As another anniversary of Uzma’s death rolls around, I expect to get texts and messages from people who loved her saying some variant of, “Thinking about you on this difficult day.”
That they care to remember shows me how much they still love her and miss her.
There are many in that group whom I have never met or spoken to. And I hear from most of them only at this time of the year. That they still reach out to me shows how much they care about what — and who — mattered to Uzma.
If that’s not love, I don’t know what is. And I genuinely look forward to those messages.
I have to admit, though, that Uzma’s anniversary is no longer particularly hard for us. It’s not because we love her less than the friends and family who mark this day. It’s because her absence is not something that shows up only once a year.
Early on, her loss felt like an earthquake. Some aftershocks hit us out of the blue. Others, we had time to brace for — like her anniversary, the first few years. Still, every one of them would rattle us to our cores.
Over time, Uzma’s absence stopped shaking us. Because it went from recurring tremors to being more like gravity.
Gravity is a constant. Unremarkable. Essential. We don’t wake up thinking about it, but every step we take is shaped by it.
Uzma’s absence isn’t something we visit on her anniversary. It’s a unique thread woven into the fabric of our lives. That fabric wouldn’t exist without her thread.
We don’t think about her on any particular day. And we don’t not think about her on any particular day either. It’s a strange experience — one that still leaves me at a loss for words.
And like gravity, her absence shows up in ordinary ways.
In the way we think and feel. In the way we show up for friends. In the kids’ mannerisms and interests. In how I make decisions.
In these seven years, we have made many memories without her.
Millions of mundane ones — changing interests, evolving friendships, small daily routines that quietly build new parts of a life — like an addition to a house. Think also of school events and social events. Pick-ups and drop-offs. Classes considered and chosen. New restaurants dined at, new movies seen, new music heard.
She is also missing from many striking memories. A global pandemic survived. Road trips and vacations enjoyed. Milestones crossed.
Conversations about Uzma come up unexpectedly as we make new memories. But when we remember those new memories themselves, she isn’t in the scenes. Instead, our memory of her is. She isn’t present as a character. But always present as context.
When people text or message to say they’re thinking of us today, I welcome it. I don’t experience it as reopening a wound. I experience it as a reminder of how wide Uzma’s circle still is. And how her life continues to ripple through the lives of all who loved her.
That kind of love is always worth acknowledging. And being grateful for.
The kids and I were at our local swimming pool on a hot summer day a few months ago. The scent of chlorine and sunscreen swirled in the air. My daughter Gauri found some friends and was enjoying splashing around with them. My son Shuja and I sat in the shade of a tree. We started chatting about all sorts of things. Friends, hopes, dreams, summer activities, travel plans…life. At one point, the talk turns to Uzma, his mother, my late wife, and the creator of this blog. I ask him, “When you go over to your friends’ homes and see both their parents, do you ever find yourself wishing that mom was here?”
Uzma had died of metastatic breast cancer over four years ago at that time. While I tried my best to be a good solo parent, I know it’s not the same as growing up in a two-parent home. And two-parent families are the norm among my kids’ closest friends. While my kids are not the jealous type, I have often wondered if they see the glaring difference between their friends’ families and ours and feel something missing.
He didn’t respond immediately, sitting with the question for half a minute. It felt like several minutes. The laughter and splashing of kids in the pool started sounding louder. It all quieted down again as he said, “I don’t want you to take this the wrong way. I miss Mom, but I don’t know how to answer that question.”
“I am listening.”
“So much of our life has happened without mom. It is impossible to imagine what it would be like if she were still alive. Who would I be if she had been with us these last few years? Wouldn’t it depend on whether she was sick the whole time or well?”
That would make a big difference, I thought. I recalled how our life shrank as cancer grew in Uzma’s body. We withdrew our kids from most activities outside school. We socialized less. All our trips became impromptu as we couldn’t really count on being able to stick to any plans.
“I don’t think about her day-to-day. But I often think about her when I am sad,” he continued, “So much has happened that it is even hard to imagine how our life would be if she were to suddenly come alive today and plop right back into our life.”
Life Goes On
When people die, it seems like a cliché to make the observation that ‘life goes on.’ When you’ve built a life with someone, it’s hard to imagine how life could go on without them. It feels profane to even approach that thought. But life goes on, not because of one big thing, but due to millions of little incidents, decisions, and memories.
