THE INVITATION | Grace Ro

I can still remember our walks from the waiting room to my office. Each effortful step. The lingering smell of your tobacco-stained jacket. Your loving wife who never missed a visit.

You came to see me for the first time after a series of attempts to end your life, all in the setting of newly diagnosed medical conditions that caused intolerable fatigue. All you wanted was the energy and mental clarity to continue your artistry and go on five-mile bike rides. With your dwindling strength and productivity, you felt your livelihood and purpose were fading. 

We discussed the complexity of your medical conditions: your increasing frailty, ailing heart and loss of agility. We reviewed risk factors and medication side effects. We weighed risks and benefits. We explored your challenges adjusting to aging, a stark contrast to your whimsical, spontaneous lifestyle. You grieved many losses and felt disconnected from life as you knew it.

Your desire to continue living was conditional: life would only be worth living if there was a pill that could instantly reverse the fatigue and make you feel normal again. You were seeking palliation from the aging process, resistant to the time and effort necessary for your conditions to steadily stabilize through consistent treatment. You were devastated by the unlikely chance that your health would return to its previous state.

You didn’t fear death and were surprised when I asked you to tell me more. You believed death was a natural part of life that led to a second existence. You found your aborted attempts to be a sign that it just wasn’t the right time yet. You asked if I feared death, the way many doctors seemed to, to which I asked if my answer would in any way change your beliefs. You smiled, commented on my avoidance, and shared your wish to continue to have these discussions together, a paradoxical sign of future orientation.

For months, you were on the high acuity pathway at the clinic. Though briefer and less frequent, you continued to require hospitalizations for medical and psychiatric reasons during our time together. Your medical conditions weren’t terminal, but it seemed like your proclivity towards death was. Yet you continued to show up to our scheduled visits without hesitation.

One Saturday afternoon, I received a message that you were missing. After hours of searching, they found evidence that you were no longer with us. I felt an instant heaviness in my heart and began to think back to every decision I made and every conversation we had. Just when I thought we could both see a glimpse of hope, you exercised your final choice in your own way. I felt betrayed because the last words you said to me were “See you next week, doc.” I thought you trusted our work. I thought you trusted me. 

A few weeks later, your wife called and invited me to a memorial celebration she organized for you. I was shocked and ashamed. What would your loved ones think of me, the psychiatrist who failed them? Why would they want me there?

After thoughtful discussions and with the guidance of my supervisor, I made the decision to attend. On my drive there, my mind filled with questions and hypotheticals, so much so that only as I pulled into the lot did I realize where I was. As I stepped out of my car, I could feel the crisp air and hear the sound of waves crashing up against the rocky shore. I took a deep breath and entered the cabin building.

Everything I imagined this moment would be like was simply untrue. The room was filled with eclectic individuals, dressed in vibrant colors. The walls were filled with your original artwork, many of which you completed, sitting on the boulders, overlooking the vast waters. 

Your wife introduced me as your psychiatrist to many important people in your life. They shared stories about your life, accomplishments and contributions to your professional and personal world. The room was filled with laughter and reminiscence, a true celebration of your character and impact. 

It was hard for me to believe or even consider that any self-inflicted death could be celebrated, yet the recurring theme among those who knew you best was that your independence was of utmost importance throughout your life. You were not one to always abide by society’s norms, which also inspired your edgy artistry. Your life path was in no way linear, and though your relationships could be tenuous at times, they were deeply rooted in mutual respect. I couldn’t help but wonder, if this was all true, why wouldn’t you want to live on? Why would you end your life?

As the celebration came to an end, an excerpt from your journal was passed out to all the guests. Written over ten years prior was an entry of your constant curiosity and contemplation between life and death. You were at peace with your belief that through death, new life continues in the earth your body is laid. The room was silent for the first time as everyone received your words, as if you weren’t saying, “goodbye,” but rather “I’m right here.” 

Just as I began to feel an uneasiness again, a woman tapped me on the shoulder. “You were his psychiatrist, right?” She embraced me and said, “He and his wife spoke of you often. Thank you for not giving up on him.” 

For the first time since that Saturday afternoon, I felt a release in the tension in my shoulders, and I took a deep breath and exhaled, so did more emotions and thoughts: the expectation of being a fixer, healer and preventer of death; the disappointment and shame for failing you and your loved ones. But also now, the relief that we could simultaneously mourn your death and celebrate your life. I was so focused on how much more time we could gain and how much more we could do, while for years, your loved ones cherished each day as another precious moment to be. I felt honored to have shared that space with you, even the challenging discussions where I felt I had no immediate solution to offer. 

As I walked to my car, a man reached out to shake my hand. He introduced himself as your community’s spiritual leader of many years. With an uneasy smile, he said, “You must think we’re a really strange bunch.” I felt the tension in my shoulders loosen yet again. “We’re all a little strange and that’s okay,” I responded. We shared a laugh and wished each other well.

Driving home, I became more aware of nature’s beauty: the blue waters, gray skies and auburn leaves. Among the endless forestry I was just a small being, making my way on a long road. I imagined your many days spent in this same space, pouring into your sketches what it felt like to be even a small part of this expansive universe. Even amid your pain, suffering and resistance to radical acceptance, you had a place to wonder, question and feel. To take a step back and remind yourself you were still part of something. 

The what-ifs and wonders about what I didn’t do or could have done differently were slowly replaced by elements of who you were as a person, what you valued and the decisions you made. Ultimately, my role as your psychiatrist was not to convince you to do what I thought was right, but for you to know that the decision to end your life was not your only choice. While saddened by your death, I also felt warmth that I could share in the celebration of who you were, surrounded by people and in a place meaningful to you.

Death frequents us in medicine but rarely do we get the opportunity to know our patients outside the hospital or clinic walls. Rarely do we sit in silence, and truly grieve the loss of even a brief connection we shared. In many cases, we don’t even allow ourselves to wonder or reflect, as we are rushed to the next pressing need and responsibility. 

I recall my supervisor suggesting that an invitation to attend such an intimate, personal event was a sign of the trust between us. Such an invitation comes with the opportunity of not only humanizing you but also humanizing me as your physician. And for that, I am forever grateful.

Grace S. Ro is a psychiatrist and teaching faculty at New York University, with specialized training in geriatric psychiatry. Her clinical and academic interests include medical/resident education, integrated psychotherapy and collaborative care. Her narrative writing and poetry have been published in Academic Medicine, Academic Psychiatry, Journal of the American Geriatrics Society, APA Psychiatric News and Ars Medica.

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