I woke up to my phone ringing. It was 2010 and I was on my twin extra-long bed in my brand-new college dorm. I rolled over to see who was calling so early on a Sunday morning. It was my stepsister, which was odd because we rarely called each other. She was sobbing over the phone. “Pablo, you have to come home. Something’s not okay with your dad. An ambulance is on the way.”

I got up, put on a t-shirt and jeans, and slipped on my Converses. The 40-minute drive from college to the hospital was over in seconds and, before I could gather my thoughts, I pulled into the parking lot.

At the hospital… my mom grabbed me by the arm. “Preparate mijo,” she said. “No va salir de esto.”

He’s not going to make it out of this one, she told me.

Her words didn’t really register with me. I heard them, but I couldn’t process them. I was 18 years old, and I couldn’t understand that my dad was dying.

—

My parents had a complicated relationship. It’s a story I’ve been told in bits and pieces. Some of it I’ve heard directly from my parents. Other parts I got from my aunts and uncles, from my grandparents.

We lived in a two-story house in Guadalajara. It was pink and had a fenced yard. It was during these times that my parents’ relationship was at its worst. I don’t remember much from this period, even though I was there, but I can picture the scene so clearly. I can see their bedroom. I can picture the bed, which had a green duvet. My mom told me she was between the bed and the wall, on her back, as my dad towered over her with his hands around her neck. She was scared that my dad would kill her. When she broke free, she coughed blood and bruises began to form where his hands had crushed the blood vessels of her neck.

She called the cops even though she knew it was worthless. In Mexico, at least at that time, the cops wouldn’t enter a house unless they had explicit permission from the owner. I think that when they showed up my belligerent dad said something like, “There’s nothing to see here. You do not have the right to come in.” He slurred his words. I’m not sure how she made it out alive.

I’ve been told of the time my dad walked through a sliding glass door, shattering it, too drunk to realize it was there. My uncles have told me about how he would go drinking and disappear for hours or days, leaving my mom to work and raise two kids. My mom would go to her parents’ house, fearful that he’d return in a rage. And often, he did. One time, my uncle got in his way and the two of them wrestled in the driveway, throwing fists at each other until the cops came. The police took my dad, but he just paid them off and was back at the bar before the night was over.

I wondered, when I heard these stories, why my mom stayed with him. I asked her and she explained that it was complicated. She was in love with him. Like, truly madly in love with him. When I was a kid, she told me over and over again that I was born out of love, and I believed it. I still do. Everyone who talks about my parents and their relationship begins by speaking of how in love they were. How my dad wooed her while they were in high school, how he would make these grand romantic gestures for her. For example, when my mom was in medical school, my dad owned two taxis and would rent them out to drivers by the day. Well, every day he would have one of his drivers pick my mom up from her house and take her to school, and when she got out that same driver would be there waiting to take her back. My mom was nuts about him and, when he was sober, they lived a blissful life.

I was in high school when my mom told me the story of how I was conceived. My mom always wanted a family, but as the abuse got worse she considered leaving him. She even told my grandmother that she was going to move back in with her, but then my mom got pregnant with my older brother. She knew that she might leave my dad at any moment because she was constantly concerned for her safety, so, two months after my brother was born, I was conceived. She timed it so that she’d get pregnant. It was a deliberate decision. That night, she told him, “You have just conceived your second child.” She was worried that, if she left him, he’d say that I wasn’t his. She told me that she didn’t know if she’d ever remarry or have another child and she didn’t want my brother to be alone in this world, so I was born to be a little brother.

The day after she almost died in my father’s hands, my mom hatched a plan. Restraining orders didn’t exist in Mexico at the time so she decided to move to the US. She wasn’t quite ready to call her marriage over though. She didn’t want to be the first one in her enormous, Catholic family to get divorced. She must have also worried that divorcing my dad in Mexico would mean that she couldn’t flee to the US with me and my brother without his permission. So, she decided to move to the US with my dad. Perhaps she hoped he could get it together or maybe it was just a ploy to leave with her two kids. I’d like to think she was going to move her life and her family to a new country to essentially run an experiment. The hypothesis was that perhaps, with the threat of a real police force, my dad would change. I can picture the look on my grandfather’s face, the devout Catholic that he was, when she told him her plan. But my mom persisted, explaining that she needed support from the police and the legal system, support that she was not getting in Mexico.

