By: Aishwarya Kumar

An Intro

I reached the hospital at around 7PM. I received the call that my dad had suffered a cardiac arrest at exactly 11:58AM on January 30th, 2020. Though I had driven from West Virginia to New Jersey in a record-setting six hours, time was not on our side that day. No one in the family had seen him collapse, but we believe that Appa was unresponsive for about five to ten minutes before anyone found him. My seventeen year old brother performed CPR for twelve minutes before the ambulance arrived. It took seven shocks to restart his heart, resulting in an excruciating  forty-five minutes before he made it into surgery and his body’s natural oxygen supply was reestablished. 

I cried myself to sleep on the couch that night after seeing my dad in his hospital bed, strapped to a cooling machine, a ventilator, and more tubes than I could count. I spent most of the next two weeks curled up on the chairs in the family respite room of the ICU. While we waited to see if his EEG would show any meaningful recovery of neurologic function, I alternated between sobbing and screaming until I couldn’t breathe, frantically flipping through every cardiac arrest survivor forum I could find on the Internet, and staring numbly at the ceiling. Occasionally, I would even open up my laptop in a feeble attempt to keep up with my coursework remotely. This was especially difficult because our class was in the middle of our Neurology block, and the very cranial nerve functions we were learning about in our lectures directly correlated to what the doctors were testing my dad for every day. 

The cut and dry “waiting game” of a cardiac arrest and the brain hypoxia that follows is why there isn’t much to this part of the story: it’s just this unrelenting week-long post-angioplasty anxiety trip, where the patient is slowly weaned off of sedatives, brought back to a normal body temperature, and repeatedly assessed for neurological function until doctors can determine how much their brain will be affected when they wake up...or if they will even wake up at all. The only thing anyone can really do is wait.

 

PART 1

Appa

I truly believe, and anyone that knew him will undoubtedly agree, that my Appa was as close to modern day sainthood as anyone can be. There is a picture on the dresser in the master bedroom of me and my parents from 1996. The shirt my dad was wearing was one he still wore frequently until he passed; he never cared about material items like new clothes or technology. During an office meeting where employees went around the table and shared their goals for the next five years, his answer of “I want to be a good father” was distinctive among the echoes of job advancement and career development. When he first came to America, he gave a loan of $1,000 to a co-worker when asked, without even questioning why. He attended the prestigious Indian Institute of Technology﹣for those of you who aren’t familiar with the place, think of MIT, Harvard, and Stanford blended into one school﹣to receive his Bachelor’s and Master’s degrees, but never mentioned it once (a rather rare quality among IIT alumni). When an IIT classmate emailed him asking for a life update, he responded with:

“..my wife is a homemaker, my son is enjoying high school, and my daughter is home for the time being.” 

He said this instead of speaking on my recent acceptance to medical school or my brother’s success as one of the highest ranked chess players of his age group in America, his multi-year stint on the American national chess team, his recent winning of the NJ racquetball championship, or his finance internship at Columbia (you can tell who the more gifted sibling is!). He was soft-spoken, kind, and endearingly awkward. Apart from his love of old historical melodramas, goldfish, and our garden, the only things that mattered to him were my brother, my mom, and me. He spent money he didn’t have on the three of us and never said the word “no.” He never went on vacations and instead was content with staying at home with his family. He saw the best in us and always believed that we could do anything we put our minds to. He often spoke to my mother about staying healthy and exercising just so that they could help my brother and I later in our lives. He had a god-like level of patience. No amount of yelling and arguing would lead him to raise his voice. To this day, my mother, brother, and I channel his thoughts and actions when we get into arguments - “What would Appa do?” He never bothered my brother and I about grades, as his main goal was to make sure that the two of us grew up to be good people...and that we practiced good dental hygiene. He defied every single stereotype about Indian dads: He was never afraid to show emotion. He would give my brother and I multiple hugs daily and kiss me on the head goodbye each day before work if I was sleeping. He would wake up in the middle of the night at the slightest noise from me in my sleep and come into my room to make sure I was okay before he returned to bed. He was selfless. If we needed anything at all, he would take the day off work without question. He would stay up late into the night refreshing his knowledge on my and my brother’s STEM classes so he could spend the whole day teaching us the concepts we needed to know. We were his only priority and he would never hesitate to do whatever we needed or asked for.

