This article was originally published on May 12, 2014 in MedPage Today’s Ivan Today.
My brother would have turned 37 today.
But he didn’t. On January 9, 1995, he died in a car accident, at the age of 17.
That was the day he became a statistic.
I don’t usually need any reminders this time of year. If I somehow forget, May 12 is often unsettlingly bracketed, as it is this year, by Mother’s Day — which fell yesterday — and my father’s birthday, May 16.
Dad, a pediatrician, died in 2010, of what I have always believed were complications from the diabetes that he allowed to spiral out of control in the years following David’s death. Armchair psychiatry is never a good idea, even if — or perhaps especially — if you and the subject are MDs. But I’d submit that our depressions following the events of January 1995 took different forms. Mine was perhaps a more classical presentation, but Dad’s refusal to seek medical help until he had peripheral neuropathy bad enough to end up with a Charcot foot, and a heart that needed quadruple bypass surgery, was a terrible yet predictable response to a father’s shocking loss.
This year, however, the reminders started early. I came across a paper in JAMA Pediatrics in April, “Higher Crash and Near-Crash Rates in Teenaged Drivers With Lower Cortisol Response.” That paper, in turn, cited a 2000 paper that began:
Considerable attention in the United States is being directed at developing and implementing countermeasures to reduce the high rate of crash involvement for young drivers. In 1995, the rate of serious crashes per million miles driven was 17.3 for 16–19-year-olds, compared with 7.8 for drivers in their 20s and 3.9 for drivers ages 30–69 years.
David was one of those serious 1995 crashes. In his case, “serious crash” was a massive euphemism. He was sober, driving down the Palisades Interstate Parkway in Rockland County, New York, in the middle of a clear afternoon, and somehow collided with a tree. We’ll never know why.
David wasn’t suicidal. Not that happy circumstances and depressive symptoms are mutually exclusive — I learned that in medical school the way we all did — but he had just been accepted to Brown University, his first choice, under their early admissions program. He had a very steady girlfriend. I had played parent the weekend of his junior formal when my parents were traveling.
A hint of how popular he was at school came on my parents’ answering machine the weekend before he died. I was spending the weekend there, after, shall we say, having needed to spend some extra time in the anatomy lab over holiday break during my first year at NYU. A friend of David’s left a message that she was sorry he couldn’t hang out that night, but she understood that his big brother was in town and that took precedence.
We ended up driving into Manhattan that night, it turns out, in the same car and over the same parkway where David would breathe his last breaths. I remember that part distinctly. We had deep conversations without any mention of depression.
The other day, I walked by the Italian restaurant in Greenwich Village where we ate. We parked on the street that night instead of a garage, and the stereo — along with a broken one in the trunk that had just been replaced — was stolen. Our dad was furious at me when I told him what happened Sunday morning. I had saved $15, but cost myself $150 for a new radio?
It was just a day later that he and my mother reached me at my dorm room to tell me what happened. I vaguely remember finding my way to the library and asking a classmate I’d become close with — to this day one of my best friends — to wait with me until my father’s pediatrics partner picked me up an hour or so later. (Yet another reminder of that day came last week, at the funeral of the practice’s longtime office manager. Louise would have almost certainly been sitting at the reception desk when state troopers arrived to give my father the news.)
Inexplicable things go through your mind at times like that while you’re trying to make sense of a life-changing event. Well, I remember thinking, it’s not because he was flipping the radio station. There was, after all, no radio.
We’ll never know what caused David’s accident. Perhaps it was, as the JAMA Pediatrics paper suggests, related to his varying cortisol levels. But any definitive explanation, given what we know about the circumstances, would be a fiction.
Life for me in the last two decades has been full of moments of fiction and fantasy: David going off to Brown, perhaps going to law school, dancing at my and our other brother’s weddings, getting married at some point himself.
Those fictions were painful and yet somehow comforting. As is often said, you can lie with statistics, but statistics don’t lie.
I had another reminder of the significance of May 12 last Friday, when I saw a New York Times book review by frequent MedPage Today contributor Elizabeth DeVita-Raeburn, who lost her brother when she was 14 and wrote The Empty Room: Understanding Sibling Loss.
Perhaps fiction should be just what doctors order for children who’ve lost siblings. In the review of two children’s books, DeVita-Raeburn writes:
Parents who have lost children often ask me how to help surviving teenage siblings talk about their feelings. Usually, I am stumped. I don’t know why the answer hasn’t occurred to me before. Next time, I will say: ‘Try fiction.’
Happy birthday, David.