I can’t imagine what it was like to make that decision. She was leaving her family, without her parents or even one of her six siblings to join her. She was leaving her religion, knowing that divorce would permanently distance her from God and from her culture. She was also leaving her career. She had studied medicine at the Universidad de Guadalajara and was a few months shy of completing her residency as an obstetrician/gynecologist. Once, I remember her telling me that her record was 13 babies delivered in one night. She loved being present in that moment when life entered the world. I have a hard time wrapping my head around all that she sacrificed to make that decision, and also how bad the situation must have been in Mexico for her to give up so many aspects of her identity just to preserve one: Mom.

My grandfather gave her his blessing and a wad of cash for emergencies. As he always did when saying goodbye, he moved his hand first to her forehead, then her chest, left shoulder, then right, and finally back to her mouth for a kiss, completing the cross. And so, life brought me back to the US. It brought me back to Los Angeles, where I was born, to a small apartment in Reseda where my mom tried to make things work.

I don’t know if she got tired of hiding the bruises, or if she had just had enough, but when she turned 35 my mom filed for that restraining order and submitted divorce paperwork. She got a government-subsidized apartment in Simi Valley and installed a deadbolt. She had escaped with her two kids. I was 4 years old then.

—

It wasn’t all bad for me though. I had two Christmases and two birthdays, and I spent most of my childhood summers in Mexico with my grandparents and my cousins. I don’t remember how long it took my dad to get sober, but he did eventually. I know that by the time I finished elementary school he had given it up. I think he stopped because he was afraid of losing us on top of losing my mom. She chose to give him joint custody, an act of kindness that demonstrated her understanding that, although he had failed as a husband, he was a good father. He got a job within driving distance of my mom. My childhood consisted of being driven back and forth between their houses, reading books in the car. As time passed, they learned to depend on each other. They had to deal with me and my brother growing up, breaking bones, and fighting with each other. They divided disciplinary duties and, in moments where money was tight, they would borrow from each other before going to family in Mexico or a bank. I wasn’t old enough to remember much of the days when my dad drank heavily. My life with him, or at least what I can remember of it, began when I was in elementary school. He would pick me up on Fridays in his Chevy El Camino, and I would sit in between him and my brother on the bench seat. He made the best of the situation, planning activities for us on Friday nights and cooking for us as best he could. I remember often having eggs and beans for dinner because those were among the few things he could make well. He took us to the fair and to zoos and to the movies. And he would make me brush my teeth.

I remember how large his hands were. They were strong and sturdy. I remember how loud his voice was. He was generous in conversation and eager to get to know other people, a trait I’ve inherited from him. I remember how he could make friends with anyone. He could connect with people in an instant. I remember how open and vulnerable he could be with me, never hesitating to share with me how much he loved me or how much he regretted his drinking and the things he did to my mom. He gave me my first car and taught me how to drive, essentially giving me the keys to freedom and autonomy. He taught me to be honest and to own up to my mistakes, something I’m not always great at. He taught me to say I love you by a call and response greeting. “I love you,” he’d say. “I love you too, Dad,” I’d reply.

—

Twelve years later, I walked into the emergency department waiting room at the Henry Mayo Hospital in Santa Clarita. A nurse asked for the family of Andres Romano. I made eye contact with her and she led me through a door. On the other side, I could see trauma bays where patients were being attended to in a flurry. I remember the nurse was wearing white scrubs, and the fluorescent lights glinted down on the linoleum floor.

“I’m so sorry, we did everything we could. Your dad is dead,” she said.

He had a heart attack.

I kept thinking to myself that I did not get there fast enough, that I missed my chance to say goodbye.

We held his services at a church he liked. In his casket, we put his favorite Lakers jersey and a wooden rosary that he wore around his neck.

My dad, like all of us, had a few different people inside of him. He was complicated. He drank too much and ruined his marriage and ruined the lives of those around him. But that’s not how I remember him. I remember him with love. I miss him. Burying him was the hardest thing I had to do in my life. Even my mom, after the funeral, said, “I didn’t expect that to be so difficult.”

—

About a year later, my brother and I were sitting with my mom discussing what her future might look like now that the two of us had gone off to college. We were eating breakfast in the kitchen of my mom’s house. Fried eggs, tortillas, salsa, coffee. That’s when she brought up the idea of having weight loss surgery.

At that moment, I thought it would be a simple procedure that would help her. She had tried Weight Watchers, and the Atkins diet, and going for walks and runs, and group challenges, and pretty much every other weight loss strategy out there. She didn’t feel comfortable in her own skin and she thought this could be a solution, a step forward.

My brother and I thought this could be another push for a better, longer, happier life. As kids, we had pushed her to stop smoking cigarettes by all sorts of devious means. We would refuse kisses from her when she smoked. One time, my brother found cigarettes in her purse after she had said she’d quit so he flushed them down the toilet.

