A few weeks ago, my friend, Glen, drove me home from work. We were stuck in traffic, so I texted my wife that I’d be home after the kids’ bedtime. “She’s pretty cool about handling both of them without you?” Glen asked. “She’s a pro,” I answered. “What about you?” he asked. “How hard is it for you when she works late?” I answered by relaying my fear that my wife will die in a car accident or other unexpected calamity, leaving me alone with the kids. “My mother-in-law would probably stay with us for a little while, but eventually I’d have to hire a full-time nanny to live with us, someone 15 or 20 years older than me, who could sort of take care of all three of us. Someone like Alice in The Brady Bunch. Hopefully she’d speak Spanish so the kids wouldn’t lose their Spanish.” Glen stared straight ahead – he was driving, but we were in traffic, so he could have easily turned his head a bit. “You’ve thought a lot about this,” he finally commented. “Doesn’t everyone?” I asked.
This conversation happened before I read three “grief memoirs” back-to-back-to-back in February: Helen Macdonald’s H is for Hawk, Paul Lisicky’s The Narrow Door, and Elizabeth Alexander’s The Light of the World. I didn’t plan this reading schedule. My wife was the one who checked out H is for Hawk from the library, and my previous holds on The Narrow Door and The Light of the World coincidentally popped up in my online library account just as I finished Macdonald’s book. I highly recommend all three books but wouldn’t necessarily recommend the process of reading them consecutively, especially if you’re the type of person who tends to ruminate on your spouse’s unexpected death. “Grief is a monster,” Lisicky writes about losing his best friend, Denise, to cancer followed by the dissolution of his marriage six months later. Alexander asks about her husband, “Do you see why I miss him? I call out, to no one. Will I remember everything? What am I meant to keep?” Like Alexander’s husband, Macdonald’s father dies from a sudden, unanticipated heart attack. Alexander, the mother of two teenage boys, wrestles with the day-to-day events of moving on without her partner. Macdonald, unattached, channels her grief into the struggle of training a goshawk.
Most patients come to my clinic, especially for their first appointment, accompanied by someone – a spouse, a child, a sibling, a close friend. I specialize in the rarest forms of kidney disease, so these patients are seeing me as a second or third opinion. They expect to hear new information about their diagnoses and want an extra pair of ears. Or they may have been told by the last nephrologist that there’s no hope and need some support just in case I plan to hang crepe, too. I was therefore not surprised to see my new patient, diagnosed with focal segmental glomerulosclerosis (FSGS), enter the exam room with her husband. I was surprised, though, when she asked him to leave a few minutes into our encounter. After we were alone, she said, “You mentioned that sometimes a virus can cause this? Is that true?” “Yes,” I said, “but that was to illustrate a larger point, about how sometimes we can identify a cause for FSGS, and other times we can’t. In your case, I think we can identify an etiology, and that etiology is obesity.” “So, you’re sure it’s not a virus that caused this, then?” she asked. I told her she’d already tested negative for HIV and parvovirus B19, the two viruses most commonly associated with FSGS. “I was worried that maybe herpes caused this,” she continued. “I have herpes, but he doesn’t know about it.” She motioned with her head to the office door and her husband waiting outside. “I assume you mean genital herpes?” I asked. She nodded yes. “How can you be sure he doesn’t know?” At this point, my questions were not related to her kidneys. I was merely curious. “We haven’t had sex for almost 20 years,” she said. “Something happened, something I learned about him, and we haven’t slept together since.” “What happened?” I asked. “I don’t see why it’s important,” she said. “It’s a big stress for me, and has been for 20 years, so unless you think that stress caused this to happen to my kidneys, I’d rather not get into it.” I was conflicted. I wanted to know, but I didn’t need to know. “Well, we don’t know if stress directly affects the kidney, but stress can lead to overeating, and stress can lead to high blood pressure, and both of those things can cause your kind of kidney injury,” I said. I drew a diagram on a piece of scrap paper, connecting the words “stress” and “obesity” and “hypertension” to a bean-shaped cartoon of a kidney. “But,” I continued, “I’m comfortable just acknowledging that there’s some stress, and you don’t need to tell me about the specifics, provided we can manage your weight and your blood pressure.” A medical student was shadowing me that afternoon; after the patient left, she said, “I can’t believe how much personal stuff she told you.” “Patients will tell you lots of things,” I told her, “if you’re willing to ask and listen. It’s like a medical version of confession. I’m actually surprised she didn’t tell us what happened with her husband 20 years ago.” The student and I each took a guess as to what the incident was, and then we moved on to the next patient.
