Oh fuck, you're still sad?

My husband Jake has been dead for a year and I still don’t believe it. Not really. Not when I look for his marginalia in new books, or read an article about self-driving cars and text him a link, or when I see an interesting new Malaysian restaurant and have the urge to make us a reservation. Certainly not when I look at our daughter, Athena, who wears Jake’s face as her own and who, especially when she’s examining an object closely, looks out at the world through the same perceptive brown eyes.

I can still see the future I’d imagined for us as clearly as I recall the past. In doing so, time collapses into a single point: Now. It feels like Jake is here right now.

Apparently, that’s a disease.

The American Psychiatric Association describes “disordered grief,” also known as “prolonged grief,” as a loss that occurred at least one measly year ago for adults (for children there’s an even faster grief clock). The diagnosis is made when people experience three of the following symptoms, every day, in the month before the diagnosis is made:

Avoidance of reminders the person has died; intense emotional pain; or, alternately, emotional numbness; difficulty with reintegration; feeling that life is meaningless; intense loneliness; feeling as though part of oneself has died; a marked sense of disbelief.

Just three?

I imagine a makeshift consensus group clad in tweed in some back room at a Psychiatric conference deciding on the shelf life of grief over coffee and Costco muffins, like it’s yogurt that’s starting to curdle. Is there a sniff test for pain? How long, exactly, is too long?

It took almost six months just to stop expecting Jake to text asking me to pick him up from Sky Harbor Airport – Terminal 3 – apologizing for his flight’s long delay. And although I no longer wonder if he’s about to walk through the door, my brain hasn’t given up the fleeting but frequent thought that he might still pick up the phone if I call.

There’s a persistent, searching feeling, as if he’s just around a corner. Last week, I met a friend at Cartel Coffee after work and was confused when she, not Jake, sat down on the couch beside me. Why had Jake sent her when he and I usually meet here after I work a night shift? Then yesterday, while loading groceries into the trunk of my car, I glanced back at the store entrance and thought- Jesus, is he still in the produce section picking out the perfect zucchini?

In neuroscience, a prediction error refers to the discrepancy between what an organism expects to happen and what actually occurs. The ability to make accurate predictions comes from repetition. When Jake laughed at my stupid jokes every time I told them; when he got irritated because I pushed too hard with the nib of his fine-tipped pen, but still lent it to me anytime I asked; when he reached out to squeeze my hand whenever I felt anxious, that wasn’t just love—that was how I built the mental model of my life. When Jake died, even though he could no longer laugh at my jokes, or lend me a pen, or hold my hans, my brain still expected him to.

Dismantling that mental model—resolving the prediction error–also requires repetition. For a year, I’ve been freshly reminded that the clacking sound from the other room isn’t Jake at his keyboard, but the refrigerator making ice; the bed is always empty when I sneak in after a late shift; the text alert on my phone isn’t Jake sending me a photo of the fancy heirloom bean soup he made for dinner, but a spam message. Sometimes, I’ll go ahead and dial Jake’s phone number in case the laws of entropy have changed, and he picks up (hey, you never know), but his phone only ever rings and then drops to voicemail. He never even recorded a message.

Repetition is the only way to create accurate predictions. Repetition is the only way to dismantle them. And in doing so, dismantle myself. Grief, then, is a terrible kind of learning.

But it seems I’m a slow learner, and, as Jake would confirm, a resistant one: Last night I logged into Jake’s gmail and forwarded myself one of the weekly letters he used to send me, chasing the way my heart reflexively jumps when I see his name in my inbox– even if it was me who put it there.

So what if I cling to disbelief. In those moments of brief delusion, I feel like myself again.

Which only sharpens the truth: Part of me died with Jake. That’s not a symptom. It’s anatomy. My brain isn’t the same, and neither is my body. A person missing an arm isn’t told it’s a sickness to believe they’re structurally altered. A phantom limb is still gone, even if its ghost causes pain. Death, too, is an amputation.

