I regret not writing sooner.

Lisa Bonchek Adams, a writer, died last Friday. I regret not telling her how moved I was by her writing, and I admit I have only read a small fraction of her blog.

Almost two years ago, she posted "Floating Away" which found its way to me through Twitter. As I read Lisa's writing, the thought occurred to me, "You know, if I had a serious illness, I'd probably want to write more. Writing would bring meaning to me through exploring the experience."

The past several summers, my wife and I have traveled to Northern Michigan with our boys to seek refuge from the humid Midwestern summer. It's a resumption of a family tradition from my youth when I would travel with my parents, brother and sister to visit my dad's family.

Sunset, Petoskey, MI State Park from Fickr user dustin_j_williams

As I sat on the beach last summer, I thought about "Floating Away." It seemed impossible that I was the same age my mother was when I was eight years old. I remember the joy of running into the crashing yet relatively subtle Lake Michigan waves. At eight, my future on earth seemed as horizonless as the blue water. Every time I would run into the cool water, I would shiver, momentarily forgetting the transient nature of this discomfort as my body adjusted. While I gleefully jumped through the waves, I would think about how life might be in the 21st century. I could never really wrap my mind around it, but I just knew it would be different in fantastic ways that could not be predicted.

At 39, my elder son replaced me as the eight-year old.  I noted how the scene around me had changed little since the time I was his age. The dunes to the left looked untouched like the font on the signs leading to the beach house. As I looked around at my family, my parents, brother, sister and their families, I was grateful to be together in this way. I thought about my patients and the loss they and their families experienced. The stability of the scene in front of me might have fooled me if not for my age.  I can start to convince myself that 1983 was a long time ago.  The average birth date of my patients predictably trends closer to mine.   Sadness momentarily overwhelmed me. 

Death is like a wall that forces us to turn around and look back.* What we see is our life and the meaning brought by having lived it.  With this hopefully comes gratitude but also the possibility for regret or guilt. Time is precious.  Is there a metric to determine the wisdom of time spent over a life? Uncertainty and imperfection make self-forgiveness important.

I faced the lake and pondered the landscape behind me. My mind wandered through hills that led to the farm where my father grew up.  The hills connect to roads leading to the other side of the lake and the urban beaches my mother frequented when she was young. The roads branch like capillaries to feed a sprawling, disorganized series of places which make up the vital organs of my life. When the clouds allow, I imagine the sun radiantly warms all simultaneously.

A cloud moved just enough to bring warmth. The water glistened and it's a moment of beauty which felt familiar, a moment in time I have lived before. I felt home.

Find a bit of beauty in the world today. Share it. If you can't find it, create it. Some days this may be hard to do. Persevere.
— Lisa Bonchek Adams (@AdamsLisa) February 26, 2015

I yearn for more moments like this and am quite hopeful for them. That Lisa Bonchek Adams cannot actively create or experience more beautiful moments is a cause for grief for her her family and friends, both near and far.  To the world, she leaves behind a trail of writing which opens a door to find more than a bit of beauty.  Having followed @adamslisa on Twitter, I know that recent times have been anything but easy.  Writing could not have alleviated all of her suffering, but hopefully she found meaning and beauty from it.

Indianapolis Today

Moments of beauty require recognition by the observer, and Lisa's quote above serves as a reminder.  The observer can create favorable circumstances for beauty to arise by how she lives her life. The wall forces the observer to turn around and look, but then she looks forward to the terrain in front of her to decide which paths to take.  The ultimate arrival of the wall is elusively out of her control.

I still like to believe that if I were seriously ill, I would write about it. How foolish am I though.  I am someone who need not turn to the internet to witness the fragility of human existence.  My initial interpretation of my inner voice as I read Lisa's blog was incorrect. The corrected version reads:

If I am to be alive, I should write about the experience. That would bring meaning to me.

Make the most of this day. Whatever that means to you, whatever you can do, no matter how small it seems.
— Lisa Bonchek Adams (@AdamsLisa) February 26, 2015

Lyle Fettig (@lfettig) is a palliative care doctor in Indianapolis where he lives with his wife and two boys. 
*He thanks Dr. William Breitbart, psychiatrist and Chair of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center (where coincidentally, Lisa received much of her care).  Dr. Breitbart presented a Keynote entitled “Meaning-Centered Psychotherapy: Meaning and Spirituality in End of Life Care” at the 2015 IUPUI RESPECT Conference. He introduced the existentialist metaphor of "death as a wall" during his comments. The recent RCT on Meaning-Centered Group Psychotherapy by Breitbart and others is worth a read and deserves a blog post on it's own.