Our kids have now lived about one-third of their lives – our son, a bit less, and our daughter, a bit more – without their mother. In these five years (over 1800 days!) we have made countless memories without Uzma. Meals, after-school activities, birthday parties, movies, vacations, game nights, conversations, holidays, walks…so many memories. So many decisions. All without Uzma.
At first, whenever faced with any decision about the kids – when they should have a smartphone, for example – I found myself thinking about what she would have said based on our talks. But as time went by, I realized that I was on my own. There were so many decisions about kids that parents don’t talk about ahead of time because we don’t assume one of us will die before facing that decision together. Often, talking aloud with each other brings us to conclusions far from where we begin. Without those talks, one has to figure things out on one’s own and process things with other trusted voices.
Life goes on…but with a twist. When grief suddenly resurfaces, it is raw and biting.
The Bouncing Ball of Grief
A few years ago, a Twitter user shared the bouncing ball analogy of grief. Imagine a box that represents our life. A ball inside that box represents grief. There’s a red button on the inside of one of the box’s walls. Whenever the grief ball touches the red button, it causes immense pain and sadness. In the immediate aftermath of a loss, that ball is enormous, occupying almost the entire box and brushing against the red button at every attempt to move.
In the original analogy, over time, the ball grows smaller. It bounces off the walls of the box of life without hitting the button as frequently as before. But when it does hit the button, the pain and sadness are just as intense as they were in the beginning.
While the analogy resonates with me, I think the ball does not change in size. It only appears smaller because the box grows with all those countless daily moments of living life. Life goes on.
Memory Is Recorded, Then Built
A friend told Uzma, in what was to be her final year, “Make videos of yourself for your kids. Leave little messages for them about your hopes and dreams. Tell them you love them.” Now and again, I wonder how our memories of her would be had she followed that advice.
With the wondrous devices that our smartphones are, it is all too easy to make such videos memorializing oneself for loved ones. Uzma could have created hundreds of videos allowing her to choose how our kids would remember her. But she never made a single one with the explicit goal of helping shape the kids’ memories.
“I want the kids to build their memory of me, not receive frozen memories as inheritance,” she said.
While our memories may begin as mental recordings, they eventually become stories. How we see ourselves and how we want to see ourselves shape the details we remember, misremember, and simply forget. The warm feeling accompanying nostalgia depends on forgetting our past’s bad and sad parts. This selective forgetting is a feature, not a bug, of our mind. As opposable thumbs make our species infinitely adaptable in the physical realm, our tendency to shape our memories makes us versatile in the emotional sphere, allowing us to live well in the present instead of dwelling in the past.
Uzma wanted our kids to be adaptable and resilient. She believed that those videos would get in the way of them being able to shape their memories of Mom. She didn’t want to be a ghostly presence telling them things from a time and emotional space that would no longer exist. And so much about our world changed since she died.
Sometimes acquaintances ask our son, “How’s chess?” He tells them he no longer plays chess. He quit not long after Uzma died. He also quit playing the trombone. But now, he runs for his school. He has board game nights with his old friends. But he has new friends whom Uzma never knew, with whom he does other things that bring him joy. He has Uzma’s knack for cutting to the chase and speaking from his heart.
Our daughter, who has Uzma’s memory for faces and love of art, picked up the trumpet after Uzma died. She, too, has new friends, with whom she has various shared interests. She sings. She plays basketball. She used to be scared of dogs. But she is now the closest to the goldendoodle we welcomed into our family just before COVID. And that dog brings so much joy to our home.
Life expands. Life goes on.
Yet, She Lives
When someone becomes part of your soul, you don’t have to miss them every day to remember them. This is even more so for kids who have lost a parent after having built memories with them. Uzma comes up in conversations in our home about all sorts of things. About foods she used to cook, things she enjoyed, the wisdom she shared, where she worked, how she lived, how she died. Once a year we go online together and make a donation in her name to the local cancer charity where she volunteered.
David Eagleman says in the book Sum: Forty Tales from the Afterlives, “There are three deaths. The first is when the body ceases to function. The second is when the body is consigned to the grave. The third is that moment, sometime in the future, when your name is spoken for the last time.”
This past summer, Iqbal, a wise and affectionate friend, invited us to dinner. As we were about to leave, Iqbal, who also knew Uzma, hugged the three of us and reminded us, “You know, as long as we speak her name, Uzma lives among us. So, let’s speak her name together.” The four of us looked to the sky and roared as loudly as we could without bothering other diners at the restaurant, “Uzma! Uzma! Uzma!”