In as little as six weeks, Axolotls can regrow not just their limbs, but parts of their brain. Starfish create an entire body from a single arm. Zebrafish can regenerate their heart.

What human has ever regrown their heart? And in just one year?

For a diagnosis of disordered grief to be made, symptoms not only have to be present a year after the death, but “significantly impact daily life and functioning.” I can’t imagine anything that “significantly impacts” life more than death, and not only for the dead guy. And yet since the night Jake died, I’ve been able to shower, drive, and do laundry. I’ve birthed a baby, nursed her, and kept her alive. I’ve returned to work in the hospital and—as far as I know—I haven’t killed anyone. I pay my bills. I brush my teeth.

I function. I appear to function very well. Maybe that means I am well.

That’s not to say that I haven’t suspected otherwise. In the first months after Jake died, when I wasn’t paralyzed by grief, I thought that meant something was wrong with me. Then, seven months after Jake’s death, when I suddenly was paralyzed by grief, I thought that meant something was wrong with me. Countless self-help books reassure me that there’s “no right way to grieve,” but it definitely feels like there’s a wrong way, and we’re quick to diagnose it.

We medicalize grief because we fear it. A diagnosis– naming what ails us – means we can fix it. Every shift I work, I have patients who are disappointed when I don’t have a clear diagnosis for them—even if it means I’ve ruled out a life-threatening one. Ambiguity means sitting with uncertainty and waiting to see how pain evolves. In a world where we swipe midway through 30 second video reels like rats hitting a cocaine lever, who has the patience for that? If what ails us has a name, that means we understand it. If we understand it, we can cure it, if we cure it, we won’t suffer.

Grief resists naming. It shifts and adapts. It’s not the same for any two people, or for any two losses.

Before the psychiatrists come for me, I understand that the spirit behind the diagnosis isn’t to pathologize a normal human experience, but to pathologize too much of that experience. As if there could be too much being human: Too much sadness. Too much struggle. Too much love.

I’m too much. And people, I think, are afraid of me. I walk into a room not as Bess, but as a reminder that awful things can happen randomly to any of us. When people first found out about Jake’s tongue cancer, they often asked what his risk factors were: did he smoke heavily? Was it HPV-positive? Did he chew tobacco? They needed to reassure themselves that their own lack of similar risks made them safe. And yet, Jake had no risk factors, which made askers visibly uncomfortable. I remember the way their faces strained to find a plausible explanation that, at the very least, excluded them from the horrible randomness of an impersonal universe.

I watch people perform the same futile calculations when they find out that I was widowed two months before the birth of my daughter. But what could the risk factors have possibly been for such a fate? What could I have done or not done that made me more susceptible to marrying a man who was dead by his 40th birthday?

Maybe the problem isn’t that my grief needs to resolve faster, but that other people need it to; then they can still believe that, when their grief comes, it will pass swiftly.

There’s no modern cultural framework for dealing with death. We hide it, sanitize it, convince ourselves we have the technology to outsmart it, as if the singularity already occurred and we aren’t all still headed for the same six- foot hole. Memento mori have been replaced by positivity culture. And death, once part of public life, is tucked behind hospital walls for ER docs like me to witness.

The Victorians had mourning dress that made their grief visible. Ancient Greek funerals proceeded through the streets with professional wailers in their wake. Grief, once collective, is now treated as if it’s contagious. It’s like glitter: grief gets everywhere, attaches to everything; just walking past it means you’ll find it stuck to your own body in odd places for months.

Is it any wonder, then, that I’ve walked for miles with my baby daughter in her stroller, away from the gaze of family and friends, to keep my grief off display? So I can weep until my throat is raw. So I can sweat and scream until I’m filthy with rage. I duck into the bathroom at work whenever I feel tears coming, splash cold water on my face, and, ten seconds later, walk out with a smile and a wave to whoever is in the hallway.

