in hopes of aligning medical treatments and plans; and while this often included conversations about resuscitation status, which is ever more imperative now, our dialogue cast a much broader net.

Given that time may be short, my patients and their families would consider their priorities, zeroing in on what they live for rather than what they need to live. Sadly, Covid-19 is rapidly accelerating this time frame, removing the luxury of time for so many and also prompting illness or causing death in some who did not initially seem at risk.

When Covid-19 first came to Boston, I met Mr. D in the emergency department. He was dying of pancreatic cancer at only 56 years of age, but coronavirus seemed to be hastening his decline. Mr. D’s greatest wish was to say goodbye to his children; however, due to strict visitation policies our communication with his family was all virtual. Mr. D’s mother wept on the phone, and my words to her felt hollow without the empathic look or touch I desperately wanted to offer. We arranged a visit for his mother and his children were able to FaceTime him, but nothing felt sufficient.

I wondered if there was something important Mr. D or his family had left unsaid, and given how quickly he was deteriorating, I knew whatever it was grew less and less likely to ever be shared. I got into my car that night and wept as I drove home — feeling sorrow unlike I have ever experienced at work. I do not think Mr. D ever saw his children in person again before he passed away a few days later.

As I observe disquiet and illness continue to sweep the globe, it feels like I am helplessly watching a storm approach the shore. In this downpour of uncertainty, I worry that we’re solely focused on that which is external—civil liberties when it comes s to mask wearing or who will create the first vaccine. I can’t help but think we are fundamentally missing this crucial chance to examine our priorities and relationships in the shadows of our collective unknowns.

Recognizing that we either have or will know someone impacted by Covid or be directly affected ourselves, I think this crisis is asking us to consider our most cherished relationships and express a level of vulnerability with one another that we so often avoid. Have you communicated and shown love openly recently? Have you relayed gratitude? Have you reminisced? Is there lingering estrangement that would be healthy and safe to resolve? Is there history you want to learn or stories you want to pass on? Is there something important you have left unsaid between you and a loved one?

In this downpour of uncertainty, I worry that we’re solely focused on that which is external — civil liberties when it comes to mask wearing or who will create the first vaccine.

The toll and virulence of Covid should give each of us immense pause; challenging us to love fully now, and consider the importance of these conversations in our daily lives. We should not run from vulnerability and connection, and the emotional effort this may take does not disavow us of its importance. We need to have courage. We need to be this brave.

When Morgan was finally extubated, I held her hand and said, “I love you and I am sorry.” I have told Morgan I love her countless times, but now these words held immense gravity. In the year since, our relationship has been unconditionally reshaped for the better.

We recently had a “staycation” together where we lounged around in plush bathrobes, ordered room service, and laughed together watching Top Gun. It was so much fun and yet, this was never something I thought to arrange for us a year ago. I think about the darkness I would feel if I was never able to tell and show Morgan how much I value her as my sister and how proud I am of her. I recognize my sheer fortune to have been given this chance.

As we look ahead, the unfortunate truth is that Covid-19 is not going away anytime soon. In this instant, as we all hold anxiety about school re-openings, unemployment, the upcoming election, and our own health, we also share a poignant opportunity in our most cherished relationships.

If we do not take this time to talk, to listen, to change, to say the words out loud, I fear more and more patients and families will arrive at the hospital with unexamined lives. In my experience, this type of grief is not easy to recuperate from. My hope is that we can each suspend our worries about the risks Covid-19 poses for long enough to consider what else this pandemic is asking of us.

She/her. Palliative Care Physician. Trans Health provider. Writer. Midwesterner at heart.

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