What Right Do I Have to Be Happy?

A little over a week ago, I went for a walk near sunset with my friend Mohsin, a fellow third-year resident and one of my closest confidantes in the program. We walked around Jamaica Pond, a gorgeous water feature in the Jamaica Plain neighborhood of Boston, reflecting on our time in residency and the seeming impossibility of it soon coming to a close. We were with Mohsin’s wife, Sam, who politely endures many of our jargon-filled rants about medicine, philosophy, epidemiology, and current events. As we watched the too-beautiful-to-be-true sun set along the horizon, our conversation turned to the recent illness of a loved one, and Mohsin and I began pontificating about what we thought could be going on – “Do the labs suggest cirrhosis? What do you think is the chronicity of this kidney injury? To what extent might this change in mental status be reversible? What is his overall prognosis?” After seven years in medical training, such questions have become routine, even mundane. But in this case, the presence of an outside observer – Sam – brought attention the abnormality of our discourse. “You’re able to remain awfully detached and analytical about this, aren’t you? Are you not disturbed? Don’t you find it sad that you can’t do anything?”

After a moment of reflection, Mohsin and I agreed that she was correct – of course we found it sad. But, as pediatric residents, we’ve become accustomed to immersing ourselves daily in the deep sadness of others’ tragedies then quickly shifting our mindset from emotional connection to inductive and deductive reasoning as we formulate a medical assessment of the situation and plan of care, balancing the human desire to empathize with the pragmatic need to operationalize said empathy with action.

Our tag-teamed response, paraphrased here, was hopefully at least partially adequate: “On any given shift, we may have the unique privilege of being present for the worst day a patient or family might experience: a new cancer diagnosis, a notification of the need to be admitted to the ICU for treatment of a severe infection, an admission of treatment failure, the notification of suicidal ideation and actions. And part of our professional responsibility is showing up and bearing witness to said tragedies, even in those cases in which we cannot fix them: the failed bone marrow transplant for multiply relapsed leukemia, the inability to resuscitate an extremely preterm infant, the drowning discovered too late. And in the moment, we hope that our presence, and our words, are enough, though we fear they are not. But then eventually we go home, and we have to go on living with the reality of what has happened, of what we’ve seen, of what we have and have not been able to do. And we are faced with a choice: do we live eternally in the darkness of the tragedies, or do we allow ourselves to seek and find joy in the other parts of our lives?”

After some additional somber reflection, our conversation returns to less weighty topics, as it always does. We walk around the pond and appreciate the sunset, marveling at the way the rays of light cast their reflection on the waves and through the foliage on shore. We discuss what we’re planning to wear to our upcoming senior resident celebratory dinner and who we’re hoping to see there. We marvel at the progress Mohsin and Sam’s cat has made in trusting his owners in the months since he was adopted from an abusive family, and pontificate on the extent to which feline and human psychology and neuroscience overlap. We discuss our favorite musical artists and how nothing can evoke emotion in quite the way music does, how melody and harmony, rhythm and meter, verse and chorus can bring out emotions that mere words, expressions, and ruminations simply cannot. We chuckle at the intensity of our shared adolescent fondness for Coldplay, noting that Chris Martin et al. may never be able to surmount the emotional intensity of their second album, A Rush of Blood to the Head. And in the end, the sun fully set, we make our separate ways home, full of thoughts and grateful for shared memories in the final weeks we have in Boston together.

Fast forward a few days and I’m slowly packing up my apartment in the aftermath of a 24-hour PICU shift where I’d seen a child have such a severe asthma attack he needed urgent intubation due to failure to breathe out enough carbon dioxide on his own. As I tape up boxes and rummage through winter clothing, bemoaning the quantity of materialistic nonsense I’ve accumulated since my last move (likely secondary to my lack of direct kinship with Marie Kondo), I find it difficult not to dwell on the images of the critically ill child from the night before, of the scared faces of his parents, of the tension in the room as we wonder if intubation will actually make his condition worse, as is often the case for patients with asthma – hence using intubation only as a last resort. Recalling the peri-pond conversation from a few nights prior, I pull up A Rush of Blood to the Head on Spotify and let the needle run. I have a vague sense of nostalgia as the tracks progress, The Scientist and Clocks dredging up memories of long nights in high school struggling with coming to accept my sexuality and wondering indeed whether I was part of the disease or part of the cure, why while no one said it would be easy, no one ever said it would be this hard.

That said, reminiscing on my closeted past is such well-worn emotional territory at this point – 10 years after coming out – that listening brought up mostly a sense of compassion for my past self and gratitude that I’d found the confidence to accept my own identify alongside friends and family who supported me as I lived authentically. And so, I go on packing, enjoying the rose-colored tint of my own nostalgia.

What I was not prepared for was the sudden rush of emotion (of blood to the head?) I had when listening to the final track on the album, Amsterdam. For those unfamiliar, Amsterdam is a mournful anthem whose last verses make a not-too-subtle reference to suicide:

Stood on a bridge, tied to the noose
Sick to the stomach
You can say what you mean
But it won’t change a thing
I’m sick of the secrets
Stood on the edge, tied to the noose

You came along and you cut me loose
You came along and you cut me loose
You came along and you cut me loose

As the song declared its crescendo to those final lines, I suddenly found myself needing to sit down due to an intense sense of unfairness and sorrow, and tears began to well up as I reflected:

How can I possibly be sitting here and doing something so mundane as pack up my apartment while the world is full of tragedy?

