Red Sky

Years before I became a medical student, I lived with one. He had just finished his third year, rotating through the major specialties, repeating the history and physical over and over. We lived abroad, on the island our families left years ago, thrown together as random roommates. We arrived just under ten years after the war that devastated our ancestors’ homeland came to a violent end. We were there, the program directors optimistically told us, to reconnect with our roots—we were the posterchildren of a pluralistic future. He was the first friend I had who shared specific identities I hold. We were so different, but I was ready to learn what it meant to be in deep community with people I had been isolated from my whole life. The first day we met, I told him I wanted to be a doctor, too.

We made a home on that island together. We bought a plant and gave it a name. We sprayed insecticide in our kitchen, battling infiltrating cockroach families. We accidentally flooded the living room one morning and forgot to bring back the rug, drying on the roof. We decorated the dining room wall with a bucket list of all the places we hoped to experience side by side.

In those first weeks we spent sweating, intermittently supporting each other through bouts of traveler’s diarrhea with coconut water and Imodium, and drinking cheap beer that got warm too fast, I was obsessive about my life path. It felt like a vacation from reality, our little home from which I could smell the sea breeze, but I couldn’t shut up about what I might do next, where I might go, how it all might work out. Every evening when the sun went down and the thoughts bubbled up, he handed me a mandarin orange and told me to breathe, that I would figure it out.

I marked the months with playlists I sent to my best friend back in the States. One playlist started with the song ‘Homebody’ by Nai Palm, which I played on repeat. “Home is where,” Nai Palm sings, “You don’t have to carry all of the worry / You don’t have to bury all of the memories.” I wrote everything down in those months, took more pictures than ever, afraid of letting anything go.

The song’s chorus states firmly: “Home is in your body.” I would repeat this mantra to myself anytime I felt out of place on the island, exposed as someone who is from somewhere but not in the right ways. But in our little apartment, I was in community with people who understood where I was coming from and didn’t question the authenticity of my background. In our home, cooking dinner together and watching the sky turn red above the water, I let the ease of my body match the comfort of the space.

Two years later, when I start medical school, one of the first things my pathology professor tells us is: “You’ve gotta rule out the things that can kill ya.” I can feel my body stir just with these words.

We are talking about hypertrophic cardiomyopathy, a heart condition that I learned my father had the year I was applying for medical school—the year after the island, after I finally let go of assuming the worst. My dad went into a procedure to remove a piece of chicken that had lodged in his esophagus during a church potluck, and his heart went haywire the night before I interviewed at the school closest to where my parents lived. I felt my pulse in my throat the next day as I shared my dreams of healing with the tired second year student evaluating me. I didn’t get in.

People say that the first sign of hypertrophic cardiomyopathy is often sudden death. The first manifestation of the disease is its deadliness, but thankfully not always, not with my dad, who has been healthy my whole life. After the diagnosis, he had a device put into his body that can shock him back on track if anything goes wrong. In the end, that overcooked chicken in his throat could save his life. In school, I learn why the doctor who assessed me after my dad’s diagnosis made me squat and stand up, listening to my heart at various levels, looking for a distinctive murmur that could mean danger. They didn’t find anything, but I still feel betrayed by this body where I’m supposed to make a home—this is where I escape the surprises of bad news; it’s not supposed to betray me.

As I move through the curriculum, we learn the diagnoses that we must rule out in a patient for fear of missing the lethal ones. We are trained to catastrophize, to assume the worst because if we don’t, we might regret it forever.

The night my friend, my old island roommate, is rushed to the hospital, I am celebrating finishing an exam focused on the respiratory system. He is hooked up to a ventilator while I brain dump all the facts I’ve learned about the flow of oxygen into and out of our bodies. I am drinking and laughing with friends who help me remember there’s more to life than understanding its processes. I go to bed tired in the way toddlers get tired, manifested in a grumpiness that I explain away by being annoyed with the person closest to me, and fully unaware of the fundamental shift that has taken place.

I get an Instagram message from his sister in the early hours of the morning, opening my phone to hear he has had a major stroke. My friend who handed me citrus fruits when anything went wrong, unresponsive in the intensive care unit. I stay glued to my phone the whole day, week, month, waiting for news that he’s woken up, that he’ll be okay, that this is all a big misunderstanding.

My loved ones warn me not to assume the worst. They tell me that my training is leading me down worst-case-scenario paths that might not be true. Months pass. Progress is marked by whether he can track movement with his eyes. We celebrate when he can get through a day without his nervous system going into overdrive.