P

P and I had been dating for three years. We had met during my senior and his junior year of college, stayed long distance throughout our gap years, and eventually attended medical school a few hours away from each other. I had happily chosen to attend a medical school with higher tuition that was further away from my family to be closer to him and his family. In short, I genuinely believed that I would spend the rest of my life with him. Less than a week before everything blew up, P told my best friend that he was planning to propose while we were in medical school. I had started looking at rings.  He was a year ahead of me and his hyper-competitive surgical specialty pick could take him anywhere in the country. I had already decided  that I would go into a non-competitive specialty so that it would be easier to land a residency position near him. I was happy to do these things and even now, I don’t regret them one bit. To me, that’s what it means to love. It’s a mentality that I inherited from my father. I think that’s precisely why his behavior over the following weeks came as such a shock to me.

When I initially told P that my Appa had been admitted to the hospital, he didn’t offer to come up to visit. At first, I didn’t think anything of it because we were both under the impression that he had just had a heart attack. After several days though, I begged him to make the four-hour drive to the hospital to see me. He was staying at home, after all, and had cars at his disposal. He told me he would try. My best friend didn’t tell me at the time, but he had actually texted her to say that he wasn’t planning to visit at all. He was scheduled to take Step 1 in four weeks and didn’t want to lose focus. A few days later, I called P and asked to speak to his parents; they had a family friend who had survived a cardiac arrest and was now living a normal life, and I wanted to hear about their experience. I think this inadvertently guilted P and his father into visiting the hospital the next day. They left after a few hours.

A week later, I found out that my father would never wake up again and I immediately began thinking about how the rest of my life would look. I called P from the hospital, told him the news, and asked him if it was okay if we took care of my mother in the future. In Indian culture, it is customary for a couple to take care of their parents and in-laws, particularly when one of them is widowed; whether that means supporting the affected parent financially or emotionally or simply living in close proximity to them is up to each family. I didn’t expect P to have a firm plan in place as this would not need to happen for another decade or more, but I just wanted to hear his reassurance that everything would be okay and that we would get through this together. Instead, P refused to discuss the issue further. He said that I was thinking too far into the future and that he didn’t want to commit to anything right now. I was shocked﹣I had just told him my dad was going to die. When I called him again later that night, I was met with the same evasive answers and lame platitudes: “You should focus on your family right now. We can talk in three weeks.” These instances where he actually picked up my phone calls or answered my text messages were rare. He wanted to simulate an environment that was as close to the exam as possible. The next day, I wasn’t getting any responses from him so I decided to confront him in person. In retrospect, I realize that this was my panicked and desperate attempt to do something: there is unfortunately nothing that can fix hypoxic brain injury, so instead I think I was focusing all of my energy on trying to fix my relationship. I was trying to get the one person who I wanted to be there for me the most, to actually be there for me. I lied to my grandparents and mother and told them I would be at the library the whole day.

We sat in my car in a parking lot near his house. His mother followed him outside and soon began interrogating me through the window: she asked if my family knew I was there, worried that they would call the cops if they thought I was missing, and expressed confusion as to why I was acting this way. I was only able to get out the words, “He told me he wouldn’t speak to me for three weeks—” before she interrupted, “He has to study! He is going to fail his exam!” When she finally walked away to give us some space, I told P that I was done. He said he understood that he was wrong in not consoling me while my dad was dying. When I went on to broach the topic of my mother again, he pulled the focus back to him: “What about my parents?” I stared at him dumbstruck, wondering out loud how he could be thinking like that right now: both of his parents were working and in good health, while my mom was a homemaker and my dad was about to die. He backtracked and apologized. He explained his evasiveness, saying he didn’t want to talk about this because there were so many logistics we needed to figure out before we could decide to live near my mother: we would need to look into residency programs near NJ, potentially pursue less competitive specialties, etc. He said he couldn’t just agree to something like this without planning. I vaguely remember thinking, “What kind of person puts logistics ahead of emotional support when their girlfriend’s dad is about to die?” He told me I would be a good doctor. I told him he wouldn’t. We hugged and I drove home. I made it back fifteen minutes before my family returned from the hospital for the night. 

On the day that my father was taken off of life support, I remember saying goodbye to him for the last time, though I blacked out as they wheeled him away. My mother was screaming at my dad about how he could leave us like this. I told Appa that I loved him and that I was proud of him and that he should rest. He always called me the leader of the Kumar family; I told him I would take up that mantle early. My brother and my uncle went downstairs to be with him until he passed. My brother bravely held his hand until he left us. I stayed upstairs. I knew I wouldn’t be able to handle seeing his extubation or hearing the monitor stop beeping. He passed peacefully and quickly. He was able to donate his kidneys to two people. His heart and tissue went to research. 

