Note: Names have been changed to respect others’ privacy.
The last text I ever sent to my friend Ellie was three days after she died. I told her I loved her, that I missed her. I thanked her for being my friend.
In the past year, our friendship had grown strong through a steady rhythm of texts. I first met her years ago in a freshman chemistry course. We spent most of college in the limbo of being “friends of friends”, but I remember her as brilliant and hardworking, with a lovely way of making you feel included in every conversation. We parted ways after college, gap years whittling away at our social circles. Though I looked forward to making new friends in medical school, I was thrilled to discover Ellie would also be in Philly for her own graduate program. I wouldn’t start this new chapter of my life alone. We met for dinner a few weeks into the semester. When I arrived, she slumped in her seat with relief saying, “Aghhh, you have no idea how nice it is to see a familiar face!” It’s rare that someone reads your mind, but it’s an incredibly powerful predictor of friendship. We talked for hours that evening and only returned home when it got a bit too dark to see the other person’s laugh.
She, too, had moved to Philadelphia to study medicine. We agreed that waking up before 7:00 AM sucked. Making friends was harder than we expected. And it was painfully hilarious how quickly our programs had summarized the entirety of our undergraduate education and moved on. (It turns out a degree in chemistry only buys about two weeks of coasting time).
Our catching up continued in a buzz on our phones. We reminisced about funny moments from college, sent memes to each other, and complained about medical school. It was weird to be back. It was also a lot harder than either of us had remembered. After realizing how deeply we were craving familiarity, we set up a weekly study date. The routine was simple. Someone would propose a new café and a time. We would meet to vent, spill tea, compare notes, and then we would work in comfortable silence until someone got tired, or busy, or we were kicked out. The regular meetups gave me some much-needed stability in an otherwise a rocky landing in med school.
It didn’t last.
Our last coffee date started late and ended early. A worsening headache sent her into an Uber home just an hour after we arrived.
I tried to keep up my half of the text conversation, but she went silent. A week later, she messaged me that her doctors discovered a mass in the left side of her brain. She had just had an MRI and fMRI, and tomorrow she would have an angiogram. The plan was to remove the mass later that week.
I knew nothing about brain tumors at the time, but even then, I sensed danger in the frenetic pace of imaging. I did my best to support her through texts, but the easy rhythm of our conversation had gone. School got busy, and I returned to our conversation less frequently. I figured that brain surgery was probably like getting a concussion – no screens during recovery. But surely, she’d respond soon.
She never did reply. Instead, I got a text from someone else on a random Friday while walking home.
“Hey. Just learned abouts Ellie’s death…”
“That’s not right,” I remember thinking, “She was just recovering in the hospital. I had literally just texted her?” But when I searched the internet for her name, the first link took me to a webpage titled “Obituary” with her beaming face staring back at me. She had passed a few days prior due to complications of her brain tumor.
I had a nauseating moment of disbelief tinged with fear. My stomach dropped through the floor, and my vision darkened on the edges. Something had gone deeply wrong- this was not supposed to happen to Ellie. Almost immediately came a sick feeling of guilt. You should have tried harder to contact her.
It felt like my head was floating away and my limbs were wrapped in plastic wrap. The sun seemed brighter than it had seconds ago, and my phone ten pounds heavier. I drifted off my typical path home and into an alley to read the rest of the memorial page. The paragraphs of text, wobbly with tears, summarized a life full of joy and kindness made tragic in its brevity.
The next few weeks lurched along in depressing little vignettes. Ugly crying in public on 21st Street. A glossy leaflet handed to me by a solemn usher. Staring blankly at a question in small group, unable to comprehend a word. Inexplicable rage at “happy-looking people.” (I’m sorry, but if you smiled in my general direction during the month of November, I was secretly a little angry at you.)
I wanted desperately for someone to ask me what was wrong, but the idea of explaining what had happened was frightening for reasons I still struggle to articulate. Eventually I realized that most of what others had to say boiled down to “sorry for your loss.” Here again, guilt reared its ugly head. Lose what? You were just a friend.
The words stung, reopening the wound left in her absence. I will never get to tell her that anatomy ended up being incredibly fun, and weird, and exciting, and that she would probably like it too. I’ll never know whether she found her place in medical school the way I eventually did.
I struggled to care about most things. I didn’t watch lectures. I withdrew from friends. I stopped running, an activity I used to adore. Why bother, it’s all kind of bullsh*t, isn’t it?
The one thing I could focus on were brain tumors. I read countless web articles, research papers, and Reddit posts about brain cancer. I scrolled through Google images of meningioma pathology. I learned that glioblastomas are the most common type of malignant brain tumor, and IDH wildtype is a harbinger of mortality.
Don’t worry—this isn’t a HIPAA violation, just counterproductive speculation. I was extrapolating miles away from the sparse data I had. Whether I acknowledged it at the time or not, I wanted to imagine a different reality in which Ellie was alive because someone had figured out what was wrong. This was a fallacy enabled by a pre-clinical education that prioritizes diagnostic knowledge and underemphasizes the complex reality of treatment. Even with resection, radiation, and chemotherapy, patients with glioblastomas rarely survive more than two years. Knowledge alone cannot save lives, nor does it spare one from grief.
No, it’s time alone that shrinks the grief.
I realized this one day in February while staring inquisitively at the gross pathology of stroke. In my curiosity, I had completely forgotten that the slice of tissue in my hands once housed a part of a person. “Glioblastoma” had become an answer on a flashcard, rendered impotent by spaced repetition. The grief had shrunk enough for me to move around it.
After my psych block, I now have shiny new clinical words like “adjustment disorder with affected mood,” “intellectualization,” and “cognitive distortion” to distance myself from the most swift and unexpected loss I have ever experienced. It is profoundly difficult to navigate such bereavement during medical school. In another life, I may have had the time to properly tend to the pain, regret, and guilt I felt. In this life, I don’t. I break off little chunks of it digest when I have the time, and I must be satisfied with whatever meaning I can extract from the milieu of grief. It’s the best way I know to keep moving forward.
I extracted two things.
First, physicians need to understand grief. It permeates the medical field unlike any other profession. Patients die in the capable hands of physicians every day for any number of reasons, but there are other kinds of bereavement too. Loss of mobility, memory, and independence can devastate with the same ferocity as the death of a loved one. It will be our responsibility to slow some of these losses, but we cannot prevent them all. What may be our most critical and profound task is to help patients and their families prepare for, make sense of, and ultimately move forward when they discover a part of themselves missing.
Second, we are all so lucky to be here. Yes, stacked lecture days are a slog, and the school sends us way too many emails, and apartment hunting in this city could drive anyone insane. But to suffer these little injustices of life is, in many respects, a privilege we take for granted.
I do often wish I had been more insistent in seeing my friend during the last month of her life. Maybe then I could have told her in person how deeply I cared for her. Instead, all the words I would have said were sent three days belated. It was surreal yet comforting, to deliver this final coda on a beautiful movement of friendship. I only wish that I hadn’t been late.
Scout Hayashi is an MS1 at the Perelman School of Medicine.
