In “Mathematical Fix | ation” (Fall 2023 Intima), Laura Pinto describes the slow decline of her father’s ability to communicate. She tries her best to accompany him along his inward spiral of dementia, in which he has become completely fixated on arithmetic and logic, to the point that she calls him “Professor” rather than father. I am struck by the small joys she discovers in his lucid moments at the end of his life, such as when he calls her by name, only once, in the way he did when she was young. Putting myself in her shoes, I wonder if I would have the grace and openness of heart to delight in similar moments, as untethered as I imagine I might be in the face of impending loss.

Writing Late reminded me how impactful are the firsts of medical education; the first time one works with a cadaver, is coached through the delivery of a baby, or finds oneself running the code.  Late draws from my internship on the GYN oncology service, entrusted to manage patients at the end of their lives.

At the other end of those decades, I now find myself thinking about the impact I have as an attending.

We see death so often as healthcare providers. I think often about the cognitive dissonance it brings to our lives: coming in such intimate proximity with it, discussing it in depth with people about themselves or their loved ones, and then returning and retreating to our own spaces and people and homes as if we can be safely tucked away from its harsh reality.

I wanted my note to sound grateful, but the words couldn’t mask my sorrow over my alienation from any familiar or valuable path. I had lived through transplantation of a stranger’s stem cells into me. The mandatory one year of donor anonymity had passed. Surely I must send thanks to the donor whose cells were keeping me alive. But three years swept me back and forth from the hospital, trying to survive infections and graft-vs-host attacks. I saw my husband’s head shake “no” to each next draft I attempted.

For many physicians, a clinical day is a river of tasks to be navigated….These moments come to us randomly, often without any advance warning.

Medical students Tessa Palisoc and Andrew Murdock comment on how the arts—in this instance painting and dance—allow the artist and the observer to “process death and find a nuanced perspective of loss.”