Happy New Year!

Happy New Year!

Imagine “The Peanuts - Winter LoFi” playing in the background, 2024 glasses set aside on the table, and a cat inching towards the charcuterie board. It’s the last day of 2023! After a seemingly never-ending year of PowerPoint presentations, small-talk, and hospital visits, my friends and I held a small party.

We gabbed about our winter break and drank sparkling apple juice. And then, we cut long strips of bright colored paper. Each piece of paper received a wish and was carefully folded into a puffy star. They felt heavy with expectation and anxiety. The neon pink, green, and blue stars made from cheap construction paper fit into our palms and matched the golden star streamers on the wall.

I kept mine in the Lego orchid plant beside my bed. I think it’s fairly obvious what I wished for — my dad beating cancer. I wrote it three different ways, one wish for each color.

1. I hope my dad my dad heals and feels no pain.

2. I hope my dad has a healthy and happy year.

3. The Lee family is going to make it through 2024 together! All of us! (Yes, I really did write it this way.)

So when I stared at the colorful paper lumps in early December 2024, I felt a cruel mix of grief and humor. There was so much blinding positivity in those words, and it felt like everyone in the audience knew about the plot twist that was about to happen in the next scene. I brought it up in therapy a week later, joking about how my New Year’s resolution was to no longer make the stupid stars.

“You were just being hopeful! That’s not a bad thing,” Heather, my therapist, reassured me.

It’s not, that’s true. But it also seems like a waste of emotional effort and a little like karmic retribution. I was scared to do anything with the little stars just in case I would disrupt their power.

She replied, “But you knew it was unlikely in the first place that any of them would come true. You didn’t ‘jinx’ yourself by writing your hopes down on paper.”

She was right, as she often is. My dad had recurrent leiomyosarcoma that metastasized to his lungs. On December 31, 2023, he was already on day 11 of another hospital admission for septic shock and bilateral hemothoraces. Saying it was unlikely that he would beat cancer is an understatement. But I had still hoped.

Medicine is deceptively nuanced. It presents itself as binary — you live or you die. But what about the in-between? What if that doesn’t take minutes, but hours? Days? Months? What do you do during that time? It seems silly to grieve for someone who isn’t gone yet, but that’s what I ended up doing. I filled my time with excessive productivity to scare away the unknown. I called my dad every spare minute I had between lectures, group assignments, and presentations. I sat in on virtual visits with the oncologist so I could speak up for my dad, who didn’t know how to ask, “Will I get better if I do another treatment?” I checked in on my brother (less than I should have) to see how he was holding up as my dad’s sole caretaker. I apologized for not being there for the Urgent Care visits. I called the Fairfax County Department of Public Safety, so when we had to call 911, they would know how to get into the apartment complex. I quit my job as a paramedic so I would be able to travel home at a moment’s notice – I was preparing for the inevitable.

But these tasks can only occupy so much of an anxious, pre-grieving mind. When I had time to take a deep breath and didn’t immediately have another task in front of me, I was still faced with a scary, empty, black hole. So I tried another strategy: cold pragmatism.

I’ve never been good at reading chest x-rays, but I learned quickly when faced with my dad’s film: scattered with cannonballs and fluffy clouds. I read the radiology report to see how many millimeters…no, centimeters…the masses had grown since the previous month. I compared those with the ones found in case studies that described miracles of lung transplants for patients that were nothing like my dad. The lack of data scared me. Google search results should never end up below 24+ pages. It was a never-ending loop: my fear of the unknown would lead to looking for clues that didn’t exist – which led to more anxiety and frustration. I was ignoring the writing on the wall (your dad is dying!) and I took this stress out on my family.

I don’t have many regrets concerning my dad, except for how often I chose this pragmatic approach. It was cruel. I didn’t like how it felt when I would remind him of the chances of infection if the JP bulb wasn’t drained correctly by the Home Health nurse, or when I had to tell him that his chest x-ray looked worse than one week ago. So why did I do it? Why couldn’t I just agree with him when he said the fuzziness on his chest x-ray looked better?

Dr. Steinweg, a retired Internist and a revered mentor at the medical school, once spoke to us about “the curse of knowledge” during our motivational interviewing lecture—where we learned how quickly physicians will overcorrect and “right” the course. In the most basic sense, I am a fixer. Being in medicine supports this innate need. In Atul Gawande’s Being Mortal, he writes that “For a clinician… [there is] nothing more threatening to who you think you are than a patient with a problem you cannot solve.” The promise and illusion of medicine is that we can achieve control over an illness by understanding it. That by aligning ourselves with scientific truth, we can master our own physiology and overcome the impossible. In the past, I solved my problems by doing more research or just putting more “effort” into it–If it worked for a research project, a fiddly ultrasound view, or a difficult exam, why couldn’t I do this with my dad? I was trying to stop a ship, destroyed by iron projectiles from the 17th century, from sinking.

I thought if I was realistic the ending would hurt less.

In hindsight, the foundation of my pragmatic approach was obviously flawed. If anything, I tortured myself and others around me two-fold. Control wasn’t the solution here. But I also sympathize with myself because I was only trying to mask my greatest fear with the curse of knowledge; I was afraid I wouldn’t be able to see my dad at my graduation or introduce him to his grandchildren. I was deeply saddened by the idea that he wouldn’t be able to answer my call when I had a bad day at school. I was worried he would never get to play the 18 holes of golf I bought for him at an exclusive country club – he was saving it for the fall, so he could see the leaves change. I just didn’t want my hero and best friend to die.

Dr. Steinweg ended his lecture on motivational interviewing with, “Never take away a patient’s hope.” I’ve forgotten a lot of the faces that took care of my dad. But I remember how my dad’s face brightened during the first admission when his internist said, “Mr. Lee, I think you’re going to make it. I believe in you.” It was harder for me to be hopeful than it was for me to be realistic and cruel, but when my dad brought up the internist’s words for weeks after, it felt more possible. My dad, strengthened by the encouragement of a physician, kept his renewed hope in his mind while taking his six morning medications. He held it in his spine while doing physical therapy. I added fuel to his dying fire by dreaming of our future. We talked about visiting my grandparents in Vancouver sometime before I graduated, maybe next year. My brother asked him how he should propose to his girlfriend in the future. I asked him what he wanted to name my daughter.

My dad passed away 11 days after I made the paper stars.

We make a galaxy of hopes and wishes in our lifetime. They might not be realistic, but maybe not everything has to be logical. We don’t have to hide behind logic to protect ourselves from our fears of dying, loneliness, failure. It is human to fold paper stars.

I still didn’t make paper stars at the end of 2024. Not because I was afraid of their cosmic karma, but because I knew I would still hope for a better 2025 regardless of cutting and folding paper. I crumpled up the old stars and tossed them in the bedside trash can. Instead, my Lego orchid now has a photo frame next to it.