“Cabron, como se te ocure tirarlos? Que no ves que son caros?”

“How could you throw them away? Can’t you see they’re expensive?” she yelled at him. He ran around the house ducking as she hurled hangers and spatulas and anything else she could grab.

She decided to have the surgery and went to a surgeon at Huntington Memorial Hospital, the same place where I was volunteering in the ER on Friday evenings. I can’t remember her surgeon’s name. He suggested gastric sleeve surgery and scheduled her procedure soon after.

The anesthesiologist put her under, and the surgeon began his work. He found the stomach and removed a large portion of it, leaving only a “sleeve” for food to pass through. After the surgery, she could only take liquids by mouth until her sutures healed. Later, she could have small amounts of pureed foods and yogurts. We didn’t expect any issues. The doctor said there should be no complications. And there weren’t any, at first.

But my mom did have complications—she was in tremendous, incessant pain and was not keeping any liquids down. Not even her beloved Coke Zero. And those complications led to more complications.

It was June 23rd, just a few days after my 20th birthday, when I pulled into the driveway to take care of my mom. My brother and I were taking turns caring for her while also balancing college classes. I settled in to watch TV for the night – The Lord of the Rings was on. As I was looking in the couch cushions for the remote, I heard a commotion coming from the bathroom. I ran over and found her on the floor. I called 911. I helped her get dressed, realizing how strange it felt to dress her after all the years she dressed me as a child. In the agonizing minutes while help was on the way, I held her hand. She kept saying, “Gracias,” over and over again while we waited.

An ambulance pulled up to my street and painted the houses red and blue. The EMT personnel were brusque, and, in my eyes, they moved too slowly. They strapped her to a backboard as I told them the details. Before driving away, they told me, “There isn’t enough room for you on the rig.”

My uncle and I followed the ambulance to the same hospital where my dad died.

We pulled up to the ER and I saw the EMTs doing CPR as they wheeled my mom in through the double doors. This can’t be happening again, I thought to myself. I knew then that this was going to end poorly. They managed to get her heart beating again at the hospital. The physician explained that part of her small intestine had been destroyed. He suspected a blood clot. This had led to life-threatening sepsis, for which she needed surgery.

Eventually, her doctors moved her to the ICU. They hoped she would stabilize enough to be fit for surgery, but she never did. She died that day. The last thing she said to me was, “Gracias.”

—

My brother and I planned her funeral, much like we had planned my dad’s. It wasn’t any easier this time, and we were both scared of crossing our family. Everyone had strong opinions about what she would have wanted, even if they hadn’t talked to her in years. For weeks, our lives were consumed by the proceedings. We visited a cemetery and purchased a plot overlooking some hills. It felt calm and serene. The nearby freeway provided a sort of white noise that drowned out some of the overwhelming sorrow. We contacted family and friends, people whose lives she had touched in some way. We hired a lawyer because we needed to go through probate to get her house, our house, signed over into our names. We spent hours on the phone with a life insurance company that was determined to question every document and every word, as if we had faked her death to collect a claim.

For months, this was my life. I would go to school and try to pay attention, try not to think of her while taking exams, try to date and lead a normal life. I managed most of the time, except at night when I would finally put down the textbooks or give up on a problem set and crawl into bed. In those quiet moments, I would break. I cried silently so as not to wake my roommates. I stayed in school because I was afraid of living in my mom’s house by myself, and also because I felt like if I dropped out of school then all of her work and all of her sacrifices would have been for nothing. But my dreams felt like they belonged to someone else. They couldn’t possibly be mine anymore. I could not go to medical school. I could not go into medicine. Hospitals are where people die, I had learned, and I could not step foot inside one again.

Before the surgery, before she died, I had trusted medicine. I grew up idolizing my mom who had previously trained to become a surgeon. I looked up to her and to all doctors, but now medicine had failed. My chosen field had failed me and my family twice. I did not know how to feel, awash in so many conflicting thoughts. I felt that, on top of losing my mom and my dad, I had lost sight of my life’s purpose. Still, life kept coming at me despite my ambivalence and uncertainty. The sun would rise, and I would go about my day unaware of what was really happening. Then the night would come, and I would cry quietly in my twin extra-long bed.

I kept waiting for a moment when it would all make sense. I was hoping that I would wake up one day and have a fresh view of the world with newfound drive and ambition. But life isn’t like that. That flash of insight never came. One day, the sun felt a little warmer. That’s it. It just got a little less hard.

