Where are you?

It sounds like a simple question. We usually answer with a room, a building, a town. But if you keep zooming out — state, country, planet, galaxy, universe — eventually the certainty dissolves. Most of us live our lives focused on schedules, responsibilities, careers, and relationships. The larger questions of existence sit quietly just outside our field of view, waiting for a moment when we’re still long enough to notice them.

During my medical training, those moments of stillness were almost nonexistent. The years of medical school, residency, and fellowship — what I sometimes call my “dark years” — demanded everything. Choosing a career in trauma and emergency surgery meant confronting human mortality daily, but not necessarily processing it. Death became another task, another page in the sign-out list, something to manage before the next pager went off. The combination of exhaustion and urgency was desensitizing. I rarely had the space to reflect on what any of it truly meant.

Only later, when life finally slowed enough to create a small crack of time, did I begin to feel the weight of that neglected curiosity about meaning, life, and death. Around that time, someone close to me decided to participate in a spiritual ceremony and asked if I would join. The timing aligned. I wasn’t seeking revelations; I wasn’t running from anything. But the door was open, and I stepped through it with an open mind.

I prefer to keep the details of that experience in the Central American jungle  vague, partly because some things resist explanation. But I can say that what followed felt like a dream, a vision, or perhaps something else entirely — a night-long confrontation with one of humanity’s oldest fears.

At a certain point in the experience, I found myself locked in what felt like a fight for survival. There was no backup, no escape. I fought, lost, and understood with absolute clarity that this was the end. The moment of accepting death was raw and total. And then, abruptly, I felt myself return to my body — relieved for only an instant before the cycle began again. I fought. I lost. I died. And then returned.

This repeated itself more times than I could count.

Although nothing was physically happening to me, the emotional and physiological intensity was overwhelming. The brain, after all, responds to imagined events with the same cascade of stress hormones as real ones. My heart raced. My muscles clenched. For two days afterward, I could hardly get out of bed. No injury had occurred, but my body had lived through something that it believed was real.

The effect, however, was not fear. It was clarity.

When you face death — even in a constructed or symbolic form — over and over again, something shifts. Perspective sharpens. Priorities reorder. And perhaps most importantly, self-forgiveness becomes possible. I returned home changed in ways that were quiet but unmistakable. Understanding that suffering is an inseparable part of the human journey, not an aberration or failure, became one of the clearest lessons from that experience.

A couple of years later, that perspective was waiting for me in a hospital room.

I was on call when the ED paged for a consultation on an 89-year-old man with free intraperitoneal air. His CT scan suggested a perforated sigmoid mass with liver lesions that looked metastatic. As I walked down to meet him, I felt a heaviness settle in. I knew the conversation we were about to have.

The options were the familiar ones: I could take him to the OR for an exploration, likely a resection, almost certainly an ostomy. If he survived the surgery and recovered — both significant “ifs” — he would face chemotherapy and everything that entails. The alternative was to focus on comfort, allow nature to take its course, and avoid interventions that would offer little in exchange for considerable suffering.

When I entered the room, he looked up at me with bright, sharp eyes. He was fully oriented, fully himself. He told me about his life: his long and happy marriage, his friends, his career as an engineer. He spoke without fear, without denial. And then he said, gently and plainly, “Doc, I had a wonderful life. I am ready to go.”

For a moment, something from that night in the jungle rose to the surface — not the fear, not the images, but the acceptance. The clarity. The recognition that death is not always an enemy to fight but sometimes a threshold to cross with dignity.

I felt a wave of compassion wash over me, deeper than what I usually accessed during the hectic rhythm of surgical life. I reached out, shook his hand, and the only words that came out were: “Journey well.”

He nodded, and in his eyes I saw not resignation, but readiness.

As physicians, we often meet patients at the exact point where their personal journey intersects with the limits of medicine. We talk a lot about outcomes and survival, but we talk less about acceptance, meaning, and the strange reality of existing in a universe whose boundaries we cannot even locate. Facing my own symbolic deaths changed the way I approach others as they face their real ones. It reminded me that suffering is part of the human contract, that mortality is not a failure, and that compassion — real compassion — requires presence, not just action.

I don’t pretend to have found answers to the big questions. But I do know this: when a patient stands at the edge of life and looks to us, sometimes the most important thing we can offer is not another intervention, but acknowledgment of the journey itself.

And a blessing for wherever it leads next.

Journey well.

Jonathan Eldor MD FACS is a husband and father, works as a trauma surgeon in New Hampshire, and is host of "The Emergency Surgeon Podcast." He is also the author of the book "A Brief Guide for the Surgical Intern."