Unknown Buddhist

There is a kind of disorientation that comes with outliving people who were supposed to outlive you.

I live with a serious illness. For years, the implicit social contract has been clear, if unspoken: I am the one being cared for. I am the fragile one. I am the variable in other people’s lives. I am the reason I have a medical case manager, an adjusted schedule for living, and a ‘what if’ contingency plan.

Strangely, mortality has a logic to it. The ill go before the well. The old before the young. That is the order of things. Mortality is simplistic, except, of course, when it isn’t.

A few weeks ago, my case manager canceled our appointment. Then again, the following week. Working in healthcare, I wasn’t frustrated. However, the relationship between someone managing a chronic condition and the person coordinating their care is not casual. There’s history. Trust. And a shared understanding of what matters and why.

I learned what had happened two days ago. My case manager, a woman only a few years older than I, had suffered a lacunar stroke. A small, deep, quiet catastrophe in the brain’s interior. She had tried to return to work. But something had shifted. Conversations that once came naturally slipped past her. The mental architecture she’d spent a career building was quietly rearranged in a matter of seconds.

I was told I would be assigned someone new. I sat with that for a while.

We do not like to admit how much of our inner life is organized around an expected order of loss. The parents go before the children. The sick go before the well. The elderly before the middle-aged. These are not just cultural assumptions; they are emotional load-bearing structures. They tell us roughly where to brace for impact. When someone dies or is profoundly diminished outside of that expected order, something more than grief occurs. There is a particular vertigo in it. A cognitive dissonance that sits alongside the sadness.

I’ve felt it more than once. Peers who seemed robust, capable, unambiguously vital, who were suddenly not. Colleagues younger than me are navigating diagnoses I’d been navigating for years. A case manager, who appeared healthy and professional, presumably with a decade ahead of her, was struck down by something small enough to be invisible on the wrong kind of MRI scan.

What does one do with that?

There is a concept in philosophy sometimes called the problem of moral luck. It is the uncomfortable idea that much of what we are held responsible for, and much of what happens to us, is a matter of circumstance rather than character or choice. We did not choose our genetics, our vascular health, the small blood vessels in the deep white matter of our brain that one day simply closed and created dead brain tissue that mirrors a small hole.

Illness, in this sense, is the great leveler. It is consoling. Rather, it’s disorienting. It does not distribute itself according to who deserves it, who has prepared for it, or who is in the so-called right position to receive it.

I am living with a condition that many would expect to define the arc of my life. And yet here I am, watching people without that condition, people presumably in better health, with stronger bodies, with cleaner medical histories, encounter their own unscheduled reckonings. This realization does not make me feel superior. I say it because it matters philosophically. Because it asks something of us.

I think it asks us to hold two things at once that we are not naturally built to hold simultaneously. The first is grief. It’s the real, genuine grief for the people who go before their time, in whatever form that takes. My case manager did not die, but something was taken from her. It was her capacity for the work that she had built her professional life around. That kind of loss is worth grieving, even quietly, even from afar. The second is something harder to name. A recalibration, perhaps. A revision of the story we tell ourselves about who is at risk and who is not. About whom has time and who does not. About the orderliness of suffering.

The truth is, none of us is waiting in a mortality queue. We are just present, simultaneously, in a world that does not sort its difficulties into neat developmental stages or sensible sequences.

I have been assigned a new case manager. I will start over and explain my history, rebuild trust, and reestablish the connectivity that develops between two people navigating complexity together. It is unglamorous work. It is also necessary.

I have been thinking about my former case manager. About what recovery from a lacunar stroke looks like. There’ll be months of rehabilitation and relearning things that once came automatically. Still, there’s a cruelty in not being the one who was “supposed” to struggle, and seeing someone who was healthy struggling.

I wonder if she ever thought about her clients, the ones managing serious illness, and felt, even briefly, that she was somehow insulated from the more dramatic expressions of physical fragility. I wonder if she sees that differently. I am sad for her misfortune, but I am strangely less alone in mine. There is something quietly profound about that. Not comfort, exactly. But a kind of companionship in the randomness. A reminder that the body does not read the actuarial tables prior to making decisions.

We tend to think of illness as isolating. And it is. But there is also something that happens when the walls between the well and the unwell become permeable, when the person who was caring for you is suddenly, themselves, in need of care. It does not make my condition easier. It does not resolve anything. But it insists, in the most concrete possible terms, on the shared humanity of the thing. But the sobering fact is that none of us, not the case managers, not the clients, not the philosophers writing about moral luck, are exempt from the randomness.

The mortality queue does not exist.

We are all simply here, for now, doing the best we can with bodies that will eventually, on their own timetable, and in their own inscrutable way, remind us of that.