“Blame the tomatoes,” you joked.
I chuckled at the thought. Like you, I had tried my hand at growing tomatoes from seed this summer, those notoriously friendly vegetables for novice gardeners. In my mind’s eye, I envisioned crimson and gold orbs bursting through the soil. Graced with morning dew, a sweetness at once vigorous and achingly delicate. Descendants of the sun itself.
You remember them less fondly. As August rays gave way to September leaves, your tomatoes overflowed the trailer park plot. Striped Germans, Ace 55s, and cascades of those curious yellow cherry tomatoes. Such a bounty that you found yourself fixing a BLT every meal for weeks.
Then one morning, the brutal stomach pain. “Must be those damn tomatoes”, you thought. Begrudgingly, you dragged yourself to the hospital, thinking you’d be home in time for dinner. (Maybe skipping tomatoes this time.)
Instead, we talked about white blood cells and bone marrow. Asked you to stay a night, then another. Then a week. We found scarring in your lungs, spurs in your wrists, and plaque in your arteries. You asked us – a faceless room of powder blue cloak and fogged-up plastic – “If they’re not bothering me, can you really call them diseases?”
We took blood. Tapped your hip for some marrow. Told you about something called “poor cytogenetics.” Then the chemo started — a baggie of poison strung up on a mobile coat rack. You called it your new girlfriend, rolling her down the hallway with your uproarious laugh.
I asked you how it all felt in this striking turn of events. With that ragged and gentle smirk, you said, “I feel just fine. Long as I can get out in time to hunt some turkeys.” I gulped and offered a meek nod, knowing that turkey season was starting sooner than chemotherapy was ending.
The next few weeks changed you. The blood in the toilet bowl and sores along your gums signposts that the journey was just beginning. Our morning visits became shorter, less laughter-filled; the autumn sun filtering through the blinds seemed to fall at a different angle now. I noticed the stillness of dust more and more each day.
One morning, the Oncology team sat with you for hours. “The transplant process is really difficult. It will be important to have someone you can stay with. Someone who can drive you to and from the hospital, and take care of your food and personal affairs.”
I remember the quietness of that room, vacuous save for the ticking clock. Piercing the silence, you reminded us, “I told you. I don’t have no one. I can’t ask anyone to do that for me.” These words struck deeply, perhaps more so because I knew you were a public school bus driver for 20 years. How many families must have benefited from you driving their kids to school every morning for two decades? I imagined all the jokes; the karmic worth of those words.
That quiet day was also my last day on the rotation. It took all of my strength to bring knuckle to door and say goodbye. I dilly-dallied, avoiding the topic altogether during pre-rounding, rounding, and a mid-day check-in. How could I be leaving today, when what you needed most was stability and support?
With exceeding awkwardness, I shared the news that I would be departing. Wished you strength and healing through the steps ahead. As the heavy hospital door latched closed, I felt its weight touch down on my chest. The sight of your face in that moment, slats of hazy sunlight at your feet, I’ll never forget.
As medical students, we move through different hospitals for months, weeks, sometimes only days at a time. We see firsthand how the body both becomes and comes undone, and this is how we learn. We accompany our patients through cross-sections of illness, but rarely stay for the entire chapter.
This idea surfaced a challenging tension for me, because it makes obvious that the reason we are there is primarily for our own best interest in training, rather than the patient’s best interest in healing. Were our discussions about tomatoes and turkeys genuine efforts at building a bridge with another human being? Or was I simply sifting through the sand of your life just to find that clinical pearl? In saying goodbye in the middle of your treatment, it was to say, “I’m leaving now, because I’ve gotten what I needed out of this experience. I’m good now.”
But of course, I’m not good. I can reason why it must be this way. Every student needs to see a variety of clinical environments. Teaching hospitals build the future workforce. Boundaries are necessary in order to sustain ourselves for the long haul. It all made sense, until it didn’t at all.
That evening I drove home, exhausted from that long, final shift. It was that exquisite mote of autumn in Minnesota, when the air is sweetly crisp, and the blue sky is flecked with oak leaves and an errant bald eagle, if one looks closely enough. I thought about how much you would have loved it — to walk in the light, rifle in tow, unencumbered by hospital blinds. The vividness of that sky was bluer than any powder blue gown.
It was also the end of the growing season, and time to harvest tomatoes. I visited my plants, and to be honest, I was disappointed in their output. After all, I was hoping for glorious, plump aggregations of crimson and gold. Instead, I saw a few meager, ruddy fruits scattered about. Some flowers never even bore fruit, destined to wither, a dream deferred.
I grasped each tomato in palm, severing it from the stalk and soil they had come to know as home. I rinsed each under the tap, carefully placing them on a towel, and admired the fruit of my labor. They were small and quite lumpy, but they were mine. That unmistakable scent of acid and earth clung, lingering for hours.
I thought about how these tomatoes grew out of sunlight, water, soil — but also from attention and care. I had gently plucked spider mites scurrying up stems, adjusted cages to ensure adequate light, awoke in the night contemplating soil pH. I visited with them every afternoon, sharing weary stories about the strange and beautiful people I met that day. I noticed these plants, where they changed and grew and decayed, how they became and came undone.
Sometimes I wonder if the tomatoes would have turned out better had I typed my progress notes faster, cut out a visit or two, told a few less jokes.
Of course, this is a false dichotomy. In life and medicine, we are bestowed the mystic, unmerited gift of time. We choose how to use it, but none of us can know the true depths of this well; the vastness of this garden.
As physicians, perhaps there is a lesson we can draw from the master gardener — he who tends to his crop with faith and devotion, season after season. He cannot predict tomorrow’s blight, not the infestation next year, yet he shows up all the same. For what is a harvest, if not a celebration of presence?
So too can we offer our attention, care, and noticing, despite knowing what lies ahead. For our loved ones, our patients, and yes, even a miraculous, lumpy tomato.