Three Little Birds

Kristin Collier, MD

So I'd like to tell the story of my friend Jake, what he taught me about living, about dying, and the limits of medicine. So it's hard to believe, but the time we spent together as residents here is now over 20 years ago. I was a resident in internal medicine here at Michigan Medicine and did my residency here from 2001 to 2004. During that time, one of my colleagues, who was a year older than I was, was Jake Deerhake.

He was the doctor everyone wanted to be and the colleague everyone wanted to work with. He was super crazy smart, funny, kind, compassionate, and cared deeply about medicine, his patients, his friends and colleagues. And he was the consummate internist. He knew the deep differential for peripheral eosinophilia at the tip of his tongue, but also could interpret ABGs, read films, and run a code. Given his talents, he was chosen to be one of our four chief medical residents. And the year before his chief year, we noticed something different about Jake. He had been losing weight, looking tired, but we all knew he had been busy. He kept telling us that he had been busy.

And one night, shortly after arriving home from a flight where he had been interviewing for cardiology fellowship out of state, he couldn't breathe. He presented to our emergency department with shortness of breath and was found to have a massively enlarged liver due to the presence of multiple terrible masses. We were hoping that this was something easy, or at least easier than what he ended up having, which I won't even name here because my anger at his particular disease has decided that its name doesn't deserve a place in the story about my friend. But what we had was bad and what he had ended up taking his life.

And this brings me to the first moment I would like to focus on here, which is the moment I found out about his diagnosis. I was a burned out, overworked, tired senior resident about to take night call for our cardiology service. I was in a call room upstairs in the hospital and realized I hadn't seen Jake in a while. And there were murmurs around the program that he was ill. So I texted one of our mutual friends and he called me back, and told me that Jake had been diagnosed with something horrible and that the situation was bad, really bad. And it was at that moment that time sort of stood still for me for a brief while.

Afterwards, I hung up and I cried and cried and all the while answering pages from the nurses that would not stop. At one point, I felt like I was going to throw up in the trash can in my call room, but I knew I had patients to take care of and I had to get myself together. People were depending on me. But all I wanted to do was run around shouting, but Jake, our beloved Jake has cancer and it's effing not fair.

I was burned out and this was the thing that really I think tipped me over the edge. I felt like here I was giving my best years of my life in my 20s, sleeping at the hospital every fourth night sometimes, exhausted, taking care of patients at the time who I often felt, in my mind, were trying their very hardest to do everything possible not to live. Yet here was our shining star of our community who got something terrible and was going to die and not be here to take care of patients and do all the good, amazing things he had the potential to do. How was this fair? How could this happen? Why him?

It was in this moment that I really realized how unfair things are, how real it is that bad things happen to good people and that none of us are immune. I mean, as a doctor, of course, I knew that people died. But this was the first moment that one of my people, one of our best people, was going to die. And it was so real and so raw and so terrible that I almost couldn't bear the weight of it all. And it was in that moment in my call room that night that my very real struggle with making sense out of suffering began.

And it was over the course of the year that our institution watched our friend die. But we also saw him live. And it was painful. He continued to work. He got married to his lovely wife, Laura. He sat through grand rounds. He loved his work and the people here. I remember when he was my chief resident, he was my attending at the VA. He would leave after rounds and go get transfused. I would hear updates from time to time about Jake having a clinic appointment or ER visit, when some new catastrophe related to his disease came up. And the piece by piece unfolding of it was horrific.

And what was even more shocking to us at some level was that we couldn't save one of our own. Here we were at one of the largest academic hospitals in the world with all the technology and treatments at our disposal. The chair of medicine at the time was an oncologist for God's sake, and we had a worldwide expert in his rare disease at our institution at the time. Yet Jake got sicker. We couldn't cure him and he died on our watch.

And this brings me to the second moment of when I knew. I was in Italy with my husband and his family for vacation in my third year of residency right before I was to start my own chief resident year here. Jake had been fighting his terrible disease for months.

So our family was outside at the place we were staying all in chaise lounges around like an old pool. And I was staring at the water and I saw three little birds come down one by one in a beautiful arcing swoop. And one by one, each one of their wings just brushed the water as they did so. And it was so beautiful and magical that I sat up to see if anyone else had seen it. And everyone else was asleep on their chair. It was just me. And I knew in that moment that Jake was gone.

About an hour later, I got a text from a co-resident back in the States that I should call her. And I found a payphone in town and called her and she told me Jake had died. But she confirmed what I already knew to be true, that he was gone. And it was in that moment that I truly realized the limits of medicine and started my subsequent exploration of religion.

So we lost our friend and the world lost a great son, a husband, brother, and doctor. Those of us, his colleagues, here who survived lost additional things. Collectively, many of us lost the deeply held belief that medicine could be our savior. And what had happened in part is that many of us, including myself, had made medicine into what theologians call an idol. We had placed, I had placed, unrealistic hope onto something that medicine didn't deserve, couldn't hold, and couldn't live up to. And when our idols come crashing down, pain ensues. But the right order of things shines out of that darkness.

I've since grown to understand the limits of medicine that are important for me to realize as I grow into the physician I need to be. And it was after those moments with Jake that I started my subsequent what I call wrestling with God. Medicine had been my God for so long. It was something I worshipped, shaped my life around, and I looked to it for all the answers.

So with that deep error now revealed to me, something else had to fill its place. I had not been raised in a religious home, and if anything was raised with an anti-religious bias that was only cultivated more strongly during my time in the academy. The God of the Scriptures wasn't even really on my radar, and religion was only something other people were concerned about. But after those moments with Jake, I started wrestling with God.

At first, wrestling with the false god of medicine, but then after that, the true God. I believe we're closer to God wrestling with Him than we are when we ignore Him completely or otherwise, unengaged. And the wrestling I've had is mostly around the concept of suffering and the theodicy. If God is all good and all powerful, then how in the world do I make sense of all the suffering I see in medicine? And how do I trust a god or love a god who would do that to Jake?

And for those listeners not familiar with the story, in Genesis 32, we are told a story of Jacob wrestling with a divine being. And after the wrestling, the angel asks Jacob his name, and he replies, Jacob. But the being responds and says, your name will no longer be Jacob, but Israel. End quote. And Jacob, now Israel, leaves that encounter with a new name and also a limp.

I have also left this years’ long wrestling with a new name and a limp of my own. And I wish I could have come to know these painful truths in a different way, in an easier way. But I still talk about Jake and what he taught me about medicine and the limits of the vocation to which I have chosen to dedicate my life. Thank you for letting me tell this story.