“This will doom my daughter,” my wife Uzma said while we were waiting for the results of her breast biopsy in 2013.
As expected, the news of Uzma’s breast cancer diagnosis in 2013 brought fear, anxiety, and sadness of unprecedented proportions in our life. What will happen to me? What if the surgery doesn’t take out everything? Will chemotherapy work? How will I survive chemotherapy? How will we manage all this with our young kids? These were some of the questions I remember Uzma asking back then. Almost anyone with a heart can imagine that someone with any cancer diagnosis would ask these questions.
But worrying that early about our daughter and her risk of breast cancer is something that only mothers and those who can learn to listen to mothers can understand. This concern was a recurrent visitor to Uzma and my discussions.
She knew it was no fault of hers that she got breast cancer. When determining a woman’s breast cancer risk, doctors ask, “Do you have a first-degree relative who was ever diagnosed with breast cancer?” And our daughter’s answer will always have to be an unequivocal yes. Uzma never could get this thought out of her head.
It wasn’t something she dwelled on a lot because there was nothing she could do about it. It was the hand that fate had dealt mom and daughter.
There was also a part of Uzma that thought there was a silver lining to her diagnosis. Two of her aunts had breast cancer. But because her mother did not, this family history did not matter in determining Uzma’s risk of breast cancer. Uzma believed that had her mother also had this scourge, her own dense breasts might have led to more aggressive investigations. And it might have made the difference between being diagnosed at Stage 2 vs. Stage 3. That would have meant a difference a prognosis. Uzma believed that her cancer will give our daughter a better chance at an earlier diagnosis.
There was a third reason that Uzma learned not to dwell too much on our daughter’s risk. It was the knowledge that genes aren’t everything. Which genes influence changes in our bodies at which times in our lives are affected by various environmental factors. The the quality of our childhood, our diet, our physical activity, and stress are some of the things that are known to affect which genes get turned on and hen. While genetics has come a long way in the last couple of decades, we still don’t know how to turn on and turn off cancer genes in a way that will make a difference in people’s lives. Even though our daughter’s risk of breast cancer will always be greater than a person without a family history, as long as we help our daughter grow to be a psychologically resilient, physically active person who eats healthy, her risk could be lowered.
[A word about the featured photo: This is a print that Uzma purchased about ten years ago, and it hangs prominently in our home in a large frame. It depicts Lord Krishna and his mother, Yashoda. Yashoda was not his biological mother but raised him as her own. Hindu children grow up hearing stories of her love for Krishna, who would have been a handful for any mother due to his mischief and daredevilry. Uzma was not a Hindu, but the image touched her as something that beautifully captures the bond between mother and child. When he was about two years old, our son believed that this image was of Uzma and him. Later, when our daughter was about two years old, she thought that it was Uzma and her. They both outgrew that belief, but there’s something in this image that captures and conveys maternal affection even to a child.]
Most people are not surprised to learn that the kids and I are in counseling since their mother, my wife Uzma, died almost a year and a half ago. Some people are, however, surprised that a psychiatrist would need counseling.
Will we need counseling? I wrestled with this question for a few months before Uzma died. When Uzma’s cancer came back as stage 4, both of us knew we were unlikely to grow old together. The diagnosis of stage 4 cancer instantaneously brings the end of life in one’s field of vision. If it happens after a period of remission, one stops being a survivor and becomes an impending mortality statistic. Each passing day, each failed treatment moves death from the periphery to a more central position in one’s mind. It casts an ominous shadow on every part of one’s life.
Many of those who love a person with stage 4 cancer start experiencing elements of grief long before that person breathes her last. Beginning to mourn for a near-certain loss before the loss happens is called anticipatory grief. I am not sure that we should continue calling such sorrow “anticipatory.” Often a death from cancer — and some other debilitating chronic illnesses — is preceded by a parade of losses, some of which I wrote about in Cost Of Cancer:
…Travel to and from the clinic where the patient receives treatment adds to the burden of illness. There are lost wages – for the patient, and also for any family member(s) or friends(s) who accompany her to various treatments. Families often have to struggle to find time to plan and cook meals. They end up eating more frozen or restaurant meals, which are less healthy and more expensive than home-cooked meals. Since Stage 4 patients will be in treatment for the rest of their lives, there’s no end to all this.
