The morning my brother Harry was airlifted from I-81 to the trauma center, I drove toward the hospital barely able to breathe. At a stoplight I noticed the people in their cars around me—a man checking his hair in the rearview mirror, a child kicking his legs in his car seat. Ordinary people doing ordinary things. Which is when it hit me that this was not a dream. I’d seen Harry the day before. Whole, alive, himself. It was the last time I’d see him that way.
When I got to the ICU, the doctor offered reassurances: “It’s still very early,” and “We’re doing everything we can”—the kinds of things doctors say to families in shock. I know this because I’ve said these things to patients myself. But I took one look at my baby brother—intubated, sedated, badly banged up—and I knew this was it.
I’m a primary care physician. Mortality, even if distant or hypothetical, is implicit in every patient encounter. What else is a doctor’s job if not to forestall death and improve life while it’s being lived? For 25 years I’ve helped people live, and I’ve also helped them die. Before I entered that ICU, I thought I understood that nothing is permanent. But there’s a difference between knowing a thing in your head and feeling it in your body.
For the three days Harry was on life support, my family took turns at his bedside as our phones exploded with messages. My world contracted to the size of his hospital room. I could hear my mother’s voice, then my father’s. I could hear the rhythm of the ventilator. But nothing else. At some point I walked down to the hospital cafeteria for coffee and wondered why it was so quiet. When I looked around, the room was bustling with people. But all I could hear was my own breath. It was as if my mind had carved out a tiny oasis of attention where only the things I needed to hear were allowed in.
I suspect my body was conserving energy for what came next. But at the time it didn’t feel like bracing. It felt strangely like presence, the kind I attempt but often fail to manufacture for myself. Perhaps, before death showed up, I had been striving too hard, with meditation or with yoga, racing into class, always a little late, hoping to find peace while knowing the parking meter outside had run out.
It turns out presence isn’t something you achieve. It’s what’s left when everything else falls away.
Lexi, the young ICU nurse, helped me get there.. Alone with Harry at his bedside, I interrupted her quiet, steady focus on the monitors and asked her, “How do you do this work, day in and day out?” It’s a question ICU nurses get all the time from people who aren’t in health care. But I know what it’s like to shepherd families through loss. I wanted her to know I saw her—just like she saw me. She paused and shifted her gaze from the machines to me and said, “I try not to get too attached. But sometimes it feels impossible.” Our eyes locked and I knew she understood my pain.
On July 16, two and a half days after his accident, Harry died in the ICU. He was 45. He was surrounded by family, twelve sets of hands holding his lifeless body, sending him onward with heartache and love and stunned disbelief. Lexi stepped out. The machines were turned off. People gathered their things. When it was time to leave, I handled the logistics. The paperwork seemed extensive for someone who wasn’t coming back. But that was the easy part. Watching my parents walk out of the hospital together, heads bowed, carrying Harry’s things, was the worst thing I will ever see.
For months after Harry died, nothing else seemed to matter. In my grief, I didn’t care about the parking ticket I got outside the post office. I didn’t care that my inbox overflowed with messages. Time had slowed down. What was the hurry? Then sometimes the cyclone in my body would churn and twist, taking my breath away. Is this what dying feels like? I wondered. Will this feeling last forever?
It didn’t. Nothing does. Losing Harry is forever, but the fear that I can’t survive this loss is not. Impermanence turns out to be the cruelest fact and the most merciful one at once.
As a doctor, I’ve been teaching this to my patients. Anxiety ebbs and flows. The pain softens with time. You’ll get through this. And I believed those words the way I believe what I read in biology class. It’s the truth. But it took losing my brother to feel impermanence like I feel gravity; I can’t see it, but I know it’s there.
So what do we have left to grab onto, if nothing truly holds? The day before the accident, Harry and I talked about mundane things: the heat wave, what my kids were up to. There was no way to know it was the last time I’d see him that way. I learned that the only honest response to impermanence is paying attention to whoever is in front of you, to the ordinary moments.
I still fail at this daily. I mindlessly scroll through Instagram. I feverishly plan my schedule weeks in advance. But something in me got recalibrated the week Harry left us. Grief showed me what quiet presence feels like. It reminded me that nothing is forever. Even love itself shifts its shape; it deepens after loss. Sometimes I lose my breath looking into the sky, wondering where Harry is and what he is doing. But my breath comes back when the clouds shift and I remember he’s been there with me all along.