My residency program hosted a quarterly book club as a way to encourage the doctors-in-training to read something other than medical journals. When we covered Joan Didion’s The Year of Magical Thinking, my friend, Mary Beth, came to the discussion but announced that she hadn’t read the book. She said something like, I can’t read sad books. She elaborated with something like, When I read, it’s to escape the hospital, so I need something light, something that gives my brain a rest. I answered something like, I only like to read sad books. That conversation happened ten years ago. Mary Beth no longer practices medicine, while I sop up the intricate details of my patients’ sad stories.
For the past two months, my wife has been taking a Jackson Pollack class at the Museum of Modern Art on Monday nights from 6 to 10 PM, so I’ve been charged with picking up the kids from daycare, feeding them, and getting them to bed. These are Monday nights of hot dogs or pasta with butter and salt. The vegetable offering is a sliced cucumber or bell pepper sitting aside a tub of hummus. I listen to a podcast while cleaning up once the kids are down. After making their snacks and lunches for the next day, I go downstairs and do yoga in the basement. Then I answer emails, surf the net, or read a book for an hour or so before going to bed. The night would feel entirely different if my wife didn’t wake me with a kiss when she gets home, if she didn’t tiptoe into the kids’ rooms to do the same.
Years ago, I said to a patient, a man in his early 20s who’d lost his kidneys due to lupus and was on dialysis, waiting for a kidney transplant, “You have such a great attitude. You’re always so optimistic. It’s got to be hard to keep that spirit up.” He answered, “No, I break down, I break down a lot, but in my home, with my family. I don’t need to do that in a doctor’s office.” I’ve thought about this exchange at all of his subsequent appointments, even visits in which we’ve discussed how well he’s doing since his kidney transplant. Because he’d once admitted that he was hiding his grief from me, I can’t put any faith in his happiness.
What did I want him to do with his grief? Write a memoir? “Art replaces the light that is lost when the day fades, the moment passes, the evanescent extraordinary makes its quicksilver,” Alexander writes in The Light of the World. “Art tries to capture that which we know leaves us, as we move in and out of each other’s lives, as we all must eventually leave this earth.” The popularity of “grief memoirs” must stem from our collective desire to grieve vicariously through others, to hope that when our own reasons to mourn arise, we’ll handle the sadness with the same artistry as these writers. Is that why my favorite patients are those who spill their secrets and share their sorrows?
I play peek-a-boo with my 1-year-old son, and when I drop off my 4-year-old daughter at daycare, I let her delight in pushing me out the door. “Go away!” she squeals. “I’m pushing you out!” The other kids do this, too. The teachers encourage the pushing as a way to help the children separate from their parents and revel in each other’s company. These practices are fun for the children and reassuring for the parents, but I’m not entirely sure why our games must involve the absence, even if it’s momentary, of a loved one. Years from now, I’ll say goodbye to my daughter, and instead of pushing me out the door, she’ll say “See you soon,” but she won’t. Likewise, my son will think, “I just saw him, he looked fine, but now he’s gone.” The games we play are dress rehearsals for future losses.
Helen Macdonald mentions D.W. Winnicott in H is for Hawk, but she does not relay the pediatrician’s famous line, “It is a joy to be hidden but a disaster not to be found.” Training the goshawk is a way for her to go into isolation after her father’s death. Lisicky pores through his friend’s old emails. Alexander lies in bed, after her sons have left for school, and dreams of her husband. Eventually, they all want to be found, which is why they’ve written these books. Likewise, I suspect my patients feel the relief of being found when they unburden themselves to me in the safety of my consultation room. The Winnicott quote makes me think of the games of hide-and-seek I play with my daughter in public playgrounds. We both cheat. She hides, but she also laughs or sticks a foot out or deliberately chooses a bad spot so that it will be impossible for me to miss her. When I pretend to close my eyes and count to 20, I put my hands over my eyes but splay out the fingers so that I can always see her. We’re playing at loss, so that neither of us has to really experience loss.
My conversation with Glen about the logistics of how I’d manage fatherhood, should my wife die, parallels the playful conversations my friends and I had, during high school lunch hour, about how we’d manage being homeless: where we’d find free food, where we’d sleep, where we’d eventually find jobs. We were privileged children whose parents and extended families would never let us reach those extremes, but those stupid conversations, those plans we hatched, were just our way of saying we didn’t understand or want to understand poverty, drug abuse, and mental illness. In that light, my fears of losing my wife and having to hire a full-time nanny to care for me and my children are just an expression of a reluctance to grieve. So is reading three “grief memoirs” back-to-back-to-back. I agree with what Mary Beth said during residency. I read to get away from the hospital, from the patients, from actual suffering and pain. I escape in the sadness of writers I’ll never know.
Andrew Bomback is a physician and writer in New York.