(Heads up: This post deals with graphic, difficult and heavy medical situations that may be difficult or traumatizing to some.) 

As I finish a stretch of 4 nights of ER shifts culminating in a 26-hour ICU call shift followed by a clinic half-day, it occurs to me that I have seen more death and illness in these 5 days than I have in a long time. And I cannot help but reflect further back still, to all that I have seen since I first hit the wards as a medical student. I can’t help but marvel at the sometimes indiscriminate distribution of pathology and health in this world.

What I have learned is this: when it’s your time, it’s your time, and when it’s not, it’s not.

Sometimes you can have done all the right things.

You may have never smoked or drank a day in your life. You can have exercised and ate right every single day, and had no family history of disease and still be struck by terminal cancer or infection or a brain aneurysm in your early 20s or 30s or 40s. You can be struck dead by any of these things, having been perfectly healthy barely a week (or even an instant) before. You can be a young mother or father, a brother or sister, a friend or a colleague, but pathology can be ruthlessly indiscriminate in this sense. Trust me, I have seen it. Time and time again.

You may have been a couple celebrating an important milestone, and having chosen to drink that night, you may have done the responsible thing and called a cab. But maybe that night, someone else chose to drink and drive, and only one of you survives. I have seen that.

You may have been the most responsible motorcyclist on the road, having done the speed limit, worn all the appropriate protective equipment and obeyed all the rules of the road. But that day, all it took was a pothole for you to wake up as a quadri- or paraplegic.

You may have only been on this earth for a very short time – say, four years – before terminal brain cancer declares itself. I’ve seen that. It sucks.

You may have thought that it was safe to stay one more night with your abusive ex – it wasn’t – and he may have taken a blunt metal object to your skull, leaving you with your brains hanging out, still conscious, asking what happens next.

You may have carried a new life in utero for a full nine, healthy months without complication, only to feel the little life for which you once held so many hopes and plans and dreams stop kicking on your due date. And in the space of one day, 9 months of love and hope and growth come to an end because of an umbilical cord around the neck. No one could have predicted or prevented it.

And sometimes, you can have done all the wrong things. But life chose you, despite that.

You can, having been caught in the throes of the worst depression of your life, have decided to end it. But a suicide attempt is not – is never – a guarantee. I have seen more than one self-inflicted gunshot wound to the head or multi-drug overdose or attempted hanging that has survived. More than I care to count. You may have survived, but the aftermath to you and your family is devastating. But you survived.

You may have boozed and smoked and used drugs gratuitously and slept around and never worked out, yet here you are, having made it to well past the age of retirement.

Or you may have defied the odds. You are the 5% of the pancreatic cancer 5-year survivors. Here too, life chose you. When it’s your time, it’s your time. When it’s not, it’s not.

Sometimes we can predict these things. Sometimes we cannot. Sometimes miracles happen. Sometimes miraculously bad things can happen. Sometimes we can mitigate these things. Sometimes we cannot.

Yet there is no sense living in fear of that which we cannot predict. Rather, we should be grateful for every moment that we have. We must not shrink back from unfair prognoses of random death sentences, nor from the horror of the trauma that we can inflict upon one another. Do not become engulfed by darkness. No. Choose light. Choose to rejoice in the freedom of health and your time on this Earth, however you choose to spend it. Spend it learning. Spend it with your loved ones. Spend it being grateful for all that you have had and experienced so far. Choose light even in times of darkness. Choose compassion and human contact, even at the height of chaos. Some of the most beautiful, yet difficult, connections that I have witnessed have stemmed from late night trauma calls, failed resuscitations and withdrawal of care situations. So, no, do not shrink back from the horror and darkness the life can bring. Instead, choose light.

Because when it’s your time, it’s your time – and when it’s not, it’s not.

And I don’t know much, but I do know this.

Every. Single. Day. Is a gift.