I have an uncommon penchant for aligning myself with disaster and death.
Tornadoes and wildfires and armed guerrillas have chased me. Riptides have caught me. Earthquakes have knocked down the walls around me. Pestilence has rained upon me in the form of scorpions and tarantulas and men with ill intent. Cholera and tuberculosis and other assorted ailments landed me in hospitals so often that for quite a while I made myself a home there.
I cozied up beside hospice beds in the terminal units — it is how I once earned my money, paid my mortgage, put gas in my car. I have cradled others' hands in my own when their blood stopped pumping through them, and I have listened to last breaths and the words that came before them.
It is an uncommon privilege to be introduced to death before death decides to introduce himself to you, and I endeavored, always, to be a good student.
I have absorbed many lessons from tragedy and from the end of other people's lives.
I was seven years deep into my formal study of death when my phone rang for the second time on the morning of September 11, 2001. The first call came from my sister, on the East Coast, rousing me from my West Coast slumber, a too-early and therefore portentous call so I answered not with "hello" but with "what happened?" and she said simply, "Turn on the TV."
I was on my knees on the floor before the television when the second call came, a weak connection from Manhattan, from a friend who'd taken cover in an underground room. An underground room close enough to street level that there was a high window peeking out onto the sidewalk. A window positioned so he couldn't see exactly what was taking place — "Something's happening," he said to me. "Is there any chance it's on the news? Can you tell what's going on?" — but close enough to the towers that pieces of things landed outside on the sidewalk. Pieces of things hit and splattered on the glass, and a woman in the underground room with my friend told him to ask me if a bakery had blown up.
"Tell her there are pieces of strawberry muffins hitting the window," I overheard the stranger say to my friend. "Tell her there's strawberry jam on the glass."
As she described the way the red jelly dripped, I watched another pair of jumpers on my screen step into the air. I understood the velocity with which they would fall, the force with which they would land. I have seen blood force its way out of bodies.
"It is not jam hitting the window," I said gently to my friend. "It is not a bakery that has exploded."
We only spoke for another minute or so that morning after I explained to him what was happening and he realized he needed to pass his phone on to others to make their last calls. But in that minute during which he spoke to me while death busied itself splattering fresh victims against the window, obliterating his view, I heard no fear of dying in his voice. Instead, like nearly every one of my patients before him, he worried not for himself but only for those who might regret his passing. He said to me over and over again, in reference to his family, his other friends, "Tell them it's okay. Tell them I'm okay," and I assured him that I would, that I heard him, that I believed.
I'd have flown to New York the next day as part of a federal disaster medical team mobilized to minister to survivors, had there been survivors, but by the next morning we already knew they needed cadaver dogs and morticians more than health care personnel. So few arose from those ashes.
When Hurricane Katrina hit New Orleans four years later — another airborne disaster flying in from nowhere — I remained homebound yet again, this time with a nursing newborn. Like before, details came to me over the phone lines, calls placed by my then-spouse and the other FEMA consultants who ventured south. They spoke to me of devastating things, certainly, of roads lined with carcasses and waterlogged front doors atilt, spray-painted with numbers announcing the dead within, but I heard also a growing refrain, a buzz behind the voices of the men with whom I spoke on the phone, a thrumming chorus as survivor after survivor pressed close enough that I could hear their anthem across the miles, their determination not to indulge regret: "Tell them it's okay. Tell them we're okay."
Let me be clear: denial is a calculable phenomenon. It is the first of Kübler-Ross's five stages of grief. It is the person who is as yet incapable of seeing what is happening and is therefore nowhere near ready to cope with it. It is the man standing in the belly of the Titanic, immobilized by panic as the water rises over his shoes, his pant cuffs, his knees, unable to step toward a seat in a lifeboat or even to reach for a piece of flotsam, arms crossed, head shaking left-right left-right no-no-no as he says over and over again, "It is okay. I am okay. Everything is fine."
This is not the kind of person I am talking about here.
I am referring to a different breed, to the man who is moving across the deck of the sinking ocean liner, lifting the last of the survivors into the one remaining lifeboat, who clasps the hand of an evacuee as he lowers her toward the safety of the open sea and says, "Tell my family it's okay. Tell them I'm okay," not because he has any illusions about his fate but because he sees and respects it.
I am talking about the opposite of denial, the other end of the grief spectrum. The fifth stage, the place I met my patients after their long withering, where the dying ended and the death commenced: acceptance.
I am talking about the me I meant to be the day the doctor called.
The doctor had sworn for the better part of a year that the pinkish tinge on my forearm was a burst capillary, a lingering bruise, an age mark. The doctor had biopsied it against his better judgment because finally the day came when I refused to exit his office until he did so. The doctor said I would see it was nothing and stop complaining about it and never again force him to cut off a piece of me needlessly. The doctor was on the verge of tears when he called and said, "The biopsy results are back. I'm so sorry. It's bad news."
I wouldn't have answered the phone had I known it was him, not because I was afraid to hear what he might say but because I was standing on a stage with my first-grader and her 25 friends who made the Brownie troop I led the largest Brownie troop in the country at that time. I had bent to pin the year-end badge on the first little girl's sash when the phone rang and I grabbed it, expecting a neighbor to quickly confirm my eight-year-old son had safely scrambled over the pasture fence and into her kitchen, but instead the doctor said, "The biopsy results are back. I'm so sorry. It's bad news" while 75 faces stared at me: 25 little girls and two parents each.
The child with the puffed-out chest beneath her Brownie vest couldn't have heard the doctor's voice, so there must have been something that crossed my face that made her wilt before me, but I quickly said, "It's okay. I'm okay," with enough conviction to convince her as I slid the phone into my back pocket and smiled at the assembled crowd. "It's okay. I'm