P wasn’t there that day. I had called him beforehand, begging him to come be with me at the hospital. I will forever remember the utter desperation, panic, and hopelessness I felt during that call. P refused repeatedly, saying something along the lines of, “If I come down, I won’t be able to go back.” I told him that my father passed away right after it happened. He sent me his condolences via text message and we talked over the phone for a little bit. Afterwards, I left him alone. I wanted him to do well on his exam.

I called P two weeks later, the day he took Step 1. Not once during our post-Step exam communication did he ask me how I was, how my family was, or mention my father. Despite this, I told him that I didn’t want to give up on us, that we could go to couple’s therapy. He had other plans. He said that our ideas about love were too different and that he didn’t want to continue our relationship. He felt that his four-hour visit nearly six weeks prior was enough and admitted that the reason he wasn’t there on the day my Appa died was because he had to study. He told me that he was emotionally exhausted from this whole ordeal, and that I was minimizing his pain and what he had gone through while my dad died. He told me to wait until I took Step 1 in a year and then I would understand. He became irritated with me soon after, not understanding why I continued to cry and call him.

He received his Step score a few weeks later. He did very well. When we talked on the phone, he told me that though he had previously considered making an effort to change his mentality, he no longer knew if that’s what he wanted or needed to do. At this point, I gave up. I no longer felt like I knew the person speaking to me on the other end of the phone. We did not speak further.

Me

First, I will speak about myself and then I will speak about my Appa. I think it’s only fitting that this ends with words about the most amazing person I will ever know. Even as a child, I was always known as the girl who cried a lot. Fortunately, I have the self-awareness to admit that I am an emotional person. For a long time, this translated to people thinking I was weak. There were even individuals who doubted my ability to become a physician. “How are you supposed to take care of other people if you can’t even take care of yourself?” they would say, “You’re so sensitive!”

With time, I too internalized this perception of myself. That’s why when my dad had his cardiac arrest, I spent my first couple of days in the hospital completely immobilized. I kept crying and crying and crying. I wanted somebody to come save me, to make things okay. I’m sure that some part of me believed that if I kept screaming and saying that I wanted my Appa, something would get better. My dad always made sure I had everything I ever wanted, so maybe he would hear me and wake up?

I know what I’m about to say is frowned upon in college essays. We are supposed to explain the process behind a change and not just state that it happened. For example, your extreme nervousness at playing your cello solo in front of your eleventh grade class cannot simply be remedied by a “I suddenly felt the strength and confidence surge through me as I stepped onto the stage,” or something like that.

With that being said, this is exactly what happened to me and I have absolutely no explanation for how or why. Maybe we all have some strength inside us that comes out when we need it the most? The moment I found out that Appa was losing cranial nerve and organ function by the day and that he would most likely not make it, I became eerily calm. I understood what this meant; we had just learned about it in Neuro. It felt like something really heavy had just moved into my chest and for some reason, the tears that had served me so well until that point in my life did not surface. I walked out to the waiting room where my aunts, mother, and family friends were sitting and this is how I intellectualized it to them and to myself. I repeat some version of this to myself almost every single day. 

He worked extremely hard in his lifetime and lived his life for everyone but himself. He took on so much stress and didn’t even mention it to us because he didn’t want us to worry. He left peacefully and unknowingly, which is for the best because if he had known he was leaving us, he wouldn’t have been able to handle it. He has lived ten or more lifetimes of fatherhood in fifty-four years. His whole life was about  me and my brother. He raised his children until adulthood and thus, lived the parts of life that he cared the most about. Especially in this society, he would have had to work until old age, but now he has done his duty. He was so proud of us and made sure that we would be okay after he left. Now, he can finally rest. 

I went back to school four days after his funeral, which I’m not going to speak on since it is still incredibly distressing for me. I had missed half of two blocks. Even though I cried every single day, I was weirdly okay, for lack of a better word. I did well in my classes. Even after I returned home mid-semester during the start of the COVID-19 pandemic, I spent my time working on several projects. I will be published in a number of journals by the time I apply for residency. I feel fueled to make sure that nothing like this ever happens to anyone ever again and if it does, that they would have the resources to overcome it. That’s why I joined Bereavemed. Even as I sit in my apartment writing this, I can’t believe that anyone could go through what I have and come out on the other side the way I did. What’s more, I can’t believe that that person is me. This wasn’t the reaction that anyone could have predicted for me. I was supposed to be in bed, paralyzed, and unable to eat or speak. I had witnessed two simultaneous and sudden betrayals: a heart that stopped beating and a love that became cruel. I have overcome something that, to many people, is insurmountable, and now nothing in my life will ever feel difficult again.