What right do I have to be happy in a world full of suffering?

What right do I have to be happy in a world where I watch parents outlive their children?

What right do I have to be happy in a world where Black children grow up fearing for their lives even in the comfort of their own homes or neighborhoods as they process the senseless deaths of Breonna Taylor, Philando Castile, Tamir Rice, and countless others?

What right do I have to be happy in a world where trans- and gender-non-conforming youth are daily driven to suicide by the hateful and ignorant actions of those who tell them that the gender identity they know to be true is a “fad” or “mental illness”?

How can I possibly sit here and laugh about how I’m planning to match outfits with the friend I’m planning to take to my upcoming senior dinner wear when on my last shift I saw someone close to death from asthma, a disease society has all the tools it needs to prevent?

How have I made it through residency without coming home every night – or morning – and sobbing?

I reach for my phone and I text my best friend from undergrad, Carrie, someone who is uniquely special to me because I know I can confide in her while in any emotional state and know that she knows that in general I don’t need to be “fixed”, I just need to be heard. And in re-reading my texts, I certainly made myself heard:

WHAT THE FUCK SO MUCH BAD HAPPENS TO PEOPLE AND I HAVE SEEN SO MUCH OF IT WHAT IS WRONG WITH THE GODDAMN WORLD AND WHY HAVE I NOT CRIED MORE FOR ALL OF THE TRAGEDY???

How am I just supposed to go around having senior formals and being happy??

Anyway just reminding myself that grief is complicated and a lot of my mourning has been displaced

And that I truly have borne witness to a lot of families’ “worst days”

But that the point of so much of what we do in medicine is to restore life and ability for others so that they can go and live rich and fulfilling lives

And thus ME living a rich and fulfilling life is actually a reminder to myself that there is something worth fighting for even in those darkest moments

And even without a response from Carrie (which of course came promptly and was beautifully empathetic as always – “are you going to write a blog about that? You should!”) I realize that the simple act of sharing has, in and of itself, allowed me to come to the conclusion I needed: horrible things happen every day in the world, whether or not I choose to pay attention to them. In fact, as a doctor, I am uniquely situated (1) to be privy to those harrowing tragedies but simultaneously (2) to bring my expertise to bear to make some difference in the lives of those for whom I have the privilege of caring, even if sometimes that “difference” only looks like providing reassurance that the tragedy that has come to pass is not anyone’s fault and that nothing could or should have been done differently.

And I think one step further: those moments in which I truly enjoyed my own life were often coincident with the moments in which I provided the best care as a doctor. When I really revel in the process of diagnostic inquiry, of taking a careful history and reading about the possible outcomes in the medical literature, discussing it with colleagues, and coming up with a thoughtful plan, I can’t help but acknowledge that I really enjoy the practice of medicine. And my enjoyment is not a denial of the seriousness or gravity of the situation – rather, it is in part a recognition of the importance of taking my work seriously and the immense psychological benefit provided by knowing that my thoughts and actions could be truly life-changing for those I’m treating.

And upon further introspection, I find that this applies not just to enjoying medicine itself, but also to being fully present and enjoying other parts of life: I am so much more present with and caring for patients and families when I have had satisfying life experiences of my own in between shifts: restorative conversations with loved ones, endorphin-filling exercise, awe-inspiring hikes through nature, uncontrollable laughter with co-residents about the unquestionable absurdity of what’s happened on a given day. Indeed, it’s ironically been in those moments where I’ve told myself that “work is the only important thing and enjoying myself is frivolous” where I’ve suddenly lost the spark or motivation to provide good care, and have slipped into the depersonalization, derealization, and emotional detachment of burnout. What’s the point of fighting for the life and well-being of others when my own life isn’t anything worth fighting for?

Flash forward a few days as I’m scrolling rather mindlessly through social media and see that a friend (whom I won’t name for fear of adding drama to an already unnecessarily dramatic situation) has been ridiculed for posting about having enjoyed their weekend when yet another act of racial violence has happened in America. And I think – outraged as I am about what happened – is tearing someone else down really the way to work against racial injustice, or does it just sow more hatred? Is there really ever anything to be gained from scolding someone else for being happy? I think not.

So as I sit here writing this reflection, post-call from another PICU shift in which I took care of yet another patient close to death from a preventable complication of a known disease (diabetic ketoacidosis from Type I diabetes in this case), I make a conscious effort to take a moment to simply appreciate and enjoy the recent events in my life, despite it all. Residency graduation this weekend with my family was just a perfect moment of love, celebration, and reflection. The sunset this evening was beautiful, the afternoon run was predictably euphoria-inducing, the Thai takeout was just the right level of spice, I’ve finished a draft of my final presentation in residency, and my friends are hilarious and witty and sassy in all the right ways when recounting their days. And as I do so, I can feel my mind flooding with other-centered emotions – compassion for those still suffering the pain of bereavement from having lost loved ones to COVID-19, vicarious frustration for those subject to the vagaries of a persistently sexist, racist, and homophobic society, concern for the stress of the parents of the patient newly diagnosed with diabetes.

That is to say: enjoying one’s life is not an abrogation of the responsibility to recognize and work to end tragedies. Rather, an appreciation of the extremes of good in our lives may just be the necessary precondition to working to end the extremes of bad.

So what right do I have to be happy? As much right as I have to mourn.