And then it was over. Mom died on a Wednesday afternoon, the wake was Friday, the funeral Saturday morning. We cleaned out her condo on Saturday and Sunday. By Tuesday, we were mostly finished. Somehow I had been made executor, perhaps when I wasn’t paying attention or because of it. But all of a sudden, the out-of-towners had left town. My sister and brother-in-law drove to Florida. The nieces and nephews returned to their homes out of state. My daughter, Bea, resumed her coursework; Ruthann flew back to Georgia. And Mom was gone for good. I felt suddenly and irrevocably grown up, as if I’d ridden a catapult into adulthood after playing make believe for thirty years. Despite surviving a life-threatening brain aneurysm, a lethal divorce, raising two kids and a daily tread through the mine-field of medicine that I called a career, I had finally—at the age of fifty-two—matured. Like many physicians my age and in my line of work, I had a graveyard behind me full of patients who’d died or nearly died while in my care. Esther, Miriam, Nathaniel, Mark, the patients whose names I never knew or couldn’t recall, plus dozens, no hundreds more—they’d taken their toll but they hadn’t done this. This was something else. The woman who stared back at me in the mirror no longer looked or felt like a kid mistakenly trapped inside an adult’s body. I’d become the age on my driver’s license. I read somewhere that when both your parents have passed, there’s nothing to stand between you and death. But that wasn’t it at all. No one had protected me from anything for a long time—I’d been a grown-up since pre-school. This was different. I felt old and looked tired. Was this what it meant to be an orphan? If so, it was awful.
I took to my bed.
I like the way that sounds: I took to my bed. It implies that I acted with style and flourish, perhaps adorned with a pink satin bed jacket. It suggests that I knew what I was doing. But I didn’t. I only know how to tell the tale.
In the days and nights after my mother died, I spent all my available time in bed. But I couldn’t sleep. Mostly, I read. I went back to work after a week, and any time of the day or night I was not working, I slipped under the covers. I forgot to eat. I didn’t pay the bills or answer the phone. I managed to walk and feed my dog Olga because she stuck her snout into my ribcage or under my elbow to remind me that she required some upkeep even if I didn’t. I read and occasionally drifted off. My choice of material wasn’t spiritual, escapist, or inspirational. I didn’t read the newspaper or any one of the books that sits in a pile on the unoccupied half of my king-sized bed. I skipped the poetry collections of Collins, Auden, Ryan, and Rilke heaped on my bedside table. I ignored my stash of New Yorkers, Economists, and New York Times Sunday Magazines from weeks past. Nope, I read Harvard Business School case studies. I did homework.
~
I remember my father telling me, on numerous occasions, that the readings at our Catholic Mass were just metaphors I should not take literally. They were just stories. “Think of what the story means, in the larger sense. Probably none of these things actually happened.”
I come from a family of storytellers.
~
Four months before Mom died I had signed up for an Executive Education course called Managing Healthcare Delivery that spanned nine months and required travelling to Boston for three separate weeks. I had enrolled somewhat impulsively near the end of my mother’s inexorable decline from dementia, when I could hardly stand the pain of it anymore: her slow disappearance, the wait for her inevitable demise. Every visit to see her grew more challenging. I couldn’t bear to be with her; I missed her in her presence. How do you watch someone die backward, regressively, from old age into infancy, without wanting to scream out loud at the injustice? It went on forever and grew worse by the day. Vicki made pansit, a traditional Filipino noodle dish, for me most weeks. Comfort food. Sometimes egg rolls too. Mom didn’t eat them. The food worked though. It felt like the kindest thing anyone had ever done for me. And when I could not stand my own conflict—my need to fix things and to flee simultaneously—I thought, incongruously, something is wrong with this picture. I’ve spent a lifetime in medicine—why can’t dying be better than this? And so I looked to Harvard Business School to find the answer. Because—I don’t know—where else do you look? The answers were not at the hospital or anywhere in medicine that I could see. I had not found them by going to Mass. I’d searched my soul; it offered no clues.
The Harvard course began one month after Mom’s death, which seemed fortuitous but was completely accidental. I’d always been an excellent student so I had to prepare. I did all the required reading in advance. I even bought new highlighters. As part of the preparation, I was required to take the Meyers- Briggsii personality test online. I vaguely remembered the test from when my sister Beth was in graduate school in psychology; she was always referring to me with letters. I...N...T...J.
~
“Stories are at the center of culture,” Daniel McAdams states in his book The Redemptive Self: Stories Americans Live By.iii “Stories teach us how to live and what our lives mean. Self and culture come to terms with each other through narrative.” In his book, McAdams examines how and why we tell the narratives of our lives in the ways that we do. He looks at highly generative adults who, in middle age, attempt to understand why they’ve come to be the people they are and why they believe what they believe. He sees the American experience as being individualistic as opposed to other, particularly Eastern, cultures that value collective ethics. He explores the life story, which he refers to as the “narrative self,” and analyzes its redemptive nature. The typical American story is that of a special sort of childhood, of some hardship overcome, which leads to a desire to achieve, to help others, and to work hard. The redemptive self is a story that links the individual person to a larger culture: who am I in relation to this society I came from?
~
Lying in bed, I slogged my way through the material for the first of three learning modules, which dealt with the design and leadership of a successful organization. In a month’s time I covered over five hundred pages. I learned about the challenges facing the U.S. healthcare delivery system; they seemed insurmountable.
I learned about strategy; I learned about cardiac care for the poor in India, cancer care at MD Anderson, orthopedics at Rittenhouse, Duke’s heart failure program, Dana-Farber’s famous chemotherapy overdose of a Boston Globe reporter, and how to redefine health care in terms of value. I liked that they used the case study method to impart these lessons. Weren’t case studies just an elegant form of storytelling?
In the weeks following my mother’s death, I was easily distracted and got lost in the details of my reading. I took Olga for long walks in Lincoln Park then started over, again and again. Some paragraphs I read four, five, even six times. In my grief, I highlighted everything. When I arrived in Boston one month later, I realized, to my chagrin, that I had acquired a lot of complex, often contrasting information, but not much sense of the overall picture. I felt muddled by the minutiae.
Stories had always clarified life for me. Narrative gave me the ability to organize my thoughts, to put my principles in order. But my parents’ deaths and the uneasiness I felt with my role as a physician had deprived me of my usual facility with narrative. Why, exactly, had I come to Boston? I suppose I wanted the Harvard faculty to weave this story together with the questions I asked myself every day. These were smart people. I felt hopeful it would happen; I would learn something worthwhile. I would learn something that helped make sense of the suffering, the waste, the inequity. These disparate worlds—my personal world of micro-managing my mother’s death from a silent, ubiquitous killer, my other world of hospital-based healthcare, and the theoretical business philosophy of national healthcare—surely were not as far apart as they seemed. I felt relatively positive that in nine months I would come to understand how they fit together. At the very least, I would learn something of practical value. That’s all I wanted.
~
Storytelling turns out to be its own form of redemption, as well as a process of discovery and explanation. We use it to illuminate