I learned to ask for help. Perhaps that’s what brought me back to my senses after moving from tears to whiskey and back again for months. I found support in those around me – professors who invited me over for Thanksgiving and friends who kept inviting me to parties despite my proclivity for waterworks. I found that my brother could be my most grounding anchor, keeping me present when I was spiraling. I found that therapy helped me name my feelings and learn the dimensions of my grief.

Despite my ambivalence towards medicine, I kept taking all of my required premedical classes. The truth is that in the weeks after my mom died I doubled down on my chosen field. I’m not sure why because, at my core, medicine scared me. I was terrified of becoming a doctor. I was afraid that I would have to tell someone that their parents died. I worried that I would be too weak to make it through medical school and that the proximity to death would keep me from succeeding. I was scared of deviating from the plan I had made with my parents. But in the end, my fear of letting my mom down was just a little bit greater than my fear of the linoleum floors and fluorescent lights of the hospital. There was no epiphany, no shining moment of clarity. I just carried on in this fashion for months. Eventually this idea coalesced in my mind: I should go into medicine not in spite of their deaths, but because of their deaths.

I’m still adjusting, in some ways, to a new normal without my parents and to my new life in medical school in a too-big white coat. The thing is, life doesn’t stop just because bad things happen to you. Sometimes it moves even faster. I’m still grieving and maybe I always will be, but I’m also in classes and going to the clinic and learning about all the ways that the human body is incredible. And all the ways that it can fall apart, too.

I thought medical school would teach me about death, and in some ways it has, but there are lessons that cannot be taught in classrooms. In fact, I was afraid that my own experiences with death would get in my way, that I would be too emotional or too raw to participate. I was afraid of breaking down, but I’ve learned that some things can only be learned by living through them. The longer I’m in school, the more confident I feel about this. Here is what I know, what I learned from death and not from a cadaver or from a professor: I know that the loss of a loved one will change every aspect of yourself. It will seep into your soul and make a home there. I’ve learned that sometimes death will sneak up on you. You could be on a date and the lovely person on the other side of your drink will ask about your parents, or you could be in class and realize that the topic of the day is the type of surgery that ultimately led to your mom’s death. It could be a scene in a movie or a car on the street or a snippet of a song or the smell of a neighbor’s cooking, but every now and then my brain is jolted to a memory I thought I had forgotten. Death does not care about your life or your plans or what you think is fair. It is pervasive, and it is constant. That kind of loss fundamentally changes who you are.

For a long time, I fought those changes. I fought the label of orphan. I fought the isolation. I fought the sadness and the desperate need for family. I tried so hard to ignore this part of my life and carry on as if everything was normal. I tried to ignore a part of myself and it wore me out. The funny thing is that medical school, the place where I’m supposed to be the busiest and the most stressed, has given me permission to actually be myself. I am no longer fighting who I am. I am an orphan, and sometimes I feel isolated and sad and desperately in need of connection. I am also my parents’ son though, and the older I get the more I want to share their stories in order to keep a piece of each of them alive, even now. I’m working to embrace all parts of me.

I learned, after they died, that when I was in high school they would get together for coffee now and then. They talked about how they would pay for college and keep me and my brother in line as we grew older. I can picture them walking into a Starbucks, my dad insisting on paying for my mom’s drink even though she earned more than he did. Knowing my dad, he probably bought a couple of pastries to snack on while they chatted. I can picture him wearing khaki shorts and a Hawaiian shirt, his usual uniform. She would be wearing a dress and a light sweatshirt, having come straight from work. I don’t know much about their relationship in the years immediately preceding their deaths, but I love to picture this scene. I like to pretend that I’m sitting a few tables away watching them chat, these two people who, after years of a relationship that brought each of them such pain, would still do it all over again. In this way, I feel that they are still around.

These days, I keep them alive in these stories. I feel my dad’s presence when I come across an El Camino on the road or when I see someone walking around in leather huaraches. I feel him when I strike up a conversation with the cashier at a grocery store or when I have dinner with my step-mom. And my mom? She’s in all that I do. People say that I have the same handwriting as she did and that we both talk almost too fast to understand. I think of her when I cook garlic over a low flame or when I decorate my apartment with trinkets that she loved, like the typewriter on my shelf or the mirror hanging by my door. I am reminded of her when I see someone wearing jewelry that hangs or when I see a fireplace, the one thing that was a must for the house she bought in the US. Recently, I delivered a baby as a medical student and I have never felt closer to her than I did that day. My parents are with me when I am at my lowest and when I am at my best. I think of them all the time. And I am still learning from them.