In school, we move into the unit on neurologic pathology, and we learn about strokes. Test question after test question asks us about the progression of cells in the part of the brain that loses oxygen. First, “red neurons” that show up fiery pink under the microscope, warning of damage. I can’t help but think of the old saying “red sky in the morning, sailor’s warning,” the red cells indicative of the storms that will come. Then engulfing cells come in to clean up the debris, and then, because the brain doesn’t scar the same way other parts of the body scar, an infiltration of cells that eventually—after weeks and months—lead to a hole where there used to be brain.

I can never commit that progression to memory. I get every one of those test questions wrong, maybe a little bit on purpose. I don’t want to know what might happen next, what’s unfolding in his body.

No one can tell me what went wrong. There’s no explanation, nothing we learn in school, nothing anyone can say that will help explain why a body and a brain react the way they do. He is moved to an extended care facility where I FaceTime in and tell him I am taking my licensing exam soon, that my brother got a dog, that the island we called home is deep in uprising and revolution. I tell him we miss him. That I miss him.

He can’t speak back to me, but sometimes he is awake to look at the screen. I hope that he can hear me and hope that he can’t at the same time—I never have anything as clever, or reassuring, or funny as what he would bring to this moment. I don’t know what awareness I want for him. He comes to me in a dream. He tells me, “You’re making things harder than you need to.”

I get annoyed, glaring at him sitting at our kitchen table with the green tablecloth, and I tell him back, “You don’t know what it’s like.”

I wake up mad at myself for being so unfair.

Seeing him through the FaceTime screen in a hospital bed reminds me of the last time I visited him before everything changed. We left at the same time, me back to my parents’ apartment and him for his shift in the ICU. He donned his scrubs and told me he looked forward to the time when he didn’t have to be overnight in the white light of the hospital, when he could just care for people day to day in the clinic. The last time we talked, he was deep in his work of care, and he told me all the long nights had been worth it.

If home is in the body then where are we to go when the body rebels? I stop feeling at home in my own body. I cherish the few moments after a long run or in a warm embrace when I can come back to myself, when I feel the blood running through me and I remember, time passes in this body whether I want it to or not. I don’t have to mark time with the things that go wrong—I can breathe, sleep well, feel the grief that bubbles up in my chest and let it sit, let myself long for an alternative before accepting the reality in front of me. I could thank my body for keeping record of the people who have made me myself. Instead, I ruminate on everything I should be doing if, for now, he can’t. I try to live the way he would want me to, but I struggle to hear his directions.

When I finally go to see him, they don’t let me hold his hand. He’s tested positive for MRSA a few days prior, and I don a gown and gloves and hope he recognizes me through the PPE.

He looks at me as I stumble over a one-sided conversation, so used to him being annoyed with me for being too quiet, to his chatter and jokes filling the space that my introversion leaves. His eyes sometimes get wide like I’ve surprised him with my mundane retellings of medical school, of trudging through the Chicago snow, of how I will accompany his mom to the Tamil restaurant he used to tell us had better Lankan food than Lanka.

What do you tell the friend who was always there to remind you that you’re more than the sum of the things you do? What do you do when you’re mourning the things you won’t get to do together? How do you show up for someone when they can’t tell you how they need you, if they even want you around?

As I stand near the edge of the bed, not sure if I’m allowed to sit, I try to think of what I could do to make this place feel a little more like the home we built together. My friend falls in and out of sleep. I let my mind wander to our last day together on the island. My flight got mixed up and I ended up staying an extra night, waking up an extra morning. We spent that day like it was the last one we’d ever have together. We took a tuk down to our favorite beach spot, and we shared our dreams for the future with our other beloved friends. Over an order of his favorite, hot butter cuttlefish, we fought over who would theoretically get to deliver our third roommate’s baby if we both made it through training someday. He sat with me as I re-packed my bags, and I cried another time and he told me, laughing in the way he laughs when things get a little too serious, “It’s not that deep, it doesn’t end here.”

I am startled back to the present, this alternate reality in the facility when someone walks through the open door to his room, sliding on her gloves as she enters.

“You’re here to see the doctor?” the woman asks me, and I hesitate, not knowing if she’s mixing me up with one of his sisters or someone who coordinates his care.

She turns to my friend and greets him like she has a hundred times before, “Hey there, Doctor.”

I respond, a little late, “Oh yes, I’m here for the doctor. Of course.”

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