Randomized: Notes on Luck, Loss, and Surrender

On the morning of September 30, I sat in the waiting room at MD Anderson, about to learn which side of the trial I’d landed on.

Earlier that month I’d spent a week in Houston being scanned, tested, and prodded — proving I was strong enough to qualify.

The trial was for a new treatment for cholangiocarcinoma — a cancer so rare that any new therapy feels like a small miracle. Two-thirds of patients would get the experimental drug. One-third would get chemo.

The computer didn’t hesitate. It chose chemo.

That’s how I learned what randomization really means — and how thin the line is between luck and loss.

The control arm: an old regimen, first built for colorectal cancer, now conscripted to fight cholangiocarcinoma — because there are so few doors left. In the key study, it added, on average, just a month of life.

The fine print spelled out the cost: neuropathy, nausea, bone-deep fatigue — and a cold so fierce that even a sip of water could feel like glass splintering down the throat.

Then comes the pump — two days tethered to a slow drip. No baths, no showers, no swimming. At the airport, it sets off alarms; a stranger in gloves traces the line from my chest to the small black pack at my waist. You don’t leave the hospital. You take it with you.

When the chemo stops working — if it ever really works — there’s no safety net. About a third of patients hold the cancer steady for a while; fewer than one in twenty see it shrink.

And when that happens, the hardest part isn’t the disease — it’s the door that closes. The new therapy is there, under the same roof, but out of reach. Once you’re assigned to chemo, the door locks behind you — even if the cancer keeps growing. The rules forbid any “cross-over” to the experimental drug.

Once, I cornered a woman from the drug company over this. She lowered her voice. She said she’d fought to change that rule — that otherwise, it was like sending patients to their deaths.

I knew the odds. But I’d come to Houston chasing a different kind of chance — a therapy built to outsmart the resistance that had outsmarted everything before it. Not the same tired chemo I could’ve had anywhere.

When that chance slipped away, I thought about walking. Why volunteer for more tests, more travel, more fluorescent rooms — only to lose what still feels like living?

But something in me refused.

Leaving would have broken a deeper thread — a quiet vow between trust and purpose.

A promise to the doctor whose brillance and steadiness have carried me through darker odds.

He told me himself — sitting level with me, voice steady, eyes soft with apology.
And in that moment, I saw what helplessness looks like in a man who has built his life on saving others.

Maybe that’s why I stayed. Because if everyone who draws the short straw walks away,
there’s no new treatment for anyone.

Somewhere, two other patients got the new drug because I didn’t.
Maybe they lifted their glasses that evening, not knowing a stranger’s loss opened the door. Maybe this is how the universe keeps its balance — one offering itself so another can walk on.

It’s not about fairness. It’s something quieter — an unseen order, a kind of balance that asks only this: stay, even when the outcome isn’t yours.

The hardest roads have always carried the deepest lessons. I suspect this one will, too.

So I stayed — not because I believed it would change the ending, but because leaving would have felt like breaking faith, closing a bridge that lets others cross, even when we don’t.

The Storm of Inner Parts

The understanding didn’t arrive gracefully. It came as a mutiny inside me — a storm of parts, an inner parliament convened in crisis.

The dissenter burst forward first, wild and furious. Enough, she shouted. She’d had it with needles, protocols, pills, ER visits. She remembered who we were at the beginning — defiant, clear: quality over quantity. She feared that we were becoming a full-time patient, living by appointment, reduced to letters on an armband.

Across from her sat the Historian, eyes wet but steady — grieving not just the body, but the world tilting toward chaos, the unfinished work, the revolution left half-built. She missed the version of us that believed purpose required motion.

A young child, the Joy-keeper, fidgeted at the edge of the room, tracing circles on the table. If there’s no laughter left, she whispered, what’s even the point?

The Tired one said nothing. She only closed her eyes, longing for quiet — a day without appointments, a morning without alarms, a week untouched by the machinery of care.

Then the Sentinel spoke, soft but steady. Stay, she said — not because you owe it to anyone, but because there’s still something to learn here. Something about grace, about what endures when everything else is stripped away. Her love was tired, but clear-eyed.

Then came the Enforcer — sharp, efficient, unrelenting. You should be doing this better, she said. You used to be strong, focused, unstoppable — and now look at you: nauseous, fragile, talking about grace as if that excuses weakness. Her tone cut deep, but beneath it was fear — that if she ever softened, everything would fall apart. She believed control was the only way to keep us safe.

And somewhere beneath them all, the Elder waited — patient, ancient, unhurried. We’ve already been given more four years more than anyone expected, she said. Four borrowed years of sunsets and breath. Maybe it’s time to stop fighting the tide and let it carry us where it always meant to go.

It didn’t sound like surrender. It sounded like truth — the kind that surfaces only when fear has burned itself out.

