Two years ago, you told me you were sick while we were sitting inside an ice cream store in Boston. It was January, and I looked at the dirty-brown city snow covering the sidewalks as I tried not to cry. The lights felt suffocating, the table sticky, and the Ariane Grande song on the speakers too loud. I sipped on my lukewarm tea as you explained your dismal odds of survival. You got up after you told me the news like you had announced you were moving rather than dying. I wanted to grab that crusty snow and throw it at every car that drove by. How dare these people act like nothing had changed? You came into the doctor’s office with a nagging shoulder ache. How had it turned into a stage IV advanced carcinoma? 

There is something bizarre about being a medical student while someone you love is undergoing intensive treatments for an incurable cancer. In class, we are often presented with cases. We are introduced to a patient through their name, age, and sex. Sometimes the author will throw in a fun fact about their family, job, or hobbies. Afterwards comes a constellation of symptoms: 

-Mr. Smith, 47 year-old teacher, presents with a 4 month history of right neck swelling that has not improved with antibiotic treatment. 

-Mrs. Johnson, 72 year-old female, who loves to spend time with her grandkids, complains of night sweats, increasing abdominal pain, and fatigue. 

We are shown their abnormal lab values and inauspicious scans. We learn about their treatment options and that sometimes, the patients do get better. 

One day, somebody will write a case that sounds like yours. AJ, 24 year-old male, who loves playing tennis presents with a shoulder ache. A sleep-deprived medical student will take a sip of coffee before pondering whether you have the malignancy they learned about in a recent lecture. They will take a look at your scans. The images will show the metastases that cover your insides but they won’t look anything like the person I have known my whole life. 

I think about you, all alone as the MRI machine whirrs. Then, I think about the jokes you make when the whole family is playing cards. Jokes that make us laugh so hard that we forget the rules of the game we’re playing. I think about all the things the case won’t say: 

-AJ, 24 year-old male who can eat obscene amounts of sushi and then ask for more. 

-AJ, 24 year-old male who loves asking about the soup of the day. 

-AJ, 24 year-old male whose ideal afternoon consists of visiting the American Tort Law Museum. 

-AJ, 24 year-old male who knows all the words to the Madagascar 2 soundtrack. 

-AJ, 24 year-old male who is the center of the room even when he’s sitting on the sidelines. 

When we were little, we would play Mario Kart for hours. Rainbow Road or Moo Moo Meadows? Motorcycle for flexibility or kart for stability? Now, the questions have changed. PD-1 or CTLA-4 inhibitor? Is your liver healthy enough to withstand another round of chemo? Did you get any sleep or does your back hurt too much? How many times did you throw up today? Are you well enough to go for a stroll? When will this end? 

Will this end? 

Two weeks ago, I came to visit you before you began yet another round of treatment. The mud caked our shoes as we walked through the woods. You put on a brave face and I tried my best to reciprocate. You pummeled me with questions about school, my friends, my crush. I answered like we had all the time in the world. 15 minutes after leaving your house, I opened my car door, screamed, then drove back to school to study for an immunology exam. 

It has been two years since you told me the news. Often, I find it in myself to be reasonable, approach the matter calmly, and trust the rigorous science that has kept you alive so far. Sometimes, I am confronted with the possibility of a world without you. On those days, I want to burn down the Connecticut River, knock down the White Mountains, and then scream again. It started as a shoulder ache! 

It was supposed to be just a shoulder ache!