 

PART 2

P

Six months later, I understand and acknowledge that the situation P faced was undeniably difficult. On one hand, he had a seemingly life-determining exam that he needed to focus on. Given the weight that Step 1 is given in the residency application process, this was, arguably, the most important exam of his career. On the other hand, his partner’s dad was dying. There literally could not have been a more perfect and high-stakes embodiment of the popular question, “What is more important to you, career or love?” The more I speak to people about what happened, the more I realize that this issue is not objectively black and white. Many people think that what he did was unconscionable and rendered him unfit to partake in medicine. Others understand where he was coming from, and though they would have done everything possible afterwards to make it up to me, they believe that the decision would have been just as difficult for them. In my opinion, we are dealing with an artificially produced measure of medical aptitude versus a human life. Exams come and go and scores can be compensated for. Death is finite. His words and actions added an unimaginable amount of suffering to my already unimaginable situation. On top of processing my father’s impending death, figuring out how to manage finances with our only source of income gone, playing translator between my family and Appa’s medical team, putting on a daily coherent front for all the visitors we received, and worrying about how this would affect the trajectory of my medical school education, I was now also running around the tri-state area, trying to understand how my boyfriend could be anything but supportive and kind to me given my situation and wondering if I ever really knew the person I had been with for three years as well as I thought I did. 

Sometimes I wonder if this represents a more systemic issue in the medical field. Are we creating a culture in medicine where students feel so much pressure to do well on this one exam that they are willing to sacrifice everything to achieve a high score? Are there not enough resources in place to ensure a backup option is available for those dealing with extreme circumstances right before this test? Or does the problem lay in our screening processes for applicants, where we encourage students to forfeit empathy and humanity for stone-cold ambition? Perhaps there isn’t even a problem in the first place. After all, don’t we need individuals who are indifferent to pain and laser-focused on their goals to push the boundaries of modern medicine and medical research? 

Intellectually speaking, I understand why this happened to my dad. I understand how a cardiac arrest works, and though my dad had no personal risk factors for what happened to him, my paternal grandfather had survived three heart attacks, and so a family history was very much present. I understand the physiology of atherosclerosis and I understand how damaging and common it is to experience a near total block in the left descending artery of the heart. What I don’t understand, however, is how someone can witness the person they love in indescribable pain and not want to do the bare minimum. How did P behave so inhumanely after his Step exam, making no effort to right his wrongs or to give me an apology? This, I don’t think I will ever understand. I owe my incomprehension of this to my father. He taught me kindness and empathy every single day through his shining example. 

The Medical System

It took me six months to write this. With that being said, I still haven’t fully processed the emotions that I experienced in February or taken the time to just be in my grief. The unfortunate reality of being a medical student is that we often don’t get the time we need to take a breather or focus on our mental health. Have I really made progress with my healing? Or am I just too busy to start? The nature of this field is that every second has the potential to be productive. It feels like the only viable solutions when something traumatic happens are to either to power through and potentially fail a course or take some time off and try again at the start of the new calendar year. Although my Dean, graduate teaching assistants, and professors went above and beyond to help me catch up with the rest of my class, I know that not everyone is this fortunate. That’s why I want to speak up about my experience and encourage others to do the same.

Maybe one day, all medical schools and medical students will understand how to support students who have experienced devastating losses. Though medical professionals arguably see more pain and suffering than anyone else, we are often expected to be unyielding pillars of strength and stoicism. But emotion is not weakness, and taking the time to grieve does not mean that we are incapable. We need to address these issues without shame and normalize a culture where it’s okay for students and professionals in medicine to freely address their mental health.

Appa

Lastly, to my Appa. He will never know this, but he still was looking out for us and still giving as much as he could even in his death. 

For starters, he gave others the gift of life. Although there is a shortage of South Asian organ donors across the country, my parents were so happy to be on the list. My mom remembers the day he came home from getting his driver’s license renewed, happily telling her that he signed up to be an organ donor. We have his donor certificate right next to his picture on the mantle and my mother wears her lime green organ donation wristband every single day. Although I didn’t expect him to give this gift so soon, I am so incredibly proud of my Appa and I hope that one day I will receive the opportunity to meet the people who received his kidneys.

