It feels like the end of the pandemic, and yet what a dreadful week.

Virus activity is waning in every state, with case reports, hospitalizations, ICU admissions, and deaths attributable to Covid all falling to their lowest levels since last summer.

We should be celebrating by bounding out of our homes and frolicking in the grass, like in that EXTRA gum commercial, For When It’s Time (if you don’t know what I’m talking about, watch it on YouTube).

Alas, there’s no rest for the weary, and the world is not particularly interested in giving us a break. Two things happened this week – one global, one local – which conspired to create an undertone of anxious dread.

The global one, of course, is Ukraine.

It seems fitting that Putin’s invasion of Ukraine is taking place at the tail end of the pandemic – they both feel anachronistic, like they should be happening in black and white: the plague and the war.

As Biden put it, ‘who in the Lord’s name’ does Putin think he is, invading another country just because he wants it for himself? What century does he think he’s living in, bombing cities and killing people for challenging his territorial ambitions?

I’ve been texting with Yevgenia Pashinsky, M.D., a Jewish-Ukrainian-American Gastroenterologist friend, and her answer is that Putin thinks he is what he actually is: an autocrat with one of the largest armies on the planet which he is using, in her words, to “re-create the Soviet Union, unite the world against him and destroy his own country and people in the process.”

Ukraine is not so much reminiscent of the Cold War – which was, after all, mostly a cold war – as it is reminiscent of the 18th, 19th, and 20th century conflicts that grew out of alliance politics; and we all know to what hell those conflicts eventually led.

Closer to home, the other thing that happened this week was the suicide of Katie Meyer, the 22 year old Stanford University Women’s Soccer team captain and star goalie.

Rachel and I didn’t know her personally, but our oldest daughter, Noa, is also a student athlete at Stanford. We all watched Katie lead her team to victory in the 2019 NCAA championship with two critical penalty kick saves in the final, and my fifteen-year old son was instantly smitten.

There were other connections as well – let’s just say that this one cut deep. The similarities between her family and ours somehow hammered home the fact that no one is immune to tragedy, making the usual denial games we play to distance ourselves from such possibilities in our own lives appear more flimsy than usual.

What do these two events have in common? The sword of Damocles.

As Chaucer put it in Canterbury Tales, “there was a sharpened sword above his head; that hung there by the thinnest simple thread.”

Doctors have a front row seat to the spectacle of human tragedy; we are vehicles for the way in which lives can be turned upside down in the span of an office visit, a lab test or biopsy result. Not that it helps us all that much: doctors are both masters of denial and enamored by control.

Covid. War. Suicide. Did any of their victims see them coming? Not well enough to avoid, in any case. They were normal people, building their lives just like us, until suddenly it wasn’t possible anymore.

The thread that holds up the sword of Damocles can snap at any moment, and we all know that eventually it will.

And yet it’s also true that we must pretend it won’t. We have to set goals and work diligently toward them. Study for the test, prepare for the interview, ask for the promotion, plan for vacations and for the future in general. Since that’s the standard recipe for success, why should we do otherwise?

We must act as though we control our lives even when a sober look at the evidence makes it clear that ultimately we do not. The problem is that no one can know if “ultimately” will come tomorrow, next week, next year, or even so long from now that it doesn’t really matter.

Tragedies are like black swans – a metaphor for an extremely negative event or occurrence that is impossibly difficult to predict. The trick is to live life based on the white swans of our past, while knowing that a black swan encounter could be just around the next bend.

The good news is that equanimity in the face of black swans – a goal of religion and philosophy – can be acquired. The bad news is that it’s a hard lesson to come by, and rarely learned from those who claim to have the answers.

Back when I was Chief of Service for the Columbia Family Medicine Residency, I ran a narrative medicine program with my friend and colleague, Craig Irvine. We used literature and writing exercises during rounds to help medical students and residents grapple with their experiences on the wards.

Craig had a friend, Robert, who would sometimes come to our weekly sessions. Robert was a tall, lanky, bald, former academic. Very brilliant, very wry, very Buddhist.

One day we were talking about one such case where a family’s life was suddenly, tragically, altered forever. The residents were upset, and I remember them turning to Robert for advice about how to deal with it all.

I expected him to impart some wisdom about living in the moment and focusing on simple pleasures: the smell of coffee, the taste of a snack, playing fetch with the dog. I would have contributed some validated happiness tools such as gratitude journaling, volunteering, mindfulness breathing, putting down your phone and spending time with real-life friends – great ideas, by the way. I’m all for them.

But Robert didn’t go down that road. Instead, he laid it out in a way that I still remember twenty years later. Not as an answer, or even as a question. More like a wish, or a dream, or a counterpoint to reality: an artifact to hold up and contrast with the world as a way to understand our condition better.

Or perhaps it was a suggestion for how even the most complicated and unpredictable events might be navigated with a little practice.

In any case, we all liked it.

He said, “You know what I want? I want someone to give me a little plot of grass and make it my job to take care of it. I’ll cut it, water it, fix the fence, and clean up after storms, or animals or whatever else.”

“That,” he said, “is all I really want.”

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!