With thousands of cancers, thousands of families and thousands of deaths, I came to see deep time. I absorbed the finite nature of existence and gained a long view. Not just yesterday’s tests, today’s battle and tomorrow’s treatment, but the loss to come. I do not know when the reaper will arrive, but understand he will. I mourn each patient before we meet. I have learned not to cry.

Call it professional distance. It is necessary when infinite loss is a daily experience. Cry every day and become a frail crust. To fight an unbeatable foe, you must parry from safety. However, I worry that I have lost more than I have gained.

Have I have stopped loving life? Has too much of me died? Are joy, warmth and compassion phantoms … a shell … a fleeting scent? Perhaps I no longer touch, taste or feel. To care for those for whom the path is set, have I stopped caring?

A remarkable event occurred. No miracle treatment or special person saved. No new patient gained or lost. No deeper understanding of the infinite, connection to the divine, nor bravery over death’s fear. Nonetheless, from the most unexpected of places, I began to cry.

My grandson is now five months old, with a round face, bald head, bright blue eyes and four limbs in continuous random movement. He has a pure smile, especially at his father’s laugh, a fixation on ceiling fans and a sly way of making believe he is still breastfeeding, just to stay close to his mom. He is capable of entertaining an entire room of adults for hours, making us all laugh. Nevertheless, sometimes, at one special time, he always makes me cry.

When I hold him, rock him and sing a bedtime tune, scrambling the words of a rock melody in a lullaby’s lull and his eyes are on mine and they gently close and his breathing becomes even and deep. That is when I cry. It is not sad, nor a time of loss or pain. It is one of life’s most magnificent moments. Yet, that child’s optimistic perfection in the purity of the moment reaches inside and pulls up forgotten pain.

I can feel that it is not the loss of one patient; it is the loss of many. It is not a single moment of suffering, but rather the suffering of years. The transcendence of the infant opens my soul to the place from which it came. He shows me who I was before death became my daily companion. His openness to the experience, joy and the potential of life, allows me to open deep places, years buried.

My children have been the great surprise of my life. I expected to raise them, teach them, protect them and help them through the world. I never expected them to raise me, teach me, protect me and help me through life. Nevertheless, they did, changing me through the years and making the journey worth any sacrifice. Now, this perfect baby arrives and helps me find part of myself lost. He makes me naïve. He helps me face today with strength, joy and hope. What a remarkable gift to receive, to be shown, once again, how to cry.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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