The House You Built

“Where do you want these plates?”

“Oh my gosh, M.  Put them down!  You don’t need to help us unpack.”

“I know I don’t need to, but I want to.  Besides, that’s J’s and my thing.  We always help people move into their kitchens.”

Holding up a blue ceramic plate, I looked around N’s new, white cabinets.  Her hand-picked pendant lights hovering over the kitchen island.  Granite counters with the shiny specks she wanted.  Months of planning had finally become her reality.  And now N was making this her home.

“So where?”

Sighing, she surveyed the mountain of boxes in her massive kitchen.

“In the cabinets by the dishwasher makes the most sense.”

Direct.  Authoritative.  Just as she was when she was my senior resident.

But now N was a full-fledged attending.  Moving into her attending house she custom built for this next chapter of her life.

“We put extra sound proofing in this room so B can bang on the drums as loudly as he wants,” she cackled.  “And this room… we could set up a wardrobe at the opening and make it a Narnia closet!  For our future kids!!”

If I could happily drown in someone’s energetic enthusiasm, it would be hers.  Normally I avoided people who exuded such vivacity – keeping up with them was just too draining.  But N had the ability to whisk you into her hurricane, hypnotize you with her diabolical laugh, hold you in with her razor sharp wit and intelligence and at the end of it all, somehow everyone would be better for it.

Like most friendships formed during residency, we’d condensed a lot of life into our short 3 years together.

Overnight call vent sessions when she’d hilariously complain about TJ, that useless intern who’d disappear in the middle of the night to lift weights in his sweaty scrubs while he stared at himself in the mirror.

Double dates with her Match.com boyfriend, B, to watching her glide effortlessly in a 20+lbs wedding dress across the dance floor, a glass of sauvignon blanc in hand without a single drop spilling onto the floor.

B jamming in our basement with J’s electric drum set as J played lead guitar, S on bass and F singing his heart out to the Avett Brothers’ January Wedding while she was working.  She howled at the updates of this budding bromance, that deep belly laugh that bounced her red curls.

A miscarriage.

N pronouncing J’s grandfather’s death, unaware I was the first one who registered the silence following his last agonal breath.  Her professional detachment slipping as she realized the patient’s family waiting outside the room was part of her residency family too.  Eyes widened in her lovely freckled face, horror reaching them as N realized she’d just been sitting in my living room, watching my mother-in-law navigate Cards against Humanity for the first time.  She never thought she’d be part of our family’s story in this way too.

Now I had the privilege of setting up her kitchen.

But it was more than deciding where the forks and spoons would go… I was getting to share in the dream of life beyond residency, to life actually starting.

What better place than to begin with the heart of the home for a woman who had one of the biggest hearts I’d known?

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I’m coming over with dinner!

Great!  See you soon.

As I stood at her front door adorned with a Pinterest-worthy purple wreath, I steeled myself against the unknown.

A lot had happened in the last 2 and a half years.

I’d graduated from residency and moved from the Midwest to start my Pacific Northwest adventure.  I, too, had experienced the highs of excitement as I embarked onto my attending life.  But I also had encountered the lows as I quickly found my way to burnout.  In fact, my struggle outlined in my first viral post on Kevin MD had just made the rounds on the internet – something I wasn’t prepared to reckon with.

N had become a beloved PCP in her community – of course she had!  Unencumbered by the sleep deprivation and irregular schedule of residency, she now tapped into a bottomless well of relentless energy.  Not only had she been voted as a top 10 doctor in her city, she had created a beautiful life in the house she built.

As B welcomed me in, I looked over to the first room on the right where they had planned on having their library, now a play room filled with a mountain of toys.  Smiling, I wondered if the Narnia closet ever came into existence.

“Hi!!!”

Her familiar chipper soprano voice greeted me, but her face couldn’t hide the terrible truth over the last 2 months.  Beyond N’s trademark brilliant smile, the exhaustion in her eyes spoke tales of living in survival mode.  But the conviction – the same look that almost drew me into a career in hematology/oncology – was there, loud and clear.

Setting the food down on the kitchen island, I quickly turned around and wrapped her into a hug as tightly as her port would allow.  Holding back tears, the journey here flashed in my mind.

The news of her cancer diagnosis spread through our residency network like wildfire.  But it wasn’t until I returned to work on Monday after a tear filled weekend that I got the full play by play.  As I divulged to my co-worker I’d received word my residency friend had metastatic colon cancer, her own eyes brimmed with tears as she furiously brought up her Facebook Physician Mom’s group page and pivoted her laptop screen my way.

“You need to read this.”

As I stood on my Ikea stepstool to frantically scroll down the social media posts while my co-worker failed to stop the tide of tears, I read from the beginning as it unfolded in real time, already knowing the horrific end.

Abdominal pain.  Blood in her stools – but it had to be from hemorrhoids post pregnancy, right?  Masses on the ultrasound, then the MRI.  The hope for a benign hepatic adenoma, crushed by elevated CEA levels.  Worsening, excruciating pain.  A hospital admission for pain control.

