In elementary school, my teachers always told us it was important to understand math because “you won’t always have a calculator in your pocket.” That sentiment hasn’t aged well, given that my iPhone and Alexa are always within reach. But no one said, “You better learn this because one day you’ll be teaching your own kids during a plague.” That was where the real value lay. In medical school, I understood that mastery would be crucial for my patients’ futures, but I never imagined that one day I would be fighting—literally fighting—to be taken seriously when I was critically ill myself. No one had said, “Pay attention, because one day the life you save might be your own.”

After several prior ER visits, I decided that today would be the day I found out what was wrong. I cleaned my house until it was spotless, stocked the pantry, dropped the kids off at camps, and then took myself to the ER. I had already been seen and evaluated earlier in the week, but I was certain I was quite ill. I figured a quiet morning might give me a better chance for a thorough evaluation. During my last visit, there had been multiple traumas in the ER, and I could sense the staff’s annoyance at a middle-aged, anxious woman taking up their time.

Blood pressure – 220/190. I felt the tears prickling in my eyes in triage. My home blood pressure cuff wasn’t wrong—something was up. That morning, I had woken with only a vague sense of something awry in my abdomen. Maybe my gallbladder? Maybe some abdominal manifestation of MS? I kept running the possibilities over in my mind. What could it be?

“Everyone can see you’re having a panic attack,” the NP told me as he examined me in the fast-track chair. For the crime of crying while waiting, they wanted me out of there as soon as possible, labeling my anxiety maladaptive. I started to question my own sanity—maybe my mind couldn’t be trusted. But I knew I fit the profile for gallbladder disease and decided to lean into that as my best bet. Begrudgingly, they sent me for a CT scan.

“What side is your abdominal pain on?” a slightly confused tech called out to me from behind the glass.

Back in my chair, the discharge papers were being drawn up. Abruptly, the NP returned and said, “Unfortunately, it’s kidney cancer, a large left-sided 10 x 12 cm renal cell carcinoma.” Strangely, I almost felt relieved—at least I had an answer. We already knew it was confined to my kidney, because my scans earlier that week had been read as normal. Except they weren’t. Despite the report’s vague note “clinical correlation may be recommended,” no one believed that a healthy woman in her forties could have anything besides anxiety. And so, the lesions in my bone, liver, and lungs remained invisible to my doctors.

“We’ll try to get someone to admit you, but you probably won’t meet criteria,” the NP said. All those years in utilization review were finally useful as I pleaded for care. I showed them the InterQual criteria for hypertensive emergency, which I most certainly had. All it took to be diagnosed and admitted was a medical degree, the confidence to insist my condition was serious, the ability to pay thousands of dollars for the ER visits where my diagnosis was missed, and an intimate knowledge of the hospital’s payment system. No big deal.

An unfortunate medical student was assigned the task of taking a more thorough history. I pulled out the list of additional symptoms that I had withheld as not to sound hysterical. The emotional whiplash of going from a diagnosis of panic attacks to incurable cancer was startling.

In the ICU, only the bone marrow treatment room was open. A cheerful nurse told me I was getting an extra-large room. Memories flooded in as I realized it was the converted NICU where I had once worked as a resident. The staff didn’t know that I had cared for critically ill tiny babies here, trying to save their lives. Or that I had lost my sister to leukemia after a bone marrow transplant twenty-eight years before. Or that today was her birthday.

Why has my life led me here? What does it all mean?

“My kids! How can I do this to my kids?” was the only steady beat in my mind. I wished so desperately that I didn’t know so much about ACEs and generational trauma. I typed “prognosis for stage 4 metastatic renal cell carcinoma” and “5-year survival” into Google. Eighteen months. Fifteen percent. I need ten years; my baby only turns eight next week.

I racked my brain for real cases—miraculous, unlikely recoveries. A child with a supraclavicular lymph node that turned out to be an incidental finding. Another child sent home on hospice who ended up in a trial and is still alive fifteen years later. In my decades in pediatrics, there had been two miracle cases. I’d always prided myself on being realistic, but now I clung to these fragile hopes. What else could I do? All I needed to get my own miracle was negative scans, negative blood work, negative biopsies, and negative genetics. The likelihood of this approached zero.

My kids are scared and come to see me one by one. This is possibly the last thing I can do for my girls: teach them how to meet tragedy with acceptance and dignity. How many times had I told a parent, “If you are calm, they will be calm”?

“You are going to be OK,” I told my oldest, who clearly noticed that I said “you” and not “we.” “We don’t know what’s going to happen,” I added. But did I know? Hadn’t I always felt the Reaper at my elbow? Hadn’t he already taken both my sisters and so many children I had cared for? Wasn’t death so familiar to me? I had spent the last twenty years scanning every environment, looking for it hiding in plain sight. But I had never once thought it was for me.

Or had I? I had always known that tomorrow is promised to no one. To the chagrin of many, I had two babies during residency, driven by a sense that time was short. I left my dream job five years ago for a more lifestyle-friendly one. Maybe that was the miracle: I had seen this coming. And now, in the most tragic of circumstances, I had no regrets.

Kelly Curtin-Hallinan is a pediatrician.