Happy Birthday, Mom!

This is a photograph of my mother at a kitchen table, one hand flat on my back to keep me from rolling off the towel. A bottle of Johnson's lotion sits within reach. The sink behind her has the old wall-mounted faucet. She is laughing at something I am doing. It is clear that I was loved.

Her name was Josie. She would be 87 today.

In another photo from that same stretch of months, she is holding me up against her hip, gingham top, cream pants, and she has put me in red shoes (I love red!). She is not looking at the camera. She is looking at me.

The photos thin out over the years.

During her illness, she stepped away from the lens almost entirely. My mother had COPD. If you have watched someone live with it, you know it doesn't arrive all at once. It takes hold slowly. The pursed-lip breathing, then the stairs, then the walk to the car, then the sentence that has to be broken in half so she can finish it. By the end, the disease had ravaged her physically, and she did not want that recorded.

I understand that impulse better now than I did then. When your body stops resembling the one you recognize, you stop wanting evidence of it. So most of what I have is early. Her hands doing the work. Her face turned toward mine with love in her eyes.

I still wonder what I could have done to lengthen her healthspan. I am a physician. I knew things. But knowing something and being able to change the arc of another person's life are two different capacities, and the distance between them is where a great deal of grief resides.

COPD does not reverse (yet). Damaged lung tissue cannot recover. Function can change, and real interventions can protect it, but they work at the margins of a disease that has already decided its direction. I know that clinically. I have said it out loud to other people's daughters.

What I have learned is to be precise about which feeling I am having. Grief is love with nowhere to go. Guilt is the belief that a different version of me could have produced a different outcome. The first one I carry. The second one I have had to put down, over and over, usually somewhere around mile three on my morning runs.

So I do for myself the things I couldn't do with or for her.

Mindset, first, because everything else depends on it. Movement, because muscle, strength, and power decide how the last decades go. Sleep, which I protected badly for most of my career and now treat as non-negotiable. Plant-powered nutrition, because it is the widest lever I have. Stress, which I manage imperfectly. Toxin awareness, which is quieter work and easy to skip, and which I no longer skip, because I have seen the outcome. Health intelligence, because the data tells me what my mirror will not.

And community, which is the hardest one for me.

I am a little introverted (ok, a lot!). My favorite hour of the day is a nearly empty gym before anyone else arrives. My favorite kind of run is a solo trot around Forest, Virginia, with the sky doing something remarkable over the fields and nobody expecting me to talk about it. Those quiet stretches are where the reflection happens. Where the why comes back into focus, especially on the days when the doing feels heavy.

If you are carrying the same question about a parent, hear this clearly. Family history is information. It is not a verdict. What your mother's chart says about her tells you where to aim your attention. It does not tell you how your story ends.

You cannot go back and change what happened to the woman who raised you. You can take what she gave you, the strength that came from her and the warnings that came from watching her, and put it to work in a body that is still yours to train.

Every breath I take on those early runs is one she could not take at the end. I do not say that for effect. I say it because it is the plain fact of my mornings, and one reason I cherish my health and my runs.

Happy birthday, Mom. Thank you for being a role model, for the wisdom I still hear coming out of my own mouth when I am talking someone through a hard week, and for continuing to shine your love down from heaven.

You were wise. You were kind. You were one of my best friends.

I miss you every day.

I am still becoming, because of you.