Joshua continued. “I eat clean, I live clean. After all this time, I can say I’m truly at peace with whatever is to be. I had cancer over twenty years ago, and they said I would die if I didn’t let them irradiate my body or fill me up with chemicals. I didn’t want that then and I don’t want it now.” He placed one hand on his chest and one on his abdomen. “So strange. I’m breathing fine. I’m feeling fine. I look fine, if I do say so myself!” He laughed aloud again. “But, no, I mean I just really feel fine,” he said, looking down at the body beneath his hands.

He inhaled for two counts and exhaled for four, looking down at his feet at the edge of the bed. Switching his attention to me, he smiled and repeated, “You know, I’m just not afraid. I’ll go to those appointments, Dr. Harper, just so I know what exactly is going on. I won’t do chemicals or radiation, but I’ll get my diagnosis, then leave it be and feel this good for as long as I can.”

His son and daughter-in-law looked at him, full of courageous love. In that moment, there was no doubt in my mind that this was the most peaceful room in the hospital, perhaps in all of Philadelphia. I wanted to stand there longer just to be with his presence. I wanted to exhale all my anxiety over the uncertainty of life and breathe in Joshua’s absolute faith in the universe, his absolute love for his body regardless of its tumors, his absolute comfort in his own skin.

“Joshua, the oncology team will call you later today to schedule your appointment. I’ve already spoken to the urology team, and they want you to return for your appointment Friday morning at nine a.m. Will that work for you?”

He nodded.

I continued: “Of course, I’ll write you prescriptions for pain and nausea medications, should you need them. Do you all have any more questions for me now?” I asked.

His children shook their heads. Joshua got up off the stretcher and put out his arms to signal a hug.

I felt my back stiffen—a reflex. We emergency room doctors don’t get too close to patients. It could be a fear of bedbugs, contaminated blood, or maybe the sacred integrity of the boundary between doctor and patient, or even just a fear of getting too close to people we hand off to others. In the split second between his extending his arms and my lumbar muscle contraction, I considered the unwritten rule of maintaining at least a gloved hand’s distance from patients at all times. In the second before his warm embrace and his kiss on my cheek, I decided that sometimes these boundaries are more effective at keeping us caged in rather than at keeping others out.

“Sis, I want to thank you for making me feel like a human being through all this.”

“My pleasure. All the best to you all. All the best on this journey.”

As Joshua and his family gathered his belongings, I returned to my station and wrote up the discharge paperwork for him and then checked the tracking board. I needed to follow up with my new patients from that morning and the ones who remained from the night before. Luckily, two of them had magically received beds. My colleague had finally arrived and picked up five patients—out of guilt, I was sure. I signed up for one of the remaining—a seventy-year-old man with chest pain and normal vitals who was currently pain-free and had a normal EKG. I put in all the typical orders, which would save time and buy me a solid forty minutes to catch up on the work from earlier.

It was a good time to make a quick coffee run. I needed some form of caffeine to be able to do my work, but I needed the glimmer of sun and fresh air the ten-minute walk to Wawa would provide even more.

Later that evening, at home, I poured myself a glass of C?tes du Rh?ne and settled in to eat dinner, a healthy comfort meal I deserved. I was glad that I had treated myself to flowers two days before. Right then, there was nothing in the world better than sunflowers, peonies, and roses as the backdrop to my meal.

I contemplated my time with Mr. Spano and Joshua. I marveled that Mr. Spano, who, once he’d learned that he wasn’t going to die that afternoon, had found the prospect of remaining in the hospital so unsettling that he had preferred to hobble out on a bloated red leg and risk dying a few days later, although he wasn’t yet thirty. I wondered what it must have felt like for him, without the haze of intoxication, to blur the relationship between himself and the truth. What was so terrible to face that death would be preferable? How might his inner contract read that he would be consumed with such a compulsion?

I am not healthy and cannot commit to healing. I am not strong enough to heal. I am fearful, so I must run. I am not worth fighting for. I am not worth healing for. I cannot endure the pain of facing my life. Because I am afraid I cannot be here sober; besides, I cannot be helped. I do not love myself enough to take care of myself. I do not love myself enough to allow you to take care of me. I do not deserve wellness, so I return to what I deserve.

What struck me powerfully was that Mr. Spano had honored every word of his inner contract. (Like everyone, he had this right of self-determination.) We do this when we select the partner who confirms our feelings of unworthiness, when we pick the job that pays us less than we deserve. It is all the same. It is all part of that contract that even if we didn’t write it for ourselves, we certainly co-signed.

I wondered, too, about my contract with myself. I wondered why the behavior of this self-hating man would rock me for even a second. I thought about how I needed to love myself enough to allow others to fulfill their contracts with themselves, be it Mr. Spano, my ex-husband, my father, my mother, Colin, the hospital administrators, or anyone else. Mr. Spano’s contract demanded that he act in ways that were dismissive of my attempts to help him. A human being can never treat another person better than he treats himself. So, if he says things that are disrespectful, this is his contract. His contract has nothing to do with mine unless I allow it to—unless I uncover a clause, in minuscule print on page 5, a clause that I overlooked, that stipulates my need to be validated by the Mr. Spanos of the world in order to feel okay about myself. He was kind enough to prompt me to review that section again, to edit out that portion for good. In that way, he was an angel of the shift.

My forehead throbbed. Each pulsation pounded against the affirmation regarding the good day I was supposed to have had.

Then again, many events don’t unfold the way we think they are “supposed to.” Leaving Colin had felt like an amputation, an amputation of the love we used to have and the love of the child he said we were destined to have. Colin had even named him. When I told him I knew that my destiny was to have a girl, he laughed and said, “No, dear. I only make boys.” So, I had lost two boys that day: Colin and the son he imagined we would have, a familiar loss that echoed the ghosts of Nella and August but was magnitudes more painful the second time around. I would get through this, too, no matter what. Over the next couple of weeks, I would set my mind back to the career stuff. It was strange to be balancing all this on the heels of my recent rebuilding. My foundation wasn’t yet set, so I certainly didn’t feel strong enough to weather this storm.

I had just listened to an interview with Astro Teller, the director of Google X, who explained that failure isn’t making mistakes, it’s not launching one project after another that fails. No, Teller defined failure as identifying that a course of action you’ve taken doesn’t work, but proceeding with it anyway. So, I guessed that in my course-correcting, I actually wasn’t failing repeatedly.

I felt myself breaking into a smile as I gazed out on my herb garden. A new reality seeped in: I would have to destroy it. The ladybugs I’d put there to take care of the aphid infestation had proved only a temporary fix; as expected, after they’d feasted, they’d flown away to explore other parts of Center City. The diluted cayenne pepper spray had failed as well. What I had was an herb garden overrun with insects.

I promised myself that I would get to it, and even considered that I’d start another organic garden in a week or two.