Endings and Beginnings

My father’s final gift to me was acceptance and an expression of love that I had wanted for many years.

My father had Alzheimer’s disease at eighty-three years old, and my mother was his caretaker. He would wander and escape, and she would have the police bring him home. He would get dressed at 3 a.m. for a day at the beach in January, and she would convince him to stay home. Her health was suffering.

I still have fond memories of my kindergarten teacher, Sister M. Elizabeth Kobierowski at Our Lady of Czestochowa School in South Brooklyn, New York. She was the first of many Sisters of the Holy Family of Nazareth I would come to know and love during my formative years in our predominantly Polish-American parish. That love would continue well into my teens, when I attended the Bishop McDonnell Memorial High School, also in Brooklyn.

Ms. K was one of the oldest patients I’d met. I wanted to sit and hear her stories, to say, “Tell me more,” the way we learned in medical school. But the equipment sustaining her left no room for a chair to sit in. And COVID had stolen her ability to speak in sentences; she puffed out words two or three at a time before inhaling again. Even so, each word was sharp and spirited and made me smile.

Her face was a rich and deeply wrinkled landscape. Ms. K’s gown hung loosely on her, exposing the silhouettes of her ribs and knobby shoulders. I was surprised when I pulled the layers of blankets back from her feet. In contrast to her thin arms, her legs were thick and smooth, due to the accumulation of fluid as a result of her weakly pumping heart. Her heart had been failing for years, yet she had beaten the odds and thrived.

“And the year 2020 came to an end and they all lived happily ever after.” Wouldn’t it be nice if we could all leave this year behind and be certain of the “happily ever after” part?

I have often wondered at the hype that typically accompanies the end of a year and the beginning of another, especially since the year starts and ends at different times, depending on which calendar we choose to follow. The Jewish New Year and the Chinese New Year do not coincide with the 1st of January, and they do not even occur on the same day each year.

It eventually occurred to me that the meaning we attach to a day or anniversary is what gives it significance, not the day itself. On one occasion during my residency training, I specifically asked to be allowed to deliver a laboring patient’s baby because it was the anniversary of my mother’s passing. I felt that helping to bring a new life into the world on the day when I could have been focusing on death would have a special meaning. I remember looking at an obituary as a child and announcing to my mother that someone had

People cheered the first trucker transporting a huge load of COVID-19 vaccines as he left the Pfizer plant in Kalamazoo, Michigan. The news anchor exclaimed, “This just might be the beginning of the end.” That driver represented one individual in a long chain of workers besides doctors and nurses needed to end the COVID-19 pandemic.

A  few days before, an email from the state health commissioner had popped up in my in-box. Its subject line caught my attention: “Urgent: Volunteers Needed for Vaccination Campaign.” To me, there’s a light at the end of the tunnel now that a vaccine is a reality. I felt excited to help and answered the call without hesitation. As an RN who has given hundreds of tetanus injections to ER patients, I have medication administration skills to offer such an effort.

“Doc, can I say just one more thing?”

Every clinician knows this moment—the so-called doorknob moment, when your hand is reaching for the exam-room door, and your patient asks the question that’s been on their mind the whole visit. It’s the issue that’s been nagging them, usually an embarrassing or emotionally laden issue, sometimes both. Every clinician knows better than to walk out on a doorknob moment.

I sit back down. “What’s on your mind?”

The mother had delivered a healthy newborn. After a careful instrument count and exchanging pleasantries, I headed for the shower. It was getting late, and I had unfinished business.

On to the ICU, but not for my usual reasons. I heard sounds of beeping intensify just before I entered the room, and I felt an ache inside. My eyes focused on the vital signs on the screen. I sat down. “Good evening,” I said.

A smile spread across her face. Struggling, she said,  “Good evening, I love you.” I was relieved, at least for the moment. Until then, I did not know if I would ever talk to her again.

I remember the way she looked at me: as through a haze. I remember regretting not having spent more time with her. I remember reassuring her that it was all going to be okay.

When I asked my mother how her day had been, she said “Okay.” But the look on her face suggested otherwise.

I knew my time was running short. I wasn’t even supposed to be there as Coronavirus had swept the globe. I was only there through subterfuge, under the guise of a physician. In truth, I

My patient, Mary Kay, was a take-charge person. Even after a surgical error left her legs completely paralyzed, at age 48, she adjusted well to living in a nursing home and was dynamic, intelligent, and dedicated to her family and friends. Some of her friends even enjoyed a weekly martini with her.

After her tragic medical experience, but before I assumed her care, Mary Kay’s husband, unable to live without her, had taken his own life. Thereafter, with the best of intentions, her family withheld other unpleasant news from her, including hiding her granddaughter’s chronic fluctuating illness. Mary Kay secretly became despondent and overdosed on her medication.

“Hi, Sue,” I said. “Here’s my letter of retirement.”

“You know I don’t want to hear this,” she replied.

“Yes, but the time has come, and I’ve been clear about my intentions for several months.”

“Do you think you could work a few extra months so you can help us find and train your replacement?”

When I was straight out of residency training, my first practice was on a small island off the coast of New England. I embraced the challenge of providing the full range of services that I had learned as a family physician, but that definitely proved to be an uphill climb on a number of levels, both personal and professional.

Although I soon felt very connected with the islanders in general and my patients, my wife and I missed our families back in New York and the familiar offerings of a  suburban community. So after three years, I decided to move to the mainland (or “America,” as the locals called it) to continue clinical practice there and the teaching that I had begun to do with a nearby medical school and residency program.

I frequently let endings dominate my life. My leaving home for graduate school ended my secure life under the care of my parents. My marriage ended my existence as a single woman who charted her own course, while my divorce ended my status as a married woman. Retiring ended my decades as a middle school teacher. The death of my parents ended my identity as a child and gave me a new persona as a sixty-seven-year-old orphan.

I have tried to teach myself, especially during these pandemic days of isolation and introspection, that with each ending comes a beginning. Life continues, even if the tomorrows take on different hues, scents and sounds than the todays and yesterdays. Just as the red light only temporarily stops my journey until the green light restarts it, so do I have the ability to create a beginning to a life that has ended.

Therein, however, lies the challenge. I have the ability to start over, to find a new way to garner meaning and purpose from my life, but do I have the mental stamina to do so? As a person with a proclivity towards depression, it is difficult for me to muster the