The voices collided and tangled — rage, duty, grief, weariness, perfection, joy — each one trying, in its own way, to protect me from what felt unbearable.

Meeting the Parts with Compassion

Beneath the noise, a quieter presence listened — not judging, not choosing sides — just holding the room until everyone had spoken.

And with it, not in strength, but in the breaking open, transfomration.

When I stopped fighting the anger, the fatigue, the ache, and the grief, something in me softened. I began to listen — not as commander but witness.

Of course you’re angry, I told them. Of course it hurts when the familiar falls away.

Slowly I saw what each one had been trying to do. The anger guarding dignity
The fatigue conserving the last reserves. The outrage insisting I still mattered.

None of them were enemies. Just children who took on impossible jobs.

When I stopped resisting, the storm quieted. Not because I won —
but because I stopped exiling them.

In the stillness, something older stirred —a presence both fierce and tender.
She didn’t rush in or command. She simply opened her arms.

You don’t have to manage this alone, she said. It felt like a homecoming.

The parts — the furious one, the weary one, the child still straining to hold up the sky — began to rest. Not because they were fixed, but because they finally felt me there: the one they’d been protecting all this time.

They were never meant to run the system, only to keep watch when it wasn’t safe to feel. Now, sensing something larger, steadier, they could trust in the protection that I could provide them.

Beneath that spreading quiet, I felt the field that holds us all; the pulse that keeps everything alive.

Maybe that’s what mercy really is: remembering that none of us were ever separate. Not even inside ourselves.

The Mirror

When the storm passed, a thin peace arrived —trembling, but real.
The kind that comes only after every voice has spoken.

They call it randomization —the coin toss that decides who gets the new drug
and who becomes the control.
But really, it’s a mirror.

It shows us our bargaining, our dread, our desire for the world to bend toward our preferences.
It reflects how tightly we cling to the illusion that choice could ever save us.

I thought I’d surrendered by signing up,
but I was still hoping fate would take my side.
And now I realized that the mirror was the point all along.

This understanding isn’t the same as knowing in the body, of course, and each time I get chemo, I have to learn it all over. The lesson keeps arriving — again and again — through the sharp scent of antiseptic, the slow drip through the IV, and the hum threading its way into my veins.

And yet, even here, small mercies keep appearing — a Chinese nurse’s hand on mine, flowers from my ex-husband on what would’ve been our twenty-fifth anniversary, the blessing of reconnecting with old friends to share our strength — reminders that beauty still finds its way through the noise.

When I caught Adrian before sleep in Sydney.
I told him this randomization felt like the story of Ram and Sita —
how they left their silks behind
and walked into the forest,
not in punishment, but in readiness.

He paused, then said softly,
You won’t believe what I’m listening to right now — Sita Ram, by Krishna Das.

Small mercies.
Quiet miracles.
Proof that even in the wreckage,
light insists on shining through.

The Fire That Refines

Suffering isn’t the opposite of grace.
It’s the doorway to it.

When everything else falls away —
the plans, the pride, the illusion of control —
what remains is the raw intimacy of being alive.
Pain opens doors that comfort never will.

The pain remains.
So does wonder.

Grace isn’t peace instead of fire.
It’s peace within it —
the trust that even here,
something larger still holds you.

Because grace was never about the odds —
only the willingness to keep saying yes.

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Postscript:

A few years ago, I applied — again and again — to get certified in Internal Family Systems Therapy with the IFS Institute. Each year, thousands of people enter the lottery for a handful of spots. After years of trying, I was finally chosen — a randomization in my favor.

IFS, or parts work as it’s often called, has become one of the most respected and fast-growing approaches in psychology and coaching. It’s being used everywhere from trauma and addiction recovery to medicine, end-of-life care, and leadership development. What makes it remarkable is its premise: that we are not broken, but composed of many inner parts — each one trying, in its own way, to protect us. When we meet those parts with curiosity and compassion instead of exile or shame, something profound begins to shift.

In my own coaching and healing work, I’ve seen this again and again — people softening toward themselves, reclaiming energy that had been locked away in self-criticism, shame or fear. It’s a quiet kind of transformation — not by force, but by allowing.

When I finally got into the IFS training two years ago, I felt a pang of guilt — knowing how many gifted therapists and coaches had been applying for years, many with decades more of practice ahead to use it. And here I was, with a limited life expectancy, taking a seat that someone else might have filled for a lifetime.

But I made a vow: that however long I had, I would use it fully — in my coaching, in my own healing, and in whatever way I could to bring this work into the world.

Trusting randomization, it turns out, has served me quite well.
This piece is part of keeping that vow, and part of the grace that comes from saying yes to what arrives.

Getting to see old friends a big plus at MD Anderson!