The first CT showing the primary cancer in her colon.

Now holding N tightly, I tried to push out the SEER cancer mortality data I’d obsessively looked up when I learned of her diagnosis.  Knowledge didn’t bring me comfort when the lens was directed at my friend.

50% survival at one year.  33% at two.  14% at five.

My blurry eyes settled on the living room that once held our short lived residency book club: The Light Between Oceans.  I hated it, complaining daily to J about how I had to read it to be a part of this club.  I hated it even more when I cried at the awful ending, to know I had become so emotionally invested in a book I despised.  J laughed at me in disbelief.  N understood.

The arrangement of the living room had now changed to accommodate N and B’s new life.  The blue couch was now pushed to the side wall to make room for even more primary coloured toys.  In the middle, the plushiest brown reclining armchair.

“I pretty much live in this damn thing now,” N said as she settled in after dinner while her mom put the kids to bed.  “I’ve trained my three-nager to bring stuff to mommy so I don’t have to move!  Gotta make her useful, you know!  But she’s just like me… stubborn.  Sassy.  Obnoxious at times.

Payback’s a bitch.”

What was N paying back to deserve this death sentence that would take her away from her mini-me?

Over the next 2.5 years I followed her journey from afar, crippled by the distance.

Chemo Friday every 2 weeks were for memes to make her laugh for the 5-6 hours that she sat in the infusion center.

Her tumors shrunk and were resected.  She returned to work, something I found difficult to wrap my mind around as I continued to struggle with burnout.  How could she spend her limited time on anything other than her friends and family?  Through her resilience and strength, she showed me the relief and comfort found in taking care of others, finding additional strength in that important work to carry her through.

A short reprieve ended when abscesses developed and chemo had to stop.  The cancer came back in a flurry, feeding off the vitality N once had.

Yet she was still able to become a vocal advocate for colon cancer research and national coalitions.  She organized 5k’s to raise awareness, a hilarious irony for a woman who’d always been vocal in never wanting to ever run.  EVER.  Perhaps it was her glee in finding a 10 foot long, giant inflatable colon to run through that fueled this about face.  Or maybe she knew getting over her deep dislike of running could help her amass funds so the next person to get diagnosed could be given the gift of more time.

Even at this juncture, she couldn’t stop herself from giving so someone else could have the possibility of more.

Cancer would never take this away from her.

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“It sounds like N recorded videos for the kids for different milestones like puberty and middle school and weddings… they’re looking for someone to help edit the videos.  I thought of E… he’d be a good person to do that work, don’t you think?  I just remember you posting a video of his and I was so struck by the touching details…”

The orange hue of the street lights blurred while I sat in traffic trying to process my friend’s request.

You don’t make videos for your kids’ future events unless you’re sure you’re not going to be there.

How many moments?  How long did she sit with her list, deciding which moments got to stay and which ones she’d let go?  How did she stare into that camera, knowing these would be the words they’d be left with when she was gone?

Who else would have that strength?

Of course it was N.

Ever the planner and a woman who got shit done, it came as no surprise that N decided even death wasn’t going to shut her up.  She was going to say her peace, even from beyond the grave.

As I sat in my car at that infinitely long red light to turn onto the highway on-ramp, my friend’s and my shared laughter and sobs finally acknowledged the truth:

It was time.

A month later she went into hospice.

She took in all the moments – cuddles with her babies in their cute Halloween outfits.  A birthday hot air balloon ride.  And when the time came, she passed away on her own terms, surrounded by the loves of her life in her own home.

The house she built.

I wish N could see the house she built in me, in all the women who had the privilege of knowing her.

To know that every time I have a real belly laugh, the kind that forces you to pause, arch your upper back and tilt your head backward to fully experience this act of pure joy, I’ll think of her.

To see her legacy of uplifting women entirely unapologetic for their brilliance and intelligence, refusing to shrink themselves because others are intimidated by their shine.

To know every time I tell a patient Comfort IN, Dump OUT, I’ll remember how her journey taught me how not to say the wrong thing via Ring Theory.

Scrolling and crying my way through hundreds of tributes to the monolith that N was, I’m struck by how our descriptions of her all ring similarly.

N wasn’t afraid to share herself with the world.

She was real.

And real is rare.

This is perhaps the greatest gift she gave the world:

An entirely unapologetic life, living her values and joy on her terms.

Even in the face of death, nevertheless she persisted.

I will forever be inspired by you, my friend.

***

If you are so moved, please consider donating to PALTOWN, a colon cancer organization near and dear to N’s heart.  It provides a network of support, encouragement and education for people living with colon cancer, something that was so immensely helpful for N.

I’ve personally donated every year since her diagnosis, and if sharing my grief translates into someone being able to have more time with their loved ones because of more funding, maybe the unfairness and tragedy of this all won’t be for nothing.

Thank you for reading.

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Photo taken of a storm rolling in over Steens Mountain, OR.

As N would say, “I am the storm”.