Stage 4 cancer didn’t just spread through Uzma’s liver. It spread throughout her life, our life. We have supportive friends and family, but it was as if cancer threw a noose around our life and slowly but steadily kept tightening it. Our social and professional life constricted during treatment…
The longer a person lives with stage 4 cancer, the more those short-of-death losses keep piling on. I have come to believe that to some degree, what we call “anticipatory” grief, in reality, is the mourning for losses that have already begun — injuries that are warning of an even more devastating loss.
What will I learn from a counselor or therapist that I don’t already know? I asked myself this question when thinking of counseling. Indeed, I have helped bereaved individuals in my work. I probably know at least as much about overcoming loss and grief as most mental health professionals. Nevertheless, in the circumstances like these, it’s not the knowledge that is faulty, but its application. The heart makes it difficult for the head to remain objective when one has to treat oneself, or one’s loved ones. As Sir William Osler, one of the wisest physicians who ever lived said:
A physician who treats himself has a fool for a patient.
Our kids and I were about to experience two significant losses — my wife and their mother. Though some psychologists rate the death of a spouse as the most stressful event a person can experience, I find it difficult to imagine any loss harder a child losing a parent. It has the potential to permanently derail the road to the development of a stable sense of self, which is essential for both happiness and success in life.
Listen to Stephen Colbert and Anderson Cooper talk about the effect of losing their fathers at ten years old. (If you play and don’t skip ahead the video will automatically stop playing at 4:07). They describe the impact of the loss of a parent in ways similar to how I have heard patients describe it:
Transcript: :
And you’ve spoken very publicly about what you experienced as a kid. And I just, a lot of it I didn’t know. I think a lot of people don’t know. So if you don’t mind, I wanted to talk to you a little about it and sort of how it has shaped who you are now?
Your dad was killed in a plane crash. You were 10 years old along with your two brothers, Peter and Paul. And they were the closest brothers to you in age.
Stephen Colbert: Right, it goes Jimmy, Eddie, Mary, Billy and Margo, Tommy, Jay, Lulu, Paul, Peter, Steven.
Anderson Cooper: 11 are there?
Colbert: I’m the youngest of 11.
Cooper: All right. My dad died when I was 10, too. It is such a horrible age to lose a father. I can’t imagine losing both my brothers at the same time as well. For me, losing my dad then, it changed the trajectory in my life.
I’m a different person than I feel like I was meant to be. And I feel like there are times I, yes, I’m, I feel like I remember when I was 10, I felt like I marked time. To this day I mark time between while my dad was alive and after. It is like the New Year zero. It’s like when Pol Pot took over Cambodia[empahsis mine].
Colbert: Without a doubt. Without a doubt. Yes. There’s another guy. There is another Steve. There is a Steve Colbert there is that kid before my father and brothers died. And it is kind of difficult. I have fairly vivid memories from right after they died to the present. It’s continuous and contiguous you know like it is all connected. There is a big break in the cable of my memory at their death. Everything before that has an odd ghostly–
Cooper: Like shards of glass. Like flashes.
Colbert: Little bits of it and then the thing that, really like music because they died in September. They died on September 11th, 1974. The music from that summer leading up to it I will undo me in an instant.
The song of the summer was band on the run. Do not play band on the run around me. Yes. You become a different person like I was just personally shattered. And then you kind of re-form yourself in this quiet, grieving world that was created in the house.
And my mother had me to take care of, which I think was sort of a gift for her, it was a sense of purpose at that point because I was the last child. But I also had her to take care of. It became a very quiet house and very dark.
And ordinary concerns of childhood suddenly disappeared. I won’t say mature because that actually was kind of delayed by the death of my father, by restarting at 10. But I had a different point of view than the children around me[emphasis mine].
Cooper: There was a writer, Mary Gordon, who wrote about fatherless girls and I think it applies and my mom used to quote it to me all the time but I think it applies to boys as well as paraphrase. A fatherless child thinks all things possible and nothing is safe. And I never really understood when my mom would say when I was alone, young but I’ve come to understand it.
All skilled mental health professionals regularly practice managing the impact of their own emotions on their treatment relationships. That, however, does not make us superhuman. In our roles as husbands, parents, children, siblings, and friends, we remain just as capable of acting on our petty and sublime feelings as our patients. Grief can emotionally paralyze grown men and women, let alone children. Growing up motherless is not easy for kids, but what would their fate be if their father were to succumb to grief? No child can survive the emotional impact of losing their mother to cancer and their father, even if not literally, at the same time.
It was a high-probability, high-risk scenario.
That’s why I decided that we would all go to grief counseling. And that is why I only waited a couple of weeks after Uzma’s death before setting up our first appointment.