I was often concerned about my dad. He never saw the point of having a strong social foundation in place aside from his family. He was a bit awkward and not the best conversationalist. It was for this reason that I often worried about him at work. Was he okay when he communicated with others? Did his co-workers like him? Did anyone misunderstand his quietness for arrogance? All my fears disappeared during my time at the hospital. His co-workers, who we had never even met before, did more for us than I could even imagine. The ICU was constantly full of people while we were there. The nurses said they had never seen anything like it; they could tell he was loved. His bosses and all of his co-workers were at the hospital daily. They told me how Appa spoke of me often, expressing how proud he was of me for matriculating into medical school. They told us to not lose hope and even until his last day, his boss did not want to give up on him; he believed that a miracle would happen. They made sure we were fed. They prayed with us. They cried with us. Some spent more time with us in those weeks than they did with their own families. The kindness that our family received from my father’s coworkers was absolutely unbelievable and my gratitude to them is something I will never be able to put into words. My lifelong worry had been assuaged. I knew that my father had spent his last ten years working in an amazing environment full of wonderful people that had become his second family. They changed my life and showed me the beauty of humanity when I needed it the most.

The amazing thing, though, is that it wasn’t just them. Everyone came together during this time. My best friend from college drove down eight hours from her PhD program in Cleveland on the very day that I asked her to come. My other best friend, an investment banker in Portland, booked a ticket amidst her impossible schedule to immediately come be with me for a weekend. My best friend from high school took leave from her clinical rotations in Michigan to be here for us. My brother’s friends were just as amazing. One of them, just eighteen years old, told my brother, mother, and I that he would take care of us. Another one of them still brings us groceries every few weeks. My aunt, uncle, and cousins flew in from California. My aunt (who had also lost her husband a few years back) and cousins in New Jersey, made sure to come to the hospital as often as they could. My grandparents flew in from India. Our family friends in New Jersey were at the hospital daily while the ones that had moved out of state flew in from Texas, Florida, California, North Carolina, and Pennsylvania. I didn’t have P, but I had everyone else.

My uncle, an interventional cardiologist, was never able to get a travel visa to the United States, but this situation allowed him to receive an emergency one. His presence alone gave our family an incredible amount of strength. Having a physician in the family to advocate for my dad made all the difference. He used his network in America to double-check every move the doctors were making and ensured that every measure was being done to save my dad. He was my mother’s rock. When we picked him up at the airport and brought him to the hospital, my mother collapsed in tears.

“I had always told Kumar that I wanted you to come to America and he made it happen,” she sobbed in Tamil. “Even in this state, he made it happen.”

I’m going to end this essay by reconciling the loss of my father with the loss of my partner and best friend. I’m not going to say that I’m over it or that any of this hurts less than it did back in February. See, it would be easier to get through a catastrophic breakup if I had my whole family. It would be easier to handle my father’s devastating passing if I had P. But I lost both, so what now? I wake up every single day and feel an indescribable pit in my chest, like there’s a hole in my heart that will never be filled. I have nightmares about the two of them frequently and often wake up feeling like I am falling. Sometimes I get flashbacks where I see myself either incoherently screaming as my family members carry my dad’s casket away to be cremated or lying on the floor of my apartment, unable to breathe as I unsuccessfully plead with P after his exam to not leave at the same time as my Appa. I take precautions to avoid driving past both the hospital system my dad passed away in as well as the highway signs directing me to P’s hometown on my trips back to New Jersey. I learned quickly that this would result in my pulling over to the side of the road in tears. I will probably continue using showers and drives as an opportunity to cry uncontrollably. I’m not the same person I was. I have good days and I have bad days. But that’s okay. I believe in the resiliency of the human spirit. 

Every day, I get closer and closer to making peace with what happened to me. I don’t believe that everything happens for a reason (I think that’s a horrible thing to say to someone who is going through something distressing). What I do believe, however, is that even in his final moments, my Appa was looking out for me. All my Appa ever wanted was for us to live the happiest and best lives possible. In his death, he illuminated a pathway to our family﹣one that brought so many selfless and benevolent people right to us when we needed them most. I believe he did the opposite as well, showing us who we were better off without. He showed me how my partner would act in times of crisis. Why should I settle for someone who barely spoke to me during the worst two weeks of my life and treated me with heartless apathy afterwards when I have been blessed to have the embodiment of human virtue, altruism, and compassion as my father? I would have lived a life sacrificing for someone who would never prioritize me, not even for the shortest of times or in the most dire of situations.

Part of me thinks this all might be another intellectualization that I tell myself to make sense of Appa’s passing. Another part, however, thinks that there’s more to it than that. I don’t believe that someone this pure and altruistic would leave us without imparting some of his wisdom and love on his family. I don’t believe that this was all meaningless. I believe that in his death, my father saved my life and preserved my future.

I will consider this, for as long as I live, to be the last gift my Appa gave to me.