And while time has taught me to manage the public messiness of grief, if anything, that’s given it space to grow in private. It feels a little shameful, the way it surges like desire behind closed doors, the way I wonder if it’s leaking out around my edges. Secretly–or maybe not so secretly now-I’ve thought: It’s been a year. Shouldn’t I be better by now?

But of course there’s still pain. Of course there’s still anger, bitterness and sorrow. Of course, there’s still loneliness- Jake’s remains are in a box on my bookshelf beside his copy of Lord of the Rings while his side of the bed remains empty. Our daughter Athena’s small, sticky hands rest on my cheek, her body dense and warm in my arms while I feed her from my own breast, and yet I’m still starving to be touched. Jake made me promise that I’d eat, and I do, but I’m never full. There’s a constant, baseline, gnawing ache.

Maybe I’m repelled by the concept of “disordered grief,” because I can’t conceive of ordered grief. Grief resists linearity. I began grieving Jake while he was still alive, as the cancer relentlessly ate away at both his body and our future together. I still love him although he’s been dead for a year. My pain is recursive: I relentlessly cycle from moments of contentment or joy to shock and sadness and yearning, until the feelings become familiar, but no less breathtaking.

Every day grief comes in a different order. Some days I wake up at 4am, seized by the need to hold Jake’s hand, and feel anger that all I have is a plaster model of it. Other days, grief waits till I’m performing a physical exam on a patient and their wet cough reminds me of the way I would awaken in the middle of the night to hear Jake choking on his own saliva. Time seems to fold in on itself: Sometimes, I close my eyes while I breastfeed my daughter and the cocktail of oxytocin and prolactin saturates my brain in a way that resurrects Jake with hallucinatory vividness. Suddenly, we’re 27 and running out of the cold Seattle rain into Belle’s Buns for coffee, and then Athena unlatches from my nipple and I’ve lost him again.

Time diverged when Jake died. For the rest of the world, a year has passed since his death, and yet, somehow, it seems like it’s only just happened for me. At first, I was hurt when the flurry of concern and well-wishing that permeated the first weeks after his death naturally receded. Promised visits failed to materialize. Calls were skipped. People move on with their own lives that continue at normal speed, while a large part of me is still kneeling beside Jake’s corpse, my fingers pressed against his absent pulse.

I don’t know how to resolve that discrepancy. How is it possible to reintegrate into a world that doesn’t understand that mine stopped? It’s hard enough trying to speak to people who haven’t experienced a similar loss, and even more difficult trying to be understood by people living a year in the future. I hadn’t realized before that grief isn’t an illness so much as a physics problem. Catching up may be impossible. I can only move so quickly.

Every cure is about timing. When a patient comes to the emergency room, I’m only as useful as my ability to react quickly. It only helps if I give epinephrine to the anaphylactic before their throat closes and they develop a hypoxic brain injury. I have 90 minutes to get a patient with a massive heart attack diagnosed, stabilized and into the cardiac cath lab for stenting before their heart is irreversibly damaged. In a patient with a massive pulmonary embolism, I may only have minutes to administer tPA. My job, really, isn’t just to figure out that death is coming, but how fast. Sometimes, that’s impossible, and I lose the race. Other times–and these are the most exciting saves–a patient is clinically dead and I snatch them back. Sometimes it takes a few seconds; in extremely rare instances, hours.

But at no time in over a decade of training did I learn how long it takes to bring a person back to life when they’re not the one who’s died.

A year is nothing. Jake will be dead forever. Then I will be too. In the meantime, I’m not going to wait to be cured of grief so I can return to life. This is life. If you’re a mortal who loves other mortals the APA’s list isn’t a warning of what you might feel if you don’t grieve right; it’s a list of what you will feel, again and again, during a lifetime of discovering what’s still worth living for.

Is that sickness? I don’